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Miller C, Ettridge K, Pettigrew S, Wittert G, Coveney J, Wakefield M, Roder D, Durkin S, Martin J, Kay E, Dono J. Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency. Public Health 2024; 230:138-148. [PMID: 38547760 DOI: 10.1016/j.puhe.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.
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Affiliation(s)
- C Miller
- School of Public Health, The University of Adelaide, Adelaide, Australia; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
| | - S Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - G Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute and Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Food for Health Alliance, Cancer Council Victoria, Melbourne, Australia
| | - E Kay
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; College of Education Psychology and Social Work, Flinders University, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, Australia; School of Psychology, The University of Adelaide, Adelaide, Australia
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Miller C, Wright K, Dono J, Pettigrew S, Wakefield M, Coveney J, Wittert G, Roder D, Durkin S, Martin J, Ettridge K. "You can't just eat 16 teaspoons of sugar so why would you drink 16 teaspoons' worth of sugar?": a qualitative study of young adults' reactions to sugary drink warning labels. BMC Public Health 2022; 22:1241. [PMID: 35733102 PMCID: PMC9219237 DOI: 10.1186/s12889-022-13648-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Several jurisdictions have introduced nutrient warning front of pack (FoP) labels in an effort to curb consumption of ultra-processed foods and beverages high in free sugars (sugars added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates). This study aimed to explore consumer understanding and perceptions of FoP warning labels that convey different nutritional and health information messages regarding the consumption of sugary drinks. Methods Sixteen focus groups were held with 4–8 young adults per group (aged 18–24; n = 105 participants in total) stratified by education level, location (rural centres, large cities) and gender (males, females) to ensure diversity. Labels shown to participants during group discussions included text warning labels of health effects, exercise equivalents, calorie/kilojoule information and sugar content as a “high in” label and as teaspoons (text and pictograms). Thematic analysis was undertaken. Results Four themes were identified related to participants’ perceived effectiveness of labels: the extent to which labels were perceived to be useful, relevant and credible; the extent to which a label elicited shock or disgust (perceived aversiveness); the extent to which the label message was resistant to self-exemption; and participants’ perceived potential of the label to reduce purchasing and consumption behaviour. Across all four themes, labels communicating the number of teaspoons of sugar in a sugary drink (whether by text or pictogram) were perceived as the most impactful, resistant to self-exemption and to have the greatest potential to reduce consumption, with enhanced reactions to the pictogram label. Labels depicting health effects, exercise equivalents, calorie/kilojoule information or a general ‘high in sugar’ warning were perceived by consumers to be less effective in one or more themes. Conclusions Labels conveying the amount of sugar in a beverage in teaspoons were perceived as highly factual, relatable and interpretable, and as having the greatest potential to impact consumption attitudes and intentions. Further quantitative studies are required to compare the potential effectiveness of the teaspoons of sugar labels in reducing purchasing and consumption behaviour than other alternative warning labels, such as health effects or “high in” sugar labels. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13648-1.
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Affiliation(s)
- C Miller
- The University of Adelaide's School of Public Health, Adelaide, Australia. .,Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - K Wright
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
| | - J Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
| | - S Pettigrew
- Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - G Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.,Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - D Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, Australia
| | - S Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - J Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Australia
| | - K Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia.,The University of Adelaide's School of Psychology, Adelaide, Australia
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Worthington J, Feletto E, Lew J, Broun K, Durkin S, Wakefield M, Grogan P, Harper T, Canfell K. Evaluating health benefits and cost-effectiveness of a mass-media campaign for improving participation in the National Bowel Cancer Screening Program in Australia. Public Health 2020; 179:90-99. [DOI: 10.1016/j.puhe.2019.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 12/22/2022]
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Schoenaker D, Brennan E, Wakefield M, Durkin S. Antismoking Social Norms Increase Cessation Behaviours Among Lower and Higher SES Smokers: An Australian Population-Based Study. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.80300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Disapproval of smoking from close others, observation of others' quitting activity and denormalisation of smoking in the broader community can provide an environment that helps smokers to quit. However, it remains unclear which social norms have the greatest influence, and if there is a similar impact on quitting-related cognitions and behaviors among lower and higher socioeconomic status (SES) smokers. Aim: This study sought to examine the influence on quitting-related cognitions and behaviors of a variety of social norms: subjective (perceived disapproval of smoking among close family and friends); internalized injunctive (feeling embarrassed about being a smoker); and close descriptive norms (living in a household with someone who, successfully or unsuccessfully, tried to quit in the past 12 months). Methods: A telephone survey was conducted among 1454 Australian adult smokers between 2012 and 2014 who were followed-up ∼1 week after the baseline interview. Logistic regression analyses examined prospective associations of baseline social norms with quitting-related cognitions and behaviors at follow-up. Analyses were adjusted for baseline demographic characteristics, addiction level, tobacco control policies (cost increases, plain packaging implementation and mass media campaign exposure) and quitting-related outcomes measured at baseline. Differences in associations between lower and higher SES smokers (based on educational attainment and area-based disadvantage) were examined through interaction terms and stratified analyses. Results: Sixty-three percent of participants perceived disapproval from family and friends, 30% felt embarrassed to be a smoker, and 12% lived with a recent quitter. Baseline disapproval, embarrassment and household quitting activity were each associated with having quitting as a high priority and with setting a firm date to quit in the next month. Both disapproval and embarrassment also predicted engaging in behaviors to limit smoking, and only embarrassment was associated with increased likelihood to talk about quitting with family or friends and to make a quit attempt. No associations were found between social norms and being highly confident to quit and seeking help to quit. Associations were mostly comparable for lower and higher SES smokers, with no significant negative effects of social norms on quitting thoughts and behaviors overall or among subgroups. Conclusion: Within the strong tobacco control environment in Australia, smokers from lower and higher SES groups who perceive that their family and friends disapprove of their smoking, feel embarrassed to be a smoker and/or who live in a household with a recent quitter are more likely to prioritize quitting and intend to quit soon. These findings also indicate that the internalized injunctive social norm (i.e., feeling embarrassed) was the strongest predictor of smokers' quitting related behaviors, including making a quit attempt.
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Affiliation(s)
- A El-Khayat
- Leicester Royal Infirmary, Leicester, Leicestershire, UK
| | - M Wakefield
- Leicester Royal Infirmary, Leicester, Leicestershire, UK
| | - P Boddy
- Leicester Royal Infirmary, Leicester, Leicestershire, UK
| | - J Prydal
- Leicester Royal Infirmary, Leicester, Leicestershire, UK
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Dobbinson SJ, Veitch J, Salmon J, Wakefield M, Staiger PK, MacInnis RJ, Simmons J. Study protocol for a natural experiment in a lower socioeconomic area to examine the health-related effects of refurbishment to parks including built-shade (ShadePlus). BMJ Open 2017; 7:e013493. [PMID: 28399511 PMCID: PMC5337679 DOI: 10.1136/bmjopen-2016-013493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Parks in disadvantaged suburbs often have low quality and few amenities, which is likely to result in them being underutilised for recreation and physical activity. Refurbishment of parks, including shade, walking paths and other amenities, may have broad health-related benefits. METHODS AND ANALYSIS The study design, methods and planned analyses for a natural experiment examining the effects of refurbishments including built-shade added to parks in disadvantaged outer suburbs of Melbourne are described. Three intervention parks and three comparison parks matched for equivalence of park and neighbourhood characteristics were selected. Using mixed methods, the outcomes will be assessed during three consecutive spring-summer periods (T1: 2013-2014; T2: 2014-2015: T3: 2015-2016). Primary outcomes included: observed park use, physical activity and shade use. Self-reported social connectedness, community engagement and psychological well-being were assessed as secondary outcomes. ETHICS AND DISSEMINATION This study was approved by Cancer Council Victoria's Human Research Ethics Committee. Studies such as ShadePlus can improve understanding of the broader effects of park refurbishments (including physical activity levels and sun protection behaviours, as well as social connectedness and psychological well-being). The study findings will be disseminated through established urban planning and parks and recreation networks, peer review publications and conference presentations.
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Affiliation(s)
- S J Dobbinson
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | - J Veitch
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences,Geelong, Australia
| | - J Salmon
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences,Geelong, Australia
| | - M Wakefield
- Cancer Council Victoria, Melbourne, Victoria, Australia
| | - P K Staiger
- Deakin University, School of Psychology, Faculty of Health, Geelong, Victoria, Australia
| | - R J MacInnis
- Cancer Council Victoria, Melbourne, Victoria, Australia
- University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia
| | - J Simmons
- Cancer Council Victoria, Melbourne, Victoria, Australia
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Rebmann T, Baskin C, Loux T, Wakefield M. Uptake and attitudes regarding hepatitis A vaccine among childcare centre staff, administrators, and parents. Public Health 2017; 142:152-158. [DOI: 10.1016/j.puhe.2016.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/11/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
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Lin K, Tinker A, Kondrashova O, Ho G, Wakefield M, Coleman R, O'Malley D, Floquet A, Sun J, Maloney L, Giordano H, Harding T, Raponi M, McNeish I, Swisher E, Scott C. Secondary mutations in RAD51C and RAD51D are associated with acquired resistance to the PARP inhibitor rucaparib in patients with high-grade ovarian cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32627-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morley B, Niven P, Dixon H, Swanson M, Szybiak M, Shilton T, Pratt IS, Slevin T, Hill D, Wakefield M. Population-based evaluation of the 'LiveLighter' healthy weight and lifestyle mass media campaign. Health Educ Res 2016; 31:121-35. [PMID: 26956039 PMCID: PMC4802349 DOI: 10.1093/her/cyw009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/03/2016] [Indexed: 05/26/2023]
Abstract
The Western Australian (WA) 'LiveLighter' (LL) mass media campaign ran during June-August and September-October 2012. The principal campaign ad graphically depicts visceral fat of an overweight individual ('why' change message), whereas supporting ads demonstrate simple changes to increase activity and eat healthier ('how' to change message). Cross-sectional surveys among population samples aged 25-49 were undertaken pre-campaign (N= 2012) and following the two media waves (N= 2005 and N= 2009) in the intervention (WA) and comparison state (Victoria) to estimate the population impact of LL. Campaign awareness was 54% after the first media wave and overweight adults were more likely to recall LL and perceive it as personally relevant. Recall was also higher among parents, but equal between socio-economic groups. The 'why' message about health-harms of overweight rated higher than 'how' messages about lifestyle change, on perceived message effectiveness which is predictive of health-related intention and behaviour change. State-by-time interactions showed population-level increases in self-referent thoughts about the health-harms of overweight (P < 0.05) and physical activity intentions (P < 0.05). Endorsement of stereotypes of overweight individuals did not increase after LL aired. LL was associated with some population-level improvements in proximal and intermediate markers of campaign impact. However, sustained campaign activity will be needed to impact behaviour.
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Affiliation(s)
- B Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic. 3004,
| | - P Niven
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic. 3004
| | - H Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic. 3004
| | - M Swanson
- Heart Foundation (Western Australia), Subiaco, WA 6008 and
| | - M Szybiak
- Heart Foundation (Western Australia), Subiaco, WA 6008 and
| | - T Shilton
- Heart Foundation (Western Australia), Subiaco, WA 6008 and
| | - I S Pratt
- Cancer Council Western Australia, Shenton Park, WA 6005, Australia
| | - T Slevin
- Cancer Council Western Australia, Shenton Park, WA 6005, Australia
| | - D Hill
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic. 3004
| | - M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Vic. 3004
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Jongenelis M, Pettigrew S, Glance D, Chikritzhs T, Pratt IS, Slevin T, Liang W, Wakefield M. The effect of cancer warning statements on alcohol consumption intentions. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Godwin S, Chen F, Wakefield M, Frederick A, Gazula H. Assessment of the Potential for Cross Contamination of Common Kitchen Surfaces by Raw Poultry Juice. J Acad Nutr Diet 2015. [DOI: 10.1016/j.jand.2015.06.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Kondrashova O, Lunke S, Mileshkin L, Alsop K, Scott C, Hamilton A, Ananda S, Quinn M, Bowtell D, McNally O, Cowie T, Wakefield M, Hsu A, Taylor G, Waring P. 2773 ALLOCATE: sorting ovarian cancer patients into treatment categories based on genetic characteristics of their tumours. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Heong V, Topp M, Rutkowski R, Ananda S, Wong S, Swisher E, Lindeman G, Haber M, Norris M, Haluska P, Wakefield M, Bowtell D, Scott C, Lindeman G. OP0024 Use of novel patient-derived xenografts and molecular subtyping to improve precision medicine in high-grade serous ovarian cancer. Eur J Cancer 2014. [DOI: 10.1016/j.ejca.2014.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dixon H, Scully M, Niven P, Kelly B, Chapman K, Donovan R, Martin J, Baur LA, Crawford D, Wakefield M. Effects of nutrient content claims, sports celebrity endorsements and premium offers on pre-adolescent children's food preferences: experimental research. Pediatr Obes 2014; 9:e47-57. [PMID: 23630014 DOI: 10.1111/j.2047-6310.2013.00169.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 01/11/2013] [Accepted: 01/30/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess pre-adolescent children's responses to common child-oriented front-of-pack food promotions. METHODS Between-subjects, web-based experiment with four front-of-pack promotion conditions on energy-dense and nutrient-poor (EDNP) foods: no promotion [control]; nutrient content claims; sports celebrity endorsements (male athletes) and premium offers. Participants were 1302 grade 5 and 6 children (mean age 11 years) from Melbourne, Australia. Participants chose their preferred product from a randomly assigned EDNP food pack and comparable healthier food pack then completed detailed product ratings. Child-oriented pack designs with colourful, cartooned graphics, fonts and promotions were used. RESULTS Compared to the control condition, children were more likely to choose EDNP products featuring nutrient content claims (both genders) and sports celebrity endorsements (boys only). Perceptions of nutritional content were enhanced by nutrient content claims. Effects of promotions on some product ratings (but not choice) were negated when children referred to the nutrition information panel. Premium offers did not enhance children's product ratings or choice. CONCLUSIONS Nutrient content claims and sports celebrity endorsements influence pre-adolescent children's preferences towards EDNP food products displaying them. Policy interventions to reduce the impact of unhealthy food marketing to children should limit the use of these promotions.
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Affiliation(s)
- H Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Carlton, Victoria, Australia
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Mullins R, Coomber K, Broun K, Wakefield M. Promoting cervical screening after introduction of the human papillomavirus vaccine: the effect of repeated mass media campaigns. J Med Screen 2013; 20:27-32. [DOI: 10.1177/0969141313478588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives In 2007, Australia implemented an ongoing, school-based human papillomavirus (HPV) vaccination programme for school-aged girls, and a catch-up programme for 18–26-year-old women that ran until the end of 2009. The availability of what is widely known as the ‘cervical cancer vaccine’ means there is the potential for women to believe, incorrectly, that they no longer require regular cervical screening, and this risk needs to be addressed. The current study aimed to assess the effect of three mass media campaigns to promote cervical screening on the rate of cervical screening tests in the Australian state of Victoria, after HPV vaccine became available. Methods Seasonal time series assessed the effect of media campaigns broadcast in 2007, 2009 and 2010 on the rate of weekly cervical screening tests in Victorian women from 2006 to 2010, stratified by time since last screening test. Results The 2007 and 2009 media campaigns significantly increased the number of cervical screening tests per week. The 2007 campaign had a significant impact on lapsed screeners (>36 months since last test), overdue screeners (28–36 months since last test), and women never previously screened. The 2009 campaign significantly increased screening tests for overdue screeners, and the 2010 media campaign was associated with a significant increase in screening tests for lapsed screeners. Conclusions A well-researched and carefully pretested television advertising campaign with accurate, actionable messages can elicit appropriate screening behaviour among some of the appropriate groups even in a changed environment of complex, and potentially competing, messages.
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Affiliation(s)
- R Mullins
- Centre for Behavioral Research in Cancer, Cancer Council Victoria, Carlton, Victoria, Australia
| | - K Coomber
- Centre for Behavioral Research in Cancer, Cancer Council Victoria, Carlton, Victoria, Australia
| | - K Broun
- Cancer Prevention Centre, Cancer Council Victoria, Carlton, Victoria, Australia
| | - M Wakefield
- Centre for Behavioral Research in Cancer, Cancer Council Victoria, Carlton, Victoria, Australia
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Affiliation(s)
- J. Gold
- a Centre for Population Health , Burnet Institute , Melbourne , 3004 , Australia
- b Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , 3004 , Australia
| | - M.E. Hellard
- c Centre for Population Health , Burnet Institute , Melbourne , 3004 , Australia
- d Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , 3004 , Australia
- e Nossal Institute for Global Health , University of Melbourne , Melbourne , 3010 , Australia
| | - M.S. Lim
- f Centre for Population Health , Burnet Institute , Melbourne , 3004 , Australia
| | - H. Dixon
- g Centre for Behavioural Research in Cancer , Cancer Council Victoria , Melbourne , 3053 , Australia
| | - M. Wakefield
- h Centre for Behavioural Research in Cancer , Cancer Council Victoria , Melbourne , 3053 , Australia
| | - C.K. Aitken
- i Centre for Population Health , Burnet Institute , Melbourne , 3004 , Australia
- j Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , 3004 , Australia
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Dixon H, Scully M, Kelly B, Chapman K, Donovan R, Martin J, Baur L, Crawford D, Maloney S, Wakefield M. Can counter-advertising reduce parent's susceptibility to nutrition content claims and sports celebrity endorsements on energy-dense, nutrient poor foods? Experimental research. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Morley B, Scully M, Martin J, Niven P, Dixon H, Wakefield M. Effects of nutrition menu labelling on adults’ fast food meal selections. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Morley B, Scully M, Niven P, Baur L, Crawford D, Flood V, Okely A, Pratt S, Salmon J, Wakefield M. Fail! Australian secondary school students’ adherence to national dietary and physical activity recommendations. Obes Res Clin Pract 2012. [DOI: 10.1016/j.orcp.2012.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gold J, Aitken CK, Dixon HG, Lim MSC, Gouillou M, Spelman T, Wakefield M, Hellard ME. A randomised controlled trial using mobile advertising to promote safer sex and sun safety to young people. Health Educ Res 2011; 26:782-794. [PMID: 21447750 DOI: 10.1093/her/cyr020] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Mobile phone text messages (SMS) are a promising method of health promotion, but a simple and low cost way to obtain phone numbers is required to reach a wide population. We conducted a randomised controlled trial with simultaneous brief interventions to (i) evaluate effectiveness of messages related to safer sex and sun safety and (ii) pilot the use of mobile advertising for health promotion. Mobile advertising subscribers aged 16-29 years residing in Victoria, Australia (n = 7606) were randomised to the 'sex' or 'sun' group and received eight messages during the 2008-2009 summer period. Changes in sex- and sun-related knowledge and behaviour were measured by questionnaires completed on mobile phones. At follow-up, the sex group had significantly higher sexual health knowledge and fewer sexual partners than the sun group. The sun group had no change in hat-wearing frequency compared with a significant decline in hat-wearing frequency in the sex group. This is the first study of mobile advertising for health promotion, which can successfully reach most young people. Challenges experienced with project implementation and evaluation should be considered as new technological approaches to health promotion continue to be expanded.
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Affiliation(s)
- J Gold
- Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
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Durkin S, Wakefield M. Comparative responses to radio and television anti-smoking advertisements to encourage smoking cessation. Health Promot Int 2009; 25:5-13. [DOI: 10.1093/heapro/dap044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Keywood C, Wakefield M, Tack J. A proof-of-concept study evaluating the effect of ADX10059, a metabotropic glutamate receptor-5 negative allosteric modulator, on acid exposure and symptoms in gastro-oesophageal reflux disease. Gut 2009; 58:1192-9. [PMID: 19460767 PMCID: PMC2719084 DOI: 10.1136/gut.2008.162040] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND In preclinical models, antagonism of metabotropic glutamate receptor 5 (mGluR5) reduces transient lower oesophageal sphincter relaxations (TLOSRs) and increases LOS pressure. This study evaluated the effect of ADX10059, a potent, selective, negative allosteric modulator of mGluR5, on oesophageal pH-metry and clinical symptoms in GORD. METHODS Two groups of patients with GORD (n = 12 per group) underwent 24-h oesophageal pH-metry on two sequential treatment days. The patients received oral placebo three times daily (tds) 30 min before a high-fat meal on Day 1 and oral ADX10059 50 mg (Group 1) or 250 mg (Group 2) tds 30 min before a high-fat meal on Day 2. The primary variable was acid exposure (%time pH<4). Secondary variables included number and duration of reflux episodes, number and duration of symptomatic episodes and symptoms recorded in diaries. Comparisons were made for Day 2 (active) versus Day 1 (placebo) treatment and for Group 1 versus Group 2. RESULTS ADX10059 250 mg tds significantly decreased the percentage of time with pH<4 from 7.2% to 3.6% (p = 0.01). ADX10059 250 mg tds reduced pH-metry-measured oesophageal acid exposure, throughout the 24 h period, nocturnally and postprandially, and significantly reduced the number and duration of symptomatic reflux episodes (p = 0.03). ADX10059 50 mg tds was not significantly superior to placebo. ADX10059 was generally well tolerated. CONCLUSION The mGluR5 negative allosteric modulator ADX10059 reduced acid reflux which was associated with improvement in clinical symptoms in patients with GORD. ADX10059 appears to have a potential role in the clinical management of GORD.
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Affiliation(s)
- C Keywood
- Addex Pharma SA, Plan-les-Ouates, CH-1228 Switzerland.
| | | | - J Tack
- Department of Gastroenterology, University of Leuven, Leuven, Belgium
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Hoffman KG, Griggs MD, Kerber CA, Wakefield M, Garrett E, Kersten C, Hosokawa MC, Headrick LA. An educational improvement project to track patient encounters: toward a more complete understanding of third-year medical students' experiences. Qual Saf Health Care 2009; 18:278-82. [PMID: 19651931 DOI: 10.1136/qshc.2008.028720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND At the University of Missouri School of Medicine (MUSOM), "commitment to improving quality and safety in healthcare" is one of eight key characteristics set as goals for our graduates. As educators, we have modelled our commitment to continuous improvement in the educational experiences through the creation of a method to monitor and analyse patient encounters in the third year of medical school. This educational improvement project allowed course directors to (1) confirm adequate clinical exposure, (2) obtain prompt information on student experiences, (3) adjust individual student rotations to meet requirements and (4) ascertain the range of clinical experiences available to students. DISCUSSION Data illustrate high levels of use and satisfaction with the educational innovation. We are in our second year using the new Patient Log (PLOG) process and are now considering expanding the use of PLOG into the fourth year of medical school.
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Affiliation(s)
- K G Hoffman
- University of Missouri-Columbia School of Medicine, Columbia, Missouri, USA.
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McLeod K, Wakefield M, Chapman S, Smith KC, Durkin S. Changes in the news representation of smokers and tobacco-related media advocacy from 1995 to 2005 in Australia. J Epidemiol Community Health 2008; 63:215-20. [PMID: 19015222 DOI: 10.1136/jech.2007.072587] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study aims to show how smokers were represented in smoking-related news articles, editorials, letters and columns in a major Australian newspaper over an 11-year period from January 1995 to December 2005. METHODS Qualitative content analysis was conducted on a sample of 618 articles to identify 21 representational categories (RCs) of the smoker. Articles were also examined for statements that lent organisational support to either tobacco control or the promotion of tobacco. RESULTS The construction of the smoker as a "regulated citizen" due to being subjected to tobacco policy was the most prevalent RC, occurring in 43.4% of articles. Of the 13 most prevalent RCs, eight were constructions of the smoker that lent support to tobacco control outcomes, two were supportive of the promotion of tobacco, and three could be used by both parties. 30.6% of articles contained at least one statement from a tobacco control advocacy source, compared with only 13.6% of articles having a statement towards the promotion of tobacco. CONCLUSION These results indicate that constructions of the smoker that support tobacco control have dominated smoking-related discourse in this Australian newspaper and that representations favouring a tobacco industry viewpoint appeared less often. However, the pro-tobacco representations of smokers in reports relating to legal issues highlight an area of media discourse in which tobacco control advocates should remain vigilant.
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Affiliation(s)
- K McLeod
- Centre for Behavioural Research in Cancer, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, Victoria 3053, Australia
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Wakefield M, Liberman J. Back to the future: tobacco industry interference, evidence and the Framework Convention on Tobacco Control. Tob Control 2008; 17:145-6. [DOI: 10.1136/tc.2008.025791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hyland A, Wakefield M, Higbee C, Szczypka G, Cummings KM. Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Educ Res 2006; 21:348-54. [PMID: 16740679 DOI: 10.1093/her/cyl048] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The objective of this study was to assess the relationship between exposure to state-sponsored anti-tobacco advertising and smoking cessation. Cessation rates in 2001 among a cohort of 2061 smokers who participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed a follow-up survey in 2001 were merged with 2000-01 television advertising exposure data from Nielsen Media Research. The relative risk for quitting was estimated to be 10% higher for every 5000 units of exposure to state anti-tobacco television advertising over the 2-year period, although this did not quite achieve statistical significance. The association was even larger among those who reported that the level of information in the media about the dangers of smoking had increased 'a lot' between 1993 and 2001 (RR = 1.19, 95% CI = 1.03-1.38). These data are consistent with the finding that increased exposure to state anti-tobacco media increases smoking cessation rates.
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Affiliation(s)
- A Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Elm.arlton Streets, Buffalo, NY 14263, USA
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Hyland A, Wakefield M, Higbee C, Szczypka G, Cummings KM. Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Educ Res 2006; 21:296-302. [PMID: 16286480 DOI: 10.1093/her/cyh068] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The objective of this study was to assess the relationship between exposure to state-sponsored anti-tobacco advertising and smoking cessation. Cessation rates in 2001 among a cohort of 2061 smokers who participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed a follow-up survey in 2001 were merged with the 2000-01 television advertising exposure data from Nielsen Media Research. The relative risk for quitting was estimated to be 10% higher for every 5000 units of exposure to state anti-tobacco television advertising over the 2-year period, although this did not quite achieve statistical significance. The association was even larger among those who reported that the level of information in the media about the dangers of smoking had increased 'a lot' between 1993 and 2001 (RR = 1.19, 95% CI = 1.03-1.38). These data are consistent with the finding that increased exposure to state anti-tobacco media increases smoking cessation rates.
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Affiliation(s)
- A Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Durkin SJ, Germain D, Wakefield M. Adult's perceptions about whether tobacco companies tell the truth in relation to issues about smoking. Tob Control 2006; 14:429-30. [PMID: 16319369 PMCID: PMC1748134 DOI: 10.1136/tc.2005.014167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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White V, Tan N, Wakefield M, Hill D. Do adult focused anti-smoking campaigns have an impact on adolescents? The case of the Australian National Tobacco Campaign. Tob Control 2003; 12 Suppl 2:ii23-9. [PMID: 12878770 PMCID: PMC1766099 DOI: 10.1136/tc.12.suppl_2.ii23] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine adolescents' awareness of and response to an adult focused anti-smoking advertising campaign. DESIGN AND SETTING Data were obtained from two cross sectional surveys of adolescents. The first study, a national evaluation study, involved a telephone survey of a randomly selected sample of 400 14-17 year olds across Australia in 1998. The second study involved a survey of 3714 students aged 12-17 years, randomly selected from a probability sample of secondary schools in the Australian State of Victoria. MAIN OUTCOME MEASURES In both surveys, adolescents answered questions on their awareness of the advertising campaign and actions taken in response to the campaign. Adolescents in the national evaluation study also answered questions assessing knowledge of health effects of smoking, impact of the campaign on adolescents, and relevance of the campaign for adolescents and other groups. Responses for smokers and nonsmokers were examined. RESULTS Among the national evaluation sample, 85% of adolescent smokers thought the campaign was relevant to them. Fifty three per cent indicated that the campaign had led some teenagers to at least try to quit and 85% thought it made smoking seem less cool and desirable. Among students who were established smokers the campaign generated quitting activity, with 27% cutting down the number of cigarettes they smoked and 26% having thought about quitting. CONCLUSION Results indicate that adolescents were very aware of this adult focused anti-smoking campaign and thought it relevant to them. The findings suggest that a graphic health effects cessation focused campaign may have been successful in promoting anti-smoking attitudes among adolescents.
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Affiliation(s)
- V White
- Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, Australia.
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Durrant R, Wakefield M, McLeod K, Clegg-Smith K, Chapman S. Tobacco in the news: an analysis of newspaper coverage of tobacco issues in Australia, 2001. Tob Control 2003; 12 Suppl 2:ii75-81. [PMID: 12878777 PMCID: PMC1766104 DOI: 10.1136/tc.12.suppl_2.ii75] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the extent and nature of newspaper coverage of tobacco related issues in Australia in 2001. DESIGN Content analysis of newspaper articles. SUBJECTS All articles (n=1188) at least seven lines long and containing at least one paragraph focused on tobacco in all major Australian national and State capital city newspapers (n=12) in 2001. MAIN OUTCOME MEASURES Number of articles, month of publication, State in which newspaper published, prominence of article, type of article, article theme, and slant of article relative to tobacco control objectives. RESULTS The number of tobacco articles varied considerably in different months over the course of the year, from a low of 51 in December to a peak of 180 in May. The most frequent theme was secondhand smoke issues (30% of articles), with the second most dominant theme related to education, prevention, and cessation programmes and services (20%). Events that were covered were predominantly positive for tobacco control: 62% of articles were related to events that were positive, compared with 21% that were negative for tobacco control objectives. Excluding news articles, the opinions expressed by the authors of articles were also mainly positive (61%) rather than negative (22%) for tobacco control objectives. The amount of coverage of and population exposure to tobacco focused articles showed considerable variation across different Australian States, with Victoria having the highest frequency and rate of articles and the most media impressions per capita throughout 2001. CONCLUSIONS : Coverage of events and opinions related to tobacco in Australian newspapers in 2001 was generally positive for tobacco control objectives. Given that over 2 million individuals (out of a population of 19 million) were potentially exposed to tobacco related newspaper articles per day in Australia, this represents good news for tobacco control advocates. The variation in news coverage in different States and at different times in the year, however, illustrates how a combination of local events and advocacy efforts may at times combine to make tobacco more newsworthy. Understanding which tobacco issues are most likely to be covered and the nature of the coverage about them provides valuable feedback for tobacco control advocates and is a useful gauge of actual events as well as the tobacco related agendas promoted by the press.
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Affiliation(s)
- R Durrant
- Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Carlton, Australia
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Wakefield M, Durrant R, Terry-McElrath Y, Ruel E, Balch GI, Anderson S, Szczypka G, Emery S, Flay B. Appraisal of anti-smoking advertising by youth at risk for regular smoking: a comparative study in the United States, Australia, and Britain. Tob Control 2003; 12 Suppl 2:ii82-6. [PMID: 12878778 PMCID: PMC1766098 DOI: 10.1136/tc.12.suppl_2.ii82] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the similarity in how youth in the United States, Australia, and Britain appraise anti-smoking advertisements with different characteristics. DESIGN Each participant viewed and evaluated a set of 10 anti-smoking adverts (from an overall total of 50 adverts) in a controlled experimental context using an audience response methodology. A structured telephone interview was completed one week after viewing the adverts, in which recall and engagement with the adverts by participants was evaluated. SUBJECTS 615 youths who were experimenting with smoking or were susceptible nonsmokers. MAIN OUTCOME MEASURES Measures of advert appraisal and engagement. RESULTS Youth in the United States, Australia, and Britain responded in very similar ways to the same anti-smoking advertisements. In full multivariate models, the target audience of the advert and the advert theme were not related to the main outcome measures employed in this study. However, adverts with visceral negative or personal testimonial executional characteristics were appraised more positively by youths and were more likely to be recalled, thought about, and discussed at follow up one week later. CONCLUSIONS Youths in three different countries responded to anti-smoking advertisements in very similar ways, suggesting that such adverts might be more actively shared among nations. The appraisal of, and engagement with, the anti-smoking adverts, however, varied substantially depending on executional characteristics. In the design of effective anti-smoking adverts, due attention needs to be paid to those characteristics that appear to most engage youth across different social and cultural environments.
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Affiliation(s)
- M Wakefield
- The Cancer Council Victoria, Melbourne, Australia.
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Abstract
OBJECTIVE To document the impact of changes to tobacco taxes on the range and price of tobacco sold during the period when the National Tobacco Campaign (NTC) was run. DATA SOURCES Information about brand availability, pack size, and price was extracted from Australian Retail Tobacconist. A retail observational survey was undertaken to monitor actual retail prices. Data on cigarette prices, brands, packet configurations, and outlets from which they were purchased were obtained from the benchmark and three follow up population telephone surveys conducted to evaluate the NTC. METHOD Data from the three sources were compared to see the extent to which the impact of tax changes had been offset by greater retail discounting and a more concerted effort by consumers to purchase cheaper products. RESULTS Smokers were unable to cushion themselves from the sharp price increases that occurred during the third phase of the NTC. Both average recommended retail prices of manufactured cigarettes and average actual cigarette prices paid by smokers increased by 25% in real prices. CONCLUSION The fall in smoking prevalence over the first two phases of the NTC was substantially greater than would be expected due to tax changes alone. The fall in smoking consumption over the first two phases was slightly less than would be expected and in the third considerably higher than would be expected.
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Affiliation(s)
- M Scollo
- VicHealth Centre for Tobacco Control, Australia
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Abstract
OBJECTIVE To track national population indices of recall and response among smokers and recent quitters to an ongoing national televised anti-smoking campaign in Australia. METHOD National cross sectional population telephone surveys of adults. MAIN OUTCOME MEASURES Unprompted recall of advertising; recognition of advertising; campaign attributed encouragement to quit or stay quit; unprompted awareness of smoking related health effects; new learning about smoking and health; and agreement with campaign related attitudes. RESULTS Campaign advertising continued to be highly memorable over the period of study, with 88% having confirmed recognition in 2000. Campaign advertising was consistently thought by half of smokers who had seen it to make them more likely to quit (49% in 2000). Specific changes between surveys in unprompted awareness of smoking related health effects, new learning about smoking and health, and agreement with campaign related attitudes were observed in relation to the main messages of the advertisements, which were time sensitive according to the year of launch of the advert. The "artery" advertisement was associated with the largest and most consistent positive change in all of these parameters. The proportion of respondents who disagreed that the dangers of smoking had been exaggerated increased significantly from 59% in May 1997 to 68% in November 2000. CONCLUSION A national campaign using graphic advertising to emphasise the health risks of smoking can make significant population wide contributions to improving new learning about smoking damage and positively influence attitudes about smoking risks.
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Affiliation(s)
- M Wakefield
- Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Victoria, Australia.
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Miller CL, Wakefield M, Roberts L. Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign. Tob Control 2003; 12 Suppl 2:ii53-8. [PMID: 12878774 PMCID: PMC1766110 DOI: 10.1136/tc.12.suppl_2.ii53] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Since June 1997, Australia has run its first nationally coordinated mass media anti-smoking campaign, with all States collaborating to offer a standard Quitline service. An overview of the Australian national Quitline service is presented as well as two studies describing (a) the relationship between television advertising and call volume and type, and (b) the quit rates of callers over time. DESIGN Data on extent of advertising, as measured by weekly television target audience rating points (TARPs), is compared with weekly call volume and disposition. A randomly selected sample of callers was followed up at 3 weeks, 6 months and 12 months to assess caller appraisal and quit rates. SETTING The Australian Quitline service, in the context of a nationally coordinated, major anti tobacco campaign. RESULTS In a one year period from June 1997, 3.6% of adult Australian smokers called the Quitline. Weekly call volume was strongly related to TARPs and increased further when an advertisement specifically promoting the Quitline was broadcast. Calls involving requests for counselling, as opposed to brief calls to request quit materials, were more likely with lower TARPs. Of the cohort who were smoking at baseline, 28% reported they had quit smoking at a one year follow up and 5% had been quit for an entire year. CONCLUSIONS In the context of a national mass media campaign, this study illustrates that it is possible to bring together differing State based services to provide an accessible, acceptable, and effective quit smoking service.
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Affiliation(s)
- C L Miller
- Tobacco Control Research and Evaluation, The Cancer Council South Australia, Unley, Australia.
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Abstract
A handful of empirical studies have related changes in youth smoking to popular laws that penalise tobacco possession, use, and purchase (PUP). In this paper, we review the literature and outline reasons why PUP laws may be unlikely to reduce youth smoking significantly at the population level. In theoretical terms, we argue that PUP laws lack important features required for punishment to be effective in changing behaviour. In practical terms, PUP transgressions seem difficult to detect. Conceptually, there is potential for PUP laws to undermine conventional avenues of discipline, such as the parent-child relationship and the school environment. Strategically, PUP laws may divert policy attention from effective tobacco control strategies, relieve the tobacco industry of responsibility for its marketing practices, and reinforce the tobacco industry's espoused position that smoking is for adults only. To assist further debate and discussion, we identify research issues requiring attention.
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Affiliation(s)
- M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, Australia.
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Abstract
PURPOSE To describe ways nurses are and are not effective in the development of health policy in the United States today, and to provide useful information for those interested in making nursing a more vital part of the policy arena. DESIGN Qualitative examination of the career experiences and observations of a purposive sample of 27 American nurses currently active in health policy at the national, state, local, or organizational level. METHOD Semi-structured interviews regarding career path, contributing resources improvement of resources available to nurses, and the strengths and weaknesses of currently available information for policy work. FINDINGS For nurse participants, policy involvement meant speaking for patients in arenas where those need of care have limited voice. Participation occurred after assessment, diagnosis, and planning revealed the need for change in the way resources were allocated. Strong belief in the capacity and importance of people caring for themselves distinguished nurses in their policy roles. Policy makers responded to the experiences and determinants of health and illness as presented by nurses. CONCLUSION Once engaged, nurses seldom turned their backs on the world of policy-making. However, they did not report significant use of nursing research or information in policy making. Further investigation and testing of systems to connect nurse policymakers with nurse scholars are recommended.
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Affiliation(s)
- K M Gebbie
- Center for Health, Columbia University School of Nursing, 630 West 168th Street, New York, NY 10032, USA.
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Abstract
OBJECTIVE To assess smokers' perceived effects of smoking bans in bars, nightclubs, and gaming venues on their smoking behaviour. DESIGN Cross sectional structured interview telephone survey of a random sample of smokers. SETTING Population survey in Victoria, Australia. PARTICIPANTS The sample comprised 597 smokers and analyses were conducted on 409 smokers who reported patronising bars, nightclubs or gaming venues at least monthly. OUTCOME MEASURES Two outcomes studied were socially cued smoking and readiness to quit as a result of restrictions on smoking in social venues. Respondents were identified as socially cued smokers if they reported attending bars, nightclubs or gaming venues at least monthly and said that they smoke more in these venues. The potential influence of bans in social venues on readiness to quit was measured by asking respondents if they would be more or less likely to quit smoking if smoking were banned in hotels, licensed bars, gaming venues, and nightclubs. RESULTS Of all adult smokers, 69% attended bars, nightclubs or gaming venues at least monthly. Of these smokers, 70% reported smoking more in these settings (socially cued smokers) and 25% indicated they would be likely to quit if smoking were banned in social venues. Compared to smokers not likely to quit if there were bans, smokers likely to quit were more likely to be socially cued (odds ratio (OR) 2.64), to be contemplating or preparing to quit (OR 2.22), to approve of bans in social venues (OR 2.44), and to be aged under 30 years (OR 1.73). Compared with smokers not socially cued, socially cued smokers were more likely to be under the age of 30 years (OR 6.15), more likely to believe that there is a safe level of cigarette consumption (OR 2.25), and more likely to have previously made a quit attempt (OR 2.60). CONCLUSIONS These findings suggest that bans on smoking in bars, nightclubs, and gaming venues could reduce cigarette consumption and increase quitting among smokers who frequently patronise these settings. These beneficial effects are likely to be strongest among younger smokers.
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Affiliation(s)
- L Trotter
- Centre for Behavioural Research in Cancer, The Cancer Council Victoria, Victoria, Australia.
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Abstract
Faced with bans on advertising, the tobacco companies are looking to new, more subtle ways of maintaining their brands' profile in the public eye.
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Affiliation(s)
- M Wakefield
- Centre for Behavioural Research in Cancer, Cancer Control Research Institute, The Cancer Council Victoria, Victoria, Australia.
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Abstract
OBJECTIVES To gain an understanding of the role of pack design in tobacco marketing. METHODS A search of tobacco company document sites using a list of specified search terms was undertaken during November 2000 to July 2001. RESULTS Documents show that, especially in the context of tighter restrictions on conventional avenues for tobacco marketing, tobacco companies view cigarette packaging as an integral component of marketing strategy and a vehicle for (a) creating significant in-store presence at the point of purchase, and (b) communicating brand image. Market testing results indicate that such imagery is so strong as to influence smoker's taste ratings of the same cigarettes when packaged differently. Documents also reveal the careful balancing act that companies have employed in using pack design and colour to communicate the impression of lower tar or milder cigarettes, while preserving perceived taste and "satisfaction". Systematic and extensive research is carried out by tobacco companies to ensure that cigarette packaging appeals to selected target groups, including young adults and women. CONCLUSIONS Cigarette pack design is an important communication device for cigarette brands and acts as an advertising medium. Many smokers are misled by pack design into thinking that cigarettes may be "safer". There is a need to consider regulation of cigarette packaging.
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Affiliation(s)
- M Wakefield
- Centre for Behavioural Research in Cancer, Anti-Cancer Council of Victoria, Victoria, Australia.
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Abstract
BACKGROUND There is some evidence that tobacco companies marketing efforts undermine the effects of comprehensive tobacco control programmes. OBJECTIVE To determine whether point-of-purchase advertising and promotions are more pervasive in states where comprehensive tobacco control programmes are underway. DESIGN Cross sectional survey using 1996 data, with merged records of the existence of local tobacco advertising restrictions. PARTICIPANTS AND SETTING 581 tobacco retail stores located in close proximity to high schools in mainland USA. MAIN OUTCOME MEASURES Existence of gift-with-purchase, number of interior advertisements, and exterior store advertisements for Marlboro cigarettes. RESULTS After controlling for store type and existence of advertising restrictions, offer of a gift-with-purchase for Marlboro cigarettes was significantly more likely in states with comprehensive tobacco control programmes than those without programmes (odds ratio 2.59, 95% confidence interval 1.57 to 4.26). Although not significant, results show an increase in the number of interior and exterior store advertisements for stores located in states with a comprehensive tobacco control programme than those in other states. CONCLUSION Results suggest some point-of-purchase tobacco promotions and advertising are more pervasive in states with comprehensive tobacco control programmes. These efforts are likely to act against the objectives of programmes and need to be accounted for in programme evaluations.
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Affiliation(s)
- S Slater
- Health Research and Policy Centers, University of Illinois at Chicago, 850 West Jackson Boulevard, Chicago, IL 60607, USA.
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Greaves IK, Svartman M, Wakefield M, Taggart D, De Leo A, Ferguson-Smith MA, Rens W, O'Brien PC, Voullaire L, Westerman M, Graves JA. Chromosomal painting detects non-random chromosome arrangement in dasyurid marsupial sperm. Chromosome Res 2001; 9:251-9. [PMID: 11330400 DOI: 10.1023/a:1016656722134] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chromosome arrangements have been studied in metaphase and interphase somatic cells and in sperm of many animal species, but there are conflicting data and it is still not clear whether chromosomes are arranged randomly or non-randomly. We used chromosome painting to reveal the positions of chromosomes in marsupial sperm. Marsupials are ideally suited for these studies because they have only a few large chromosomes. Here, we show that chromosomes occupy fixed positions in the immature and mature sperm of Sminthopsis crassicaudata. We suggest that the non-random arrangement of chromosomes in marsupial sperm may be important in establishing chromosome arrangement and patterns of gene activity within the developing embryo.
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Affiliation(s)
- I K Greaves
- Department of Genetics and Evolution, La Trobe University Bundoora, Vic, Australia.
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Munn MB, Owen J, Vincent R, Wakefield M, Chestnut DH, Hauth JC. Comparison of two oxytocin regimens to prevent uterine atony at cesarean delivery: a randomized controlled trial. Obstet Gynecol 2001; 98:386-90. [PMID: 11530117 DOI: 10.1016/s0029-7844(01)01479-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if high-dose oxytocin reduces the need for additional uterotonic agents at cesarean. METHODS A randomized, double-masked trial of two oxytocin regimens was performed to prevent postpartum uterine atony in laboring women. The pharmacy prepared sequentially numbered oxytocin solutions containing either 10 U/500 mL or 80 U/500 mL of lactated Ringer's solution infused over 30 minutes after cord clamping. The need for additional uterotonic agents was determined by the surgical team. Hypotension was diagnosed and treated with crystalloid or a pressor agent. To detect a 50% decrease in the need for additional uterotonic agents and considering a beta error of 0.2, 220 patients would be required in each group (alpha = 0.05, two-tailed chi(2) test). RESULTS The low-dose group (n = 163) received 333 mU/min, and the high-dose group (n = 158) received 2667 mU/min of oxytocin. The groups were similar with respect to risk factors for atony. Women in the low-dose group received additional uterotonic medication significantly more often than those in the high-dose group (39% compared with 19%, P <.001, relative risk 2.1, 95% confidence interval 1.4, 3.0). Moreover, more women in the low-dose group received methylergonovine, 15-methyl prostaglandin F(2alpha) or both (9% compared with 2%, relative risk 4.8, 95% confidence interval 1.4, 16) after additional oxytocin (median 20 U) had been added to the study solution. The incidence of hypotension was similar in both groups. CONCLUSION Compared with an infusion rate of 333 mU/min, oxytocin infused at 2667 mU/min for the first 30 minutes postpartum reduces the need for additional uterotonic agents at cesarean delivery.
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Affiliation(s)
- M B Munn
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
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44
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Bednash G, Jones CB, Moody L, Wakefield M. Building health services research capacity in nursing: views from members of nursing's leadership [interview by Candice Cook Bowman and Deborah Gardner]. Nurs Outlook 2001; 49:187-92. [PMID: 11514792 DOI: 10.1067/mno.2001.116334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite a short history that dates back to the 1960s, health services research (HSR) has become an important force in shaping the delivery system in the current health care environment. Nursing has been noticeably absent from this endeavor, and if it does not increase its presence, it risks missing an important opportunity to influence future directions of health care delivery. PURPOSE Our purpose was to evaluate the state of nursing's HSR contributions and to consider ways to increase its capacity in this arena. METHOD An interview with four members from nursing's leadership was conducted. DISCUSSION Nurses can increase the capacity by becoming better collaborators with those who are currently contributing to HSR, both nurses and members of other healthcare disciplines. Also, by reshaping undergraduate and graduate curricula and creating mentorships, nursing can increase its involvement through an informed workforce. CONCLUSIONS Solutions that were offered in this discussion are presented.
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Affiliation(s)
- G Bednash
- Quality Enhancement Research Initiative-HIV, Veterans Affairs San Diego Healthcare System, San Diego, Calif., USA.
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Abstract
Australia has one of the world's most successful records on tobacco control. The role of public health advocacy in securing public and political support for tobacco control legislation and policy and program support is widely acknowledged and enshrined in World Health Organization policy documents yet is seldom the subject of analysis in the public health policy research literature. Australian public health advocates tend to not work in settings where evaluation and systematic planning are valued. However, their day-to-day strategies reveal considerable method and grounding in framing theory. The nature of media advocacy is explored, with differences between the conceptualization of routine "programmatic" public health interventions and the modus operandi of media advocacy highlighted. Two case studies on securing smoke-free indoor air and banning all tobacco advertising are used to illustrate advocacy strategies that have been used in Australia. Finally, the argument that advocacy should emanate from communities and be driven by them is considered.
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Affiliation(s)
- S Chapman
- Department of Public Health and Community Medicine, University of Sydney, Australia.
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46
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Adams R, Wakefield M, Wilson D, Parsons J, Campbell D, Smith B, Ruffin R. Quality of life in asthma: a comparison of community and hospital asthma patients. J Asthma 2001; 38:205-14. [PMID: 11392360 DOI: 10.1081/jas-100000107] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study compares the quality of life of a community sample of people with asthma in South Australia, using population norms, people suffering from other chronic diseases, and a sample of asthma patients from two hospital clinics. A representative population survey was performed by trained interviewers in spring 1995 of 3001 respondents aged > or = 15 years. A physician's diagnosis of current asthma was reported by 299 (9.9%). The hospital clinic sample had a physician's diagnosis and lung function evidence of asthma (n = 293). All completed the SF-36 health survey. Standardized SF-36 scores, adjusted for age, sex, and social class, were significantly lower for respondents with asthma, compared with population norms, across all subscales of the SF-36 (p < 0.05). Physical component summary (PCS) and mental component summary (MCS) scores were not significantly different in people in the community sample with asthma from scores in people with diabetes and arthritis. PCS and MCS scores did not differ for those with similar symptom frequency in the community and hospital asthma samples, except that hospital patients with frequent symptoms had significantly lower MCS scores (p < 0.01). Asthma has a major impact on the health-related quality of life in the community, comparable to other chronic diseases. The SF-36 performs uniformly in asthma in different situations.
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Affiliation(s)
- R Adams
- Department of Medicine, The University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
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47
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Clegg Smith K, Wakefield M. USA: the name of Philip Morris to sit on 28 million school desks. Tob Control 2001; 10:8. [PMID: 11347535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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48
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Abstract
Questionable quality of health care delivered in the United States has become a front-line issue, taking a strong place alongside more traditional concerns such as increasing costs and access to care. Given that nurses comprise the largest component of the health care workforce, safety and error reduction in health care are central concerns for the profession.
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Affiliation(s)
- P J Maddox
- Office of Research, Center for Health Policy, Research and Ethics, George Mason University, Fairfax, Virginia, USA
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49
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Abstract
OBJECTIVES The purpose of this study was to determine the extent to which various levels of restrictions on smoking in the home may be associated with children's exposure to environmental tobacco smoke (ETS). METHODS The methodology consisted of a cross-sectional survey involving 249 children with asthma aged 1 to 11 attending hospital outpatient clinics, with at least one parent who smoked, linked to the child's urinary cotinine to creatinine ratios (CCR). RESULTS After adjustment for child's age, mother's smoking status, and total parental daily cigarette consumption, a total ban was associated with significantly lower urinary CCR levels (7.6 nmol/mmol) than bans with exceptions or limited smoking in the home. Where exceptions to bans were made (14.9 nmol/mmol), children's urinary CCR levels were no different from homes in which smoking was allowed in rooms the child rarely frequented (14.1 nmol/mmol). These two intermediate levels of restriction were in turn associated with significantly lower CCR levels than unrestricted smoking in the home (26.0 nmol/mmol). CONCLUSIONS Making exceptions to bans on smoking at home measurably undermines the protective effect of a ban. However, making some exceptions to a ban and limiting smoking to rooms where the child rarely goes may result in reduced exposure to ETS, compared with unrestricted smoking.
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Affiliation(s)
- M Wakefield
- Health Research and Policy Centers, University of Illinois at Chicago, Illinois 60607, USA.
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50
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Richardson WC, Berwick DM, Bisgard JC, Bristow LR, Buck CR, Cassel CK, Coye MJ, Detmer DE, Grossman JH, James B, Lawrence DM, Leape L, Levin A, Robinson-Beale R, Scherger JE, Southam AM, Wakefield M, Warden GL, Corrigan JM. The Institute of Medicine Report on Medical Errors: misunderstanding can do harm. Quality of Health Care in America Committee. MedGenMed 2000; 2:E42. [PMID: 11104488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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