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Introduction: Widespread commercial promotion of alcohol products in Australia undermines the abstinence message for young people. This study aims to document the frequency of adolescents' exposure to alcohol advertising and examine associations with drinking behaviours. Methods: Students aged 12–17 years (n = 3618) participating in a cross‐sectional survey self‐reported their exposure to alcohol advertising via eight sources. Students also indicated whether they had never consumed alcohol, consumed at least a few sips of alcohol in their lifetime but none in the past month ('irregular drinkers') or consumed more than 10 drinks in their lifetime including at least one drink in the past month ('drinkers'). Multinomial logistic regression analyses examined associations between both single‐channel and cumulative exposure to alcohol advertising and drinking status, controlling for sex, age and education sector. Results: Television (61%), the internet (56%) and at sporting events (50%) were the most common channels through which students reported seeing alcohol advertising. Weekly exposure via each of the eight assessed channels was associated with being a drinker (vs. a non‐drinker or an irregular drinker, respectively), whereas only weekly exposure via television and sporting events was associated with being an irregular drinker (vs. a non‐drinker). As students' level of cumulative exposure to alcohol advertising increased, so too did their likelihood of being a drinker. Discussion and Conclusions: Alcohol advertising exposure is positively associated with drinking among Australian adolescents. Tighter restrictions on alcohol advertising across all media in Australia may reduce adolescent exposure and help de‐normalise alcohol use. [ABSTRACT FROM AUTHOR]

Health warning labels (HWLs) on alcohol containers may help reduce population-level alcohol consumption. However, few studies have examined the most effective formats for alcohol HWLs. This study tested the effects of three different types of alcohol HWLs. In an online experiment, N = 1,755 Australian adult drinkers were randomly assigned to one of five conditions: (a) No HWL control; (b) DrinkWise control (industry-developed labels currently on some containers); (c) Text-Only HWLs; (d) Text + Pictogram HWLs; or (e) Text + Photograph HWLs. In the three intervention conditions, participants were exposed to eight HWLs, each depicting a different long-term harm. Exposure occurred during an initial session, and repeatedly over the subsequent eight days. Differences between conditions were assessed immediately following initial exposure and at nine-day follow-up. Compared to participants in the No HWL control, participants exposed to Text + Pictogram HWLs were more likely to have intentions to avoid drinking alcohol completely in the next month (post-exposure) and intentions to drink less alcohol in the next week (follow-up), and participants in all three intervention conditions reported stronger negative emotional arousal (follow-up) and weaker positive emotional arousal (follow-up). Compared to participants in the DrinkWise control, those exposed to Text + Pictogram HWLs had stronger intentions to drink less alcohol in the next week and intentions to avoid drinking alcohol completely in the next month (follow-up), participants in the Text + Photograph condition reported significantly weaker positive emotional arousal, and all three intervention conditions resulted in stronger negative emotional arousal. There would likely be benefits to public health if any of the three types of intervention HWLs were implemented. However, there is some evidence that Text + Pictogram HWLs should be recommended over Text-Only or Text + Photograph HWLs, given they were the only HWLs to increase intentions to drink less. [ABSTRACT FROM AUTHOR]

Front-of-pack (FoP) warning labels are a viable policy option with the potential to inform consumer choice and assist in reducing sugar-sweetened beverage (SSB) consumption as part of a multi-faceted approach. This study explored parents' perceptions and understanding of a range of SSB warning labels. Focus groups (n = 12) with 82 parents of school-aged children were conducted, stratified according to education level, sex and location. Health effects, exercise equivalents, sugar content (teaspoons in text and pictograms, "high in") and energy content labels were shown. Through thematic analysis we identified three themes. Theme 1 related to perceptions of effectiveness of labels, underpinned by four subthemes: perceptions of labels as credible, informative and useful, personally relevant and having the potential to change be haviour. Theme 2 related to participants finding opportunities for self-exemption (e.g., physically active) and message rejection (e.g., misinterpretation). Theme 3 encompassed the potential negative consequences of some labels (e.g., body image concerns). The text teaspoons label was perceived most favourably across all themes, with minimal negative issues raised. These results provide in-depth insight into potential responses to labelling as a policy intervention, providing important guidance for the development of labels to ensure optimal message content and framing for future testing and subsequent implementation. [ABSTRACT FROM AUTHOR]

Issue addressed: Introduced relatively recently in the Australian market, flavour capsule cigarettes pose a risk to adolescents by providing a palatable pathway to smoking initiation. The present study aimed to establish the prevalence of the use of flavour capsule cigarettes in Australian adolescents and to examine the association between frequency of use and smoking behaviour and intentions and perceptions of cigarette brand differences. Methods: Data were from a 2017 cross‐sectional school‐based survey of secondary students aged 12‐17 years (N = 4266) in Victoria who self‐reported their smoking behaviours, smoking intentions and cigarette brand perceptions. Regression analyses were conducted controlling for sex, age group, education sector and other covariates. Results: Overall, 5% (n = 195) of all students reported ever using flavour capsule cigarettes. Of the 675 students who had ever smoked, 29% (n = 194) had tried a flavour capsule cigarette. The likelihood of past‐month and past‐week smoking was significantly higher, and future smoking intentions were significantly stronger, for ever‐smokers who had used flavour capsule cigarettes multiple times compared to those who had never used this type of cigarette. Ever‐smokers were more likely to agree that 'some brands of cigarettes are easier to smoke than others' if they had tried a flavour capsule cigarette. Conclusions: There are high levels of use of flavour capsule cigarettes among Australian adolescent smokers, with more frequent use associated with greater involvement in smoking. So what?: These findings add to those of other studies suggesting that flavour capsule cigarettes may have negative impacts on youth smoking, strengthening the case for their prohibition in Australia. [ABSTRACT FROM AUTHOR]

Objective: There are numerous health effects associated with excess sugar-sweetened beverage (SSB) consumption. Interventions aimed at reducing population-level consumption require understanding of the relevant barriers and facilitators. This study aimed to identify the variables with the strongest relationship with intentions to reduce SSB consumption from a suite of variables derived from the literature.Design: Random-digit dialling of landline and mobile phones was used to survey adults using computer-assisted telephone interviews. The outcome variable was 'likelihood of reducing SSB consumption in next 6 months', and the predictor variables were demographics, SSB attitudes and behaviour, health risk perceptions and social/environmental exposure.Setting: Australia.Participants: A subsample of 1630 regular SSB consumers from a nationally representative sample of 3430 Australian adults (38 % female, 51 % aged 18-45 years, 56 % overweight or obese).Results: Respondents indicated that they were 'not at all' (30·1 %), 'somewhat' (43·9 %) and 'very likely' (25·3 %) to reduce SSB consumption. Multivariate nominal logistic regressions showed that perceiving future health to be 'very much' at risk was the strongest predictor of intention to reduce SSB consumption (OR = 8·1, 95 % CI 1·8, 37·0, P < 0·01). Other significant predictors (P < 0·01) included self-perceptions about too much consumption, habitual consumption, difficulty reducing consumption and likelihood of benefitting from reduced consumption.Conclusions: Health risk perceptions had the strongest relationship with intentions to reduce consumption. Age and consumption perceptions were also predictors in the multivariate models, whereas social/environmental exposure variables were not. Interventions may seek to incorporate strategies to denormalise consumption practices and increase knowledge about perceived susceptibility to health risks. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of a mass media campaign designed to increase bowel cancer screening participation. Methods: We assessed weekly participation, from January 2015 to December 2017, in the Australian National Bowel Cancer Screening Program in Victoria, where a seven-week campaign aired in mid-2017, and in the adjacent comparison state of South Australia. Participation, defined as the number of immunochemical faecal occult blood tests returned out of those invited by the Screening Program in the past 16 weeks, was analysed using negative binomial regression. Results: Compared with non-campaign weeks, there was an increase in the return rate in the campaign state during campaign weeks (adjusted return rates non-campaign weeks = 34.4% vs. campaign weeks = 45.3%, p < 0.01), not observed in the comparison state (38.3% vs. 40.3%, p > 0.05). The increase in the return rate was significantly greater in the campaign state (Rate Ratio of Campaign/Non-Campaign weeks = 1.31, p < 0.01) than the comparison state (1.05, p > 0.05, interaction p < 0.001), and did not differ significantly by age, sex or socio-economic area. The relative increase was greater among never-participants (Rate Ratio of Campaign/Non-Campaign weeks = 1.24) than previous-participants (1.16), interaction p < 0.001). Conclusions: This mass media campaign increased bowel cancer screening participation, including from never and low participation subgroups. To maximize participation and ensure equitable population benefit, repeated campaigns that reach eligible people about bowel cancer risks and potential life-saving benefits of screening should be standard. [ABSTRACT FROM AUTHOR]

Objective To assess public support for 10 potential policy initiatives to reduce sugar-sweetened beverage (SSB) consumption. Design A 2014 historical data set, which employed a face-to-face survey in one Australian state (study 1), provided the basis for comparison with our 2017 nationally representative, cross-sectional, computer-assisted telephone interviewing population survey (study 2). Participants Study 1: South Australians, 15+ years (n=2732); study 2: Australians, 18+ years (n=3430). Primary outcome measures: levels of support for SSB-specific policy initiatives. For the 2017 national study (study 2), demographic characteristics, body mass index, knowledge of potential harms caused by consuming SSBs and SSB consumption were included in multivariable regression analyses. Results In 2017, all 10 potential policy initiatives received majority support (60%-88% either 'somewhat' or 'strongly' in favour). Initiatives with educative elements or focused on children received high support (>70%), with highest support observed for text warning labels on drink containers (88%) and government campaigns warning of adverse health effects (87%). Higher support was observed for SSB tax paired with using funds for obesity prevention (77%) than a stand-alone tax (60%). Support for policy initiatives was generally greater among those who believed SSB daily consumption could cause health problems in adults (4%-18% absolute difference) and/or in children (8%-26% absolute difference) and lower among SSB high consumers (7+ drinks per week; 9%-29% absolute difference). State-specific data comparison indicated increased support from 2014 to 2017 for taxation (42%vs55%; χ2=15.7, p<0.001) and graphic health warnings (52%vs68%; χ2=23.4. p<0.001). Conclusions There is strong public support for government action, particularly regulatory and educational interventions, to reduce SSB consumption, which appears to have increased since 2014. The findings suggest that framing policies as protecting children, presenting taxation of SSBs in conjunction with other obesity prevention initiatives and education focused on the harms associated with SSB consumption will increase support. [ABSTRACT FROM AUTHOR]

Introduction: Australia's excise and customs duty on tobacco has been automatically increased biannually since 1984. Increases in duty on par with inflation ensured that tobacco stayed at least as costly as other goods. This would be expected to maintain, rather than drive down, smoking prevalence. We examined the association between smoking prevalence and duty over a 10-year period.Methods: Using monthly data from five Australian capital cities, collected from March 2001 to March 2010 among Australians aged at least 18 years, multiple linear regression modeled associations between smoking prevalence and the two components (duty and non-duty) of the recommended retail price of an average packet of cigarettes, adjusting for policy covariates.Results: Prevalence declined from 23.6% in March 2001 to 17.0% in March 2010 [absolute difference 6.6%; 95% confidence interval (CI) = 6.5 to 6.8]. Duty increased from $0.2026 to $0.2622 per cigarette over the same period. In the adjusted model, a 1-cent increase in the duty component of price was not associated with changes in prevalence (0.019; 95% CI = -0.035 to 0.028). Increased non-duty component of price was associated with a decline in prevalence (-0.027; 95% CI = -0.052 to -0.002). This effect was stronger when changes in income were controlled for.Conclusions: In line with expectations, inflation-adjusted duty was not associated with changes in smoking prevalence, but it may have prevented upward pressure on prevalence that increasing affordability could have exerted. Frequent increases in duty greater than the growth in both wages and goods would more effectively reduce smoking than regular indexation.Implications: Few countries inflation-adjusted excise duty to ensure that tobacco products do not become more affordable; however, Australia experienced a decade of inflation adjustment alone, enabling the impact of this policy to be studied. This study shows that inflation-adjusted duty likely did prevent tobacco becoming more affordable and that indexation was associated with declines in smoking when tobacco companies over-shifted the duty rises (ie, increased price over and above duty rises).The study also suggests that frequent increases in taxation that exceed both wage growth and increases in costliness of other goods are needed to prompt increased rates of quitting. [ABSTRACT FROM AUTHOR]

Objectives and design This field experiment aimed to compare bowel cancer screening participation rates prior to, during and after a mass media campaign promoting screening, and the extent to which a higher intensity campaign in one state led to higher screening rates compared with another state that received lower intensity campaign exposure. Intervention An 8-week television-led mass media campaign was launched in selected regions of Australia in mid-2014 to promote Australia's National Bowel Cancer Screening Program (NBCSP) that posts out immunochemical faecal occult blood test (iFOBT) kits to the homes of age-eligible people. The campaign used paid 30-second television advertising in the entire state of Queensland but not at all in Western Australia. Other supportive campaign elements had national exposure, including print, 4-minute television advertorials, digital and online advertising. Outcome measures Monthly kit return and invite data from NBCSP (January 2012 to December 2014). Return rates were determined as completed kits returned for analysis out of the number of people invited to do the iFOBT test in the current and past 3 months in each state. Results Analyses adjusted for seasonality and the influence of other national campaigns. The number of kits returned for analysis increased in Queensland (adjusted rate ratio 20%, 95% CI 1.06% to 1.35%, p<0.01) during the months of the campaign and up to 2 months after broadcast, but only showed a tendency to increase in Western Australia (adjusted rate ratio 11%, 95% CI 0.99% to 1.24%, p=0.087). Conclusions The higher intensity 8-week televisionled campaign in Queensland increased the rate of kits returned for analysis in Queensland, whereas there were marginal effects for the low intensity campaign elements in Western Australia. The low levels of participation in Australia's NBCSP could be increased by national mass media campaigns, especially those led by higher intensity paid television advertising. [ABSTRACT FROM AUTHOR]

Background: Social denormalisation of smoking can provide an environment that helps smokers to quit. This study examined which of three measures of anti-smoking social norms have the greatest influence on quitting-related cognitions and behaviours, and if this influence differs according to socioeconomic status (SES). Methods: The Victorian Tracking Survey measured social norms among 1,348 (n(weighted) = 1,373) Australian adult smokers (aged 18–59) between 2012 and 2014, who were followed-up one week later. Weighted logistic regression analyses examined prospective associations of baseline subjective (family and friends’ disapproval of smoking), injunctive (feeling embarrassed about being a smoker) and descriptive norms (living with someone who tried to quit in the past 12 months), with quitting-related cognitions and behaviours at follow-up. Data were weighted to account for telephony status (landline or mobile phone), sex and age. Analyses were adjusted for demographic characteristics, addiction level, tobacco control policies 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-four percent of participants (n(weighted) = 872) perceived disapproval from family and friends, 31% (n(weighted) = 419) felt embarrassed to be a smoker, and 11% (n(weighted) = 155) lived with a recent quitter. All three norms were associated with having set a firm date to quit in the next month and with engaging in smoking limiting behaviours. Embarrassment was also associated with an increased likelihood of talking about quitting and with making a quit attempt. Associations were mostly comparable for lower and higher SES smokers, with no significant negative rebound effects overall or among subgroups. Conclusions: These findings indicate close others’ disapproval and feelings of embarrassment most strongly motivate smokers to try to quit. If tobacco control policies or media campaigns further denormalise smoking, there should be no reason for concern that such denormalisation undermines cessation behaviours. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To determine (i) whether the strength of Australian alcohol control policy in three domains (youth access, trading hours and drink driving) changed during the 2000s; and (ii) estimate associations between these policies and adolescent drinking after adjusting for television alcohol advertising exposures, alcohol outlet density, alcohol price changes, exposure to negative articles about alcohol in daily newspapers and adult drinking prevalence. Design: Repeated cross‐sectional surveys conducted triennially from 2002 to 2011. Multi‐level modelling examined the association between alcohol control policies and drinking prevalence after adjusting for covariates. Setting: Four Australian capital cities between 2002 and 2011. Participants: Students aged 12–17 years participating in a triennial national representative school‐based survey (sample size range/survey: 9805–13 119). Measurements: Outcome measures were: past month drinking and risky drinking (5+ drinks on a day) in the past 7 days. Policy strength in each of three domains (youth access, trading hours, drink‐driving) were the key predictor variables. Covariates included: past 3‐month television alcohol and alcohol‐control advertising, alcohol outlet density, alcohol price change, negatively framed newspaper alcohol articles, adult drinking prevalence and student demographic characteristics. Findings: During the study period, the strength of youth access policies increased by 10%, trading hours policies by 14% and drink‐driving policies by 58%. Past‐month and risky drinking prevalence decreased (e.g. past‐month: 2002: 47.4% to 2011: 26.3%). Multivariable analyses that included all policy variables and adjusted for year, student and other covariates showed past‐month drinking to be associated inversely with stronger trading hours policies [odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.69, 0.94], but not youth access (OR = 0.92 95% CI = 0.81, 1.04) or drink‐driving (OR = 1.00, 95% CI = 0.93, 1.09). Risky drinking was associated inversely with stronger youth access policies (OR = 0.82, 95% CI = 0.69, 0.98), but not trading hours (OR = 0.85, 95% CI = 0.66, 1.09) or drink‐driving (OR = 1.02, 95% CI = 0.90, 1.14) policies. Conclusions: Population‐directed policies designed to reduce alcohol availability and promotion may reduce adolescents’ alcohol use. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To compare the immediate effects on drinkers of television advertisements focusing upon short‐ versus long‐term harms with and without low‐risk drinking guidelines. Design: Between‐participants on‐line experiment, with random assignment to view: (a) alcohol product advertisements (ALC control); (b) advertisements unrelated to alcohol (NON‐ALC control); (c) advertisements featuring short‐term harms (STH) of alcohol; (d) advertisements featuring STH plus a STH guideline (STH+G); (e) advertisements featuring long‐term harms (LTH); or (f) advertisements featuring LTH plus a LTH guideline (LTH+G). Setting: Australia, 2016. Participants: A total of 3718 drinkers aged 18–64 years (48.5% male). Measurements: Post‐exposure likelihood that participants provided a correct estimate of drinking levels associated with short‐ and long‐term harms; post‐exposure intentions to avoid alcohol or reduce consumption. Findings: After exposure to STH+G or LTH+G advertisements, participants were more likely to estimate correctly rather than overestimate drinking levels associated with harm, compared with those exposed to STH (P < 0.001) and LTH advertisements without guidelines, respectively (P = 0.019) and ALC control (STH+G, P < 0.001; LTH+G, P < 0.001) and NON‐ALC control conditions (STH+G, P < 0.001; LTH+G, P = 0.011). Drinkers exposed to STH conditions were more likely to intend to reduce next‐week alcohol consumption than those exposed to ALC control (both P < 0.001) and NON‐ALC control conditions (STH, P = 0.001; STH+G, P < 0.001); a similar pattern was observed for intentions to avoid alcohol. Drinkers exposed to LTH conditions were also more likely than drinkers exposed to ALC or NON‐ALC controls to intend to avoid and reduce alcohol in the next week. Additionally, drinkers exposed to LTH+G were more likely to intend to reduce drinking than those exposed to LTH advertisements without guidelines (P = 0.022). Response patterns for low‐ and high‐risk drinkers by condition were similar. Conclusions: Alcohol harm television advertisements increase intentions to reduce alcohol consumption among both low‐ and high‐risk drinkers. The addition of low‐risk drinking guidelines can enhance these effects for advertisements featuring long‐term harms and improve estimates of both short‐ and long‐term harmful drinking levels. [ABSTRACT FROM AUTHOR]

Emotive anti-tobacco advertisements can increase quitting. Discrete emotion theories suggest evoking fear may be more effective than sadness; less research has focused on hope. A weekly cross-sectional survey of smokers and recent quitters (N = 7683) measured past-month quit attempts. The main predictor was level of exposure to four different types of anti-tobacco advertisements broadcast in the two months prior to quit attempts: advertisements predominantly evoking fear, sadness, hope, or evoking multiple negative emotions (i.e., fear, guilt, and/or sadness). Greater exposure to fear-evoking advertisements (OR = 2.16, p < .01) increased odds of making a quit attempt and showed similar effectiveness among those in lower and higher SES areas. Greater exposure to advertisements evoking multiple negative emotions increased quit attempts (OR = 1.70, p < .01), but interactions indicated this was driven by those in lower SES, but not higher SES areas. Greater exposure to hope-evoking advertisements enhanced effects of fear-evoking advertisements among those in higher SES, but not lower SES areas. Findings suggest to be maximally effective across the whole population avoid messages evoking sadness and use messages eliciting fear. If the aim is to specifically motivate those living in lower SES areas where smoking rates are higher, multiple negative emotion messages, but not hope-evoking messages, may also be effective. [ABSTRACT FROM AUTHOR]

Background: Evidence-based policies encouraging healthy behaviours are often strongly opposed by well-funded industry groups. As public support is crucial for policy change, public health advocates need to be equipped with strategies to offset the impact of anti-policy messages. In this study, we aimed to investigate the effectiveness of theory-based public health advocacy messages in generating public support for sugary drink/alcohol policies (increased taxes; sport sponsorship bans) and improving resistance to subsequent anti-policy messages typical of the sugary drink/alcohol industry.Methods: We conducted a two-wave randomised online experiment assigning Australian adults to one of four health policies (sugary drink tax; sugary drink industry sports sponsorship ban; alcohol tax; alcohol industry sports sponsorship ban). Within each health policy, we randomised participants to one of five message conditions: (i) non-advocacy based message about the size and seriousness of the relevant health issue (control); (ii) standard pro-policy arguments alone; (iii) standard pro-policy arguments combined with an inoculation message (forewarning and directly refuting anti-policy arguments from the opposition); (iv) standard pro-policy arguments combined with a narrative message (a short, personal story about an individual's experience of the health issue); or (v) standard pro-policy arguments combined with a composite inoculation and narrative message. At time 1, we exposed participants (n = 6000) to their randomly assigned message. Around two weeks later, we re-contacted participants (n = 3285) and exposed them to an anti-policy message described as being from a representative of the sugary drink/alcohol industry. Generalised linear models tested for differences between conditions in policy support and anti-industry beliefs at both time points.Results: Only the standard argument plus narrative message increased policy support relative to control at time 1. The standard argument plus narrative and standard argument plus inoculation messages were effective at increasing resistance to the persuasive impact of anti-policy messages relative to control at time 2.Conclusions: Dissemination of advocacy messages using inoculation or narrative components can help strengthen public resistance to subsequent anti-policy messages from industry groups. [ABSTRACT FROM AUTHOR]

Smokers often talk about antismoking campaigns, and these conversations can contribute to campaign effectiveness. However, little is known about the predictors and content of naturally occurring campaigngenerated conversations. In two studies (Study 1, N = 480; Study 2, N = 232), we systematically examined whether the occurrence and content of smokers' conversations after exposure to one of eight antismoking television advertisements were predicted by characteristics of (a) the message, (b) intrapersonal responses to the message, (c) the individual, and (d) the social context in which exposure occurred. In multivariable models, we found that conversations were more likely to occurwhen advertisement exposure occurred in the presence of others, and as the amount of anxiety elicited by the advertisement increased. Conversationsweremore likely to contain a favorable appraisal of the advertisement when the message elicited higher levels of sadness, and less likely to contain favorable appraisals when the respondent had finished secondary education (vs. lower levels of education). Stronger feelings of guilt reduced the likelihood that conversations contained unfavorable appraisals, and increased the likelihood that they contained quitting talk. These findings suggest several promising avenues for future investigations into why smokers talk and talk in particular ways. [ABSTRACT FROM AUTHOR]

Aims To determine (i) whether Australian adolescents' exposure to television alcohol advertisements changed between 1999 and 2011 and (ii) examine the association between television alcohol advertising and adolescent drinking behaviours. Design Cross-sectional surveys conducted every 3 years between 1999 and 2011. Analyses examined associations between advertising exposures and reported drinking. Setting Five Australian major cities. Participants Students aged 12-17 years participating in a triennial nationally representative school-based survey residing in the television advertising markets associated with the major cities (sample size range per survey: 12 644-16 004). Measurements Outcome measures were: drinking in the past month, past week and past-week risky drinking (5+ drinks on a day). The key predictor variable was past-month adolescent-directed alcohol advertising Targeted Rating Points (TRPs, a measure of television advertising exposure). Control measures included student-level characteristics, government alcohol-control advertising TRPs, road safety (drink-driving) TRPs and time of survey. Findings Average monthly adolescent alcohol TRPs increased between 1999 (mean = 2371) to 2005 (mean = 2679) ( P < 0.01) then decreased between 2005 and 2011: (mean = 880) ( P < 0.01). Multi-level logistic regression analyses that adjusted for survey timing, student level factors and alcohol-control advertising variables showed a significant association between past-month alcohol TRPs and past-month drinking [odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.07-1.15), past-week drinking (OR = 1.10, 95% CI = 1.06-1.14) and past-week risky drinking (OR = 1.15, 95% CI = 1.09-1.22). Past-week risky drinking was associated inversely with road safety TRPs (OR = 0.69, 95% CI = 0.49-0.98). Conclusions While Australian adolescents' exposure to alcohol advertising on television reduced between 1999 and 2011, higher levels of past-month television alcohol advertising were associated with an increased likelihood of adolescents' drinking. The reduction in television alcohol advertising in Australia in the late 2000s may have played a part in reducing adolescents' drinking prevalence. [ABSTRACT FROM AUTHOR]

Background: Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads).Method: Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded.Results: In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults.Conclusions: Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given most alcohol-attributable harm is due to long-term disease, these findings suggest future campaigns may fill a potentially important gap if they were to focus on long-term harms. There is scope for such long-term harm campaigns to place greater emphasis on encouraging reduced personal consumption of alcohol, potentially through more frequent communication of low-risk drinking guidelines. [ABSTRACT FROM AUTHOR]

Objectives: To improve the effectiveness of alcohol harm reduction mass media campaigns, this study aimed to (1) identify existing advertisements (ads) with greatest potential to motivate reduced alcohol consumption, (2) assess consistency across audience subgroups in ad effectiveness and (3) identify ad features associated with effectiveness. Design: Cross-sectional online ad response study with random assignment to view ads. Participants: 2174 Australian adult weekly drinkers recruited from an online panel. Procedure: Participants were randomly assigned to view three of 83 English-language alcohol harm reduction ads. Each ad was viewed and rated by a mean of 79 participants. Outcome measure: After viewing each ad, participants reported the extent to which they felt motivated to reduce their drinking. Ads were ranked from most to least motivating using predicted means adjusted for demographic characteristics and alcohol consumption. We compared the characteristics of the top-ranked 15% of ads (most motivating) with the middle 70% and bottom 15%. Results: An ad about the link between alcohol and cancer ('Spread') was most motivating, whereas an ad that encouraged drinking water instead of beer ('Add nothing') was least motivating. Top-ranked ads were more likely than other ads to feature a 'why change' message and less likely to carry a 'how to change' message; more likely to address long-term harms; more likely to be aimed at the general adult drinking population and more likely to include drinking guidelines. There was substantial overlap in top-ranked ads for younger versus older adults, men versus women and high-risk versus low-risk drinker subgroups. Conclusions: The effectiveness of alcohol harm reduction campaigns may be improved by directly communicating alcohol's long-term harms to the general adult population of drinkers along with drinking guidelines. By doing so, campaigns can also efficiently influence high-risk drinkers and key demographic subgroups. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of branding, as indicated by brand name, on evaluation of the cigarette smoking experience. Design: Between-subjects and within-subjects experimental study. Participants were randomly allocated to smoke a cigarette from a pack featuring a premium brand name and a cigarette from a pack featuring a value brand name. Within each condition, participants unknowingly smoked two identical cigarettes (either two premium or two value cigarettes). Setting: Australia, October 2014, 2 years after tobacco plain packaging implementation. Participants: 81 current cigarette smokers aged 19-39 years. From apparently premium and value brand-name packs, 40 smokers were allocated to smoke the same actual premium cigarettes and 41 were allocated to smoke the same actual value cigarettes. Primary outcome measures: Experienced taste (flavour, satisfaction, enjoyment, quality, liking, mouthfeel and aftertaste), harshness, dryness, staleness, harm/strength measures (strength, tar, lightness, volume of smoke), draw effort and purchase intent. Results: Cigarettes given a premium brand name were rated as having a better taste, were less harsh and less dry than identical cigarettes given a value brand name. This pattern was observed irrespective of whether the two packs actually contained premium or value cigarettes. These effects were specific: the brand name did not influence ratings of cigarette variant attributes (strength, tar, volume of smoke, lightness and draw effort). Conclusions: Despite the belief that brand names represent genuine differences between cigarette products, the results suggest that at least some of this perceived sensory difference is attributable to brand image. [ABSTRACT FROM AUTHOR]

Objectives: Many e-cigarette advertisements (ads) are reminiscent of ads for cigarettes. This study explored the effects of e-cigarette ad exposure among former smokers in 2 countries with different e-cigarette regulation contexts. Methods: In an online study, 408 US and 405 Australian former smokers from survey panels were randomized to one of 14 e-cigarette or 2 control ads. Analyses examined effects of ad condition, and interactions by country and relapse susceptibility. Results: Effects were generally consistent across countries. Compared to control ads, those exposed to e-cigarette ads not only were more likely to have some urge or susceptibility to use e-cigarettes, but also were more likely to be reminded of smoking and have some desire to smoke cigarettes; US former smokers were less likely to be confident to abstain from smoking. These effects were especially pronounced among those susceptible to relapse. E-cigarette ad exposure was not associated with estimates of e-cigarette prevalence or perceptions of quitting ease. Conclusions: Exposure to e-cigarette ads can increase former smokers' desire to smoke and weaken their confidence to abstain. Regulators may need to consider the potential population impact of allowing former smokers to be exposed repeatedly to e-cigarette advertising. [ABSTRACT FROM AUTHOR]

Campaign-stimulated conversations have been shown to increase the effectiveness of antismoking campaigns. In order to explore why such effects occur, in the current study we coded the content of naturally occurring conversations. We also examined whether the short-term effects of talking, and of different types of talk, on quitting intentions were mediated through intrapersonal message responses. Using the Natural ExposureSMmethodology, we exposed 411 smokers to 1 of 6 antismoking advertisements while they were watching television at home. Responses to the advertisement—conversation participation and content, emotional responses, personalized perceived effectiveness, and changes in intentions to quit—were measured within 3 days of exposure. Conversations were coded for appraisal of the advertisement (favorable, neutral, or unfavorable) and the presence of quitting talk and emotion talk. Mediation analyses indicated that the positive effects of talking on intention change were mediated through personalized perceived effectiveness and that the positive effects were driven by conversations that contained a favorable appraisal and/or quitting talk. Conversely, conversations that contained an unfavorable appraisal of the advertisement were negatively associated with campaign effectiveness. These findings highlight the importance of measuring interpersonal communication when evaluating campaigns and the need for further research to identify the message characteristics that predict when smokers talk and when they talk only in desirable ways. [ABSTRACT FROM PUBLISHER]

Background: Mass media communications are an important component of comprehensive interventions to address population levels of overweight and obesity, yet we have little understanding of the effective characteristics of specific advertisements (ads) on this topic. This study aimed to quantitatively test audience reactions to existing adult-focused public health television ads addressing overweight and obesity to determine which ads have the highest levels of message acceptance, argument strength, personalised perceived effectiveness and negative emotional impact. Methods: 1116 Australian adults aged 21-55 years recruited from a national online panel participated in this web-based study. Quotas were applied to achieve even numbers of males and females, those aged 21-29 years and 30-55 years, and those with a healthy weight (BMI = 18.5-24.9) and overweight/obesity (BMI = 25+). Participants were randomly assigned to view and rate four of eight ads that varied in terms of message content (health consequences, supportive/encouraging or social norms/acceptability) and execution style (graphic, simulation/animation, positive or negative testimonial, or depicted scene). Results: Toxic fat (a graphic, health consequences ad) was the top performing ad on all four outcome measures and was significantly more likely than the other ads tested to promote strong responses in terms of message acceptance, argument strength and negative emotional impact. Measure up (a negative testimonial, health consequences ad) performed comparably on personalised perceived effectiveness. Most ads produced stronger perceptions of personalised perceived effectiveness among participants with overweight/obesity compared to participants with healthy weight. Some ads were more likely to promote strong negative emotions among participants with overweight/obesity. Conclusions: Findings provide preliminary evidence of the most promising content and executional styles of ads that could be pursued as part of obesity prevention campaigns. Ads emphasising the negative health consequences of excess weight appear to elicit stronger cognitive and emotional responses from adults with overweight/obesity. However, careful pre-testing of these types of ads is needed prior to their inclusion in actual campaigns to ensure they do not have unintended negative impacts such as increased stigmatisation of vulnerable individuals and increased levels of body dissatisfaction and/or eating-disordered behaviour among at-risk population sub-groups. [ABSTRACT FROM AUTHOR]

Background: Mass media communications are an important component of comprehensive interventions to address population levels of overweight and obesity, yet we have little understanding of the effective characteristics of specific advertisements (ads) on this topic. This study aimed to quantitatively test audience reactions to existing adult-focused public health television ads addressing overweight and obesity to determine which ads have the highest levels of message acceptance, argument strength, personalised perceived effectiveness and negative emotional impact. Methods: 1116 Australian adults aged 21-55 years recruited from a national online panel participated in this web-based study. Quotas were applied to achieve even numbers of males and females, those aged 21-29 years and 30-55 years, and those with a healthy weight (BMI = 18.5-24.9) and overweight/obesity (BMI = 25+). Participants were randomly assigned to view and rate four of eight ads that varied in terms of message content (health consequences, supportive/encouraging or social norms/acceptability) and execution style (graphic, simulation/animation, positive or negative testimonial, or depicted scene). Results: Toxic fat (a graphic, health consequences ad) was the top performing ad on all four outcome measures and was significantly more likely than the other ads tested to promote strong responses in terms of message acceptance, argument strength and negative emotional impact. Measure up (a negative testimonial, health consequences ad) performed comparably on personalised perceived effectiveness. Most ads produced stronger perceptions of personalised perceived effectiveness among participants with overweight/obesity compared to participants with healthy weight. Some ads were more likely to promote strong negative emotions among participants with overweight/obesity. Conclusions: Findings provide preliminary evidence of the most promising content and executional styles of ads that could be pursued as part of obesity prevention campaigns. Ads emphasising the negative health consequences of excess weight appear to elicit stronger cognitive and emotional responses from adults with overweight/obesity. However, careful pre-testing of these types of ads is needed prior to their inclusion in actual campaigns to ensure they do not have unintended negative impacts such as increased stigmatisation of vulnerable individuals and increased levels of body dissatisfaction and/or eating-disordered behaviour among at-risk population sub-groups. [ABSTRACT FROM AUTHOR]

Background Plain packaging (PP) with larger graphic health warnings (GHWs) was implemented in Australia in late 2012. This study examined effects of these packaging changes on short-term changes in quitting-related cognitions and behaviours. Methods We used a series of cohorts of Australian adult cigarette smokers originally sourced from a nationally representative cross-sectional tracking survey, followed up approximately 1 month after their baseline interview (n(weighted)=5441). Logistic regression analyses compared changes in seven quitting-related outcomes over this 1-month follow-up period for the cohorts surveyed before PP, over the period of transition to PP, and during the first year of PP, adjusting for baseline levels of the outcome and covariates. Results Compared to the referent group of smokers who completed their follow-up survey pre-PP, those who were followed-up in the early transition period showed significantly greater increases in rates of stopping themselves from smoking (OR=1.51, 95% CI (1.08 to 2.10)) and higher quit attempt rates (OR=1.43, 95% CI (1.00 to 2.03)), those followed-up in the late transition period showed greater increases in intentions to quit (OR=1.42, 95% CI (1.06 to 1.92)) and pack concealment (OR=1.55, 95% CI (1.05 to 2.31)), and those followed-up in the first year of PP showed higher levels of pack concealment (OR=1.65, 95% CI (1.01 to 2.72)), more premature stubbing out of cigarettes (OR=1.55, 95% CI (1.01 to 2.36)), and higher quit attempt rates (OR=1.52, 95% CI (1.01 to 2.30)). Conclusions These findings provide some of the strongest evidence to date that implementation of PP with larger GHWs was associated with increased rates of quitting cognitions, microindicators of concern and quit attempts among adult cigarette smokers. [ABSTRACT FROM AUTHOR]

Background We assessed whether the Australian plain packs with larger graphic health warnings (GHWs) achieved three specific objectives of reducing the appeal of tobacco, increasing health warning effectiveness and reducing the ability of packaging to mislead about smoking harms. Methods We compared responses from continuous cross-sectional telephone surveys of n=2176 cigarette smokers during pre-plain packaging (April-September 2012, pre-PP) with n=759 surveyed in the transition period (October-November 2012) and n=4240 during the first year of implementation (December 2012-November 2013, PP year 1), using multivariate logistic regression analyses. Results From pre-PP to PP year 1, more smokers disliked their pack (p<0.001), perceived lower pack appeal (p<0.001), lower cigarette quality (p<0.001), lower satisfaction (p<0.001) and lower value (p<0.001) and disagreed brands differed in prestige (p=0.003). There was no change in perceived differences in taste of different brands. More smokers noticed GHWs (p<0.001), attributed much motivation to quit to GHWs (p<0.001), avoided specific GHWs when purchasing (p<0.001), and covered packs (p<0.001), with no change in perceived exaggeration of harms. PP year 1 saw an increased proportion believing that brands do not differ in harmfulness (p=0.004), but no change in the belief that variants do not differ in strength or the perceived harmfulness of cigarettes compared with a year ago. Interactions signified greater change for four outcomes assessing aspects of appeal among young adults and two appeal outcomes among mid-aged adults. Conclusions The specific objectives of plain packaging were achieved and generally sustained among adult smokers up to 12 months after implementation. [ABSTRACT FROM AUTHOR]

Aims We observed tobacco pack display and smoking at outdoor venues over three summers to assess changes in their prevalence following Australia's introduction of plain tobacco packaging with larger pictorial health warnings. Methods Between January and April 2012 (preplain packaging (PP)), 2013 (early post-PP) and 2014 (1 year post-PP), we counted patrons, smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack type (branded, plain or unknown) and orientation were noted. Rates of active smoking, pack display and pack orientation were analysed using multilevel Poisson regression. Results Prevalence of pack display among patrons declined from pre-PP (1 pack per 8.7 patrons) to early post-PP (1 pack per 10.4), and remained low 1 year post-PP (1 pack per 10.3). This appeared to be driven by a sustained decline in active smoking post-PP (pre-PP: 8.4% of patrons were smoking; early post-PP: 6.4%; 1 year post-PP: 6.8%). Notably, active smoking declined more in venues with children present than in those without. While early post-PP, plain packs were less often displayed face-up (74.0%) and more often concealed (8.9%) than branded packs pre-PP (face-up: 85.2%; concealed: 4.0%), this was not sustained 1 year post-PP (face-up: 85.7%; concealed: 4.4%). Also, external case use increased from pre-PP (1.2%) to early post-PP (3.5%), but returned to pre-PP levels 1 year post-PP (1.9%). Conclusions This study demonstrated a sustained reduction in visibility of tobacco products and smoking in public, particularly in the presence of children, from pre-PP to 1 year post-PP. This effect is likely to reduce smoking-related social norms, thereby weakening an important influence on smoking uptake and better supporting quit attempts. [ABSTRACT FROM AUTHOR]

Background Implementation of tobacco plain packaging (PP) with larger graphic health warnings (GHWs) in Australia had positive effects on responses reflecting the specific objectives of the PP policy and on follow-up quitting-related cognitions and behaviours. The aim of this study was to examine predictive relationships between these proximal and distal outcomes. Methods A nationally representative sample of Australian adult cigarette smokers completed a baseline survey and a 1-month follow-up survey within the first year of policy implementation (n(weighted)=3125). Logistic regression analyses tested whether baseline measures of cigarette appeal, GHW effectiveness, perceived harm and concern/enjoyment predicted each of seven follow-up measures of quitting-related cognitions and behaviours, adjusting for baseline levels of the outcome and covariates. Results In multivariable models, we found consistent evidence that several baseline measures of GHW effectiveness positively and significantly predicted the likelihood that smokers at follow-up reported thinking about quitting at least daily, intending to quit, having a firm date to quit, stubbing out cigarettes prematurely, stopping oneself from smoking and having attempted to quit. Two of the quitting-related outcomes were also predicted by feeling more smoking-related concern than enjoyment. A smaller number of the appeal variables were prospectively associated with quitting-related outcomes, while believing that brands do not differ in harmfulness did not positively predict any outcomes. Conclusions These findings provide an initial insight into the pathways through which PP with larger GHWs may lead to changes in smoking behaviour. Future research should examine whether the effects are conditional on individual demographic and smoking characteristics. [ABSTRACT FROM AUTHOR]

Objective To examine how the intensity and duration of tobacco control advertising relate to adolescent smoking prevalence. Methods Australian students (aged 12-17 years) participating in a national survey conducted triennially between 1993 and 2008 (sample size range 12 314-16 611). The outcome measure was students' smoking in the previous 4 weeks collected through anonymous, self-completed surveys. For each student, monthly targeted rating points (TRPs, a measure of television advertising exposure) for tobacco control advertising was calculated for the 3 and 12 months prior to surveying. For each time period, cumulative TRPs exposure and exposure to three intensity levels (≥100 TRPs/month; ≥400 TRPs/month; ≥800 TRPs/month) over increasing durations (eg, 1 month, 2 months, etc) were calculated. Logistic regression examined associations between TRPs and adolescent smoking after controlling for demographic and policy variables. Results Past 3-month cumulative TRPs were found to have an inverse relationship with smoking prevalence. Low TRPs exposure in the past 12 months was positively associated with adolescent smoking prevalence. However, smoking prevalence reduced with cumulative exposure levels above 5800 cumulative TRPs. Additionally, exposure to ≥400 TRPs/month and ≥800 TRPs/month were associated with reduced likelihood of smoking, although the duration needed for this effect differed for the two intensity levels. When intensity was ≥400 TRPs/month, the odds of smoking only reduced with continuous exposure. When intensity was ≥800 TRPs/month, exposure at levels less than monthly was associated with reductions in smoking prevalence. Conclusions Both antismoking advertising intensity and duration are important for ensuring reductions in adolescent smoking prevalence. [ABSTRACT FROM AUTHOR]

Background Decisions about which antismoking advertisements should be aired are often guided by audience ratings of perceived effectiveness (PE). Given that the usefulness of PE measures depends on their ability to predict the likelihood that a message will have a positive impact on outcomes such as behaviour change, in the current study we used pre-exposure, postexposure and follow-up measures to test the association between PE and subsequent changes in quitting intentions and smoking behaviours. Methods Daily smokers (N=231; 18 years and older) completed baseline measures of quitting intentions before watching an antismoking advertisement. Immediately following exposure, intentions were measured again and PE was measured using six items that factored into two scales: ad-directed PE (ADPE) and personalised PE (PPE). A follow-up telephone survey conducted within 3 weeks of exposure measured behaviour change (reduced cigarette consumption or quit attempts). Results From pre-exposure to postexposure, 18% of smokers showed a positive change in their intentions. Controlling for baseline intentions, PPE independently predicted intention change (OR=2.57, p=0.004). At follow-up, 26% of smokers reported that they had changed their behaviour. PPE scores also predicted the likelihood of behaviour change (OR=1.93, p=0.009). Conclusions Audience ratings of PPE, but not ADPE, were found to predict subsequent intention and behaviour change. These findings increase confidence in the use of PE measures to pretest and evaluate antismoking television advertisements, particularly when these measures tap the extent to which a smoker has been personally affected by the message. [ABSTRACT FROM AUTHOR]

Objectives: To test for early evidence whether, following the standardisation of tobacco packaging, smokers in Australia were-as predicted by the tobacco industry-less likely to purchase from small mixed business retailers, more likely to purchase cheap brands imported from Asia and more likely to use illicit tobacco. Design: Serial cross-sectional population telephone surveys in November 2011 (a year prior to implementation), 2012 (during roll-out) and 2013 (a year after implementation). Setting/participants: Smokers aged 18 years and over identified in an annual population survey in the Australian state of Victoria (2011: n=754; 2012: n=590; 2013: n=601). Main outcome measures: Changes between 2011 and 2013 in: proportions of current smokers who purchased their last cigarette from discount outlets such as supermarkets compared with small mixed business retail outlets; prevalence of regular use of low-cost brands imported from Asia and use of unbranded tobacco. Results: The proportion of smokers purchasing from supermarkets did not increase between 2011 (65.4%) and 2013 (65.7%; p=0.98), and the percentage purchasing from small mixed business outlets did not decline (2011: 9.2%; 2012: 11.2%; p=0.32). The prevalence of low-cost Asian brands was low and did not increase between 2011 (1.1%) and 2013 (0.9%; p=0.98). The proportion reporting current use of unbranded illicit tobacco was 2.3% in 2011 and 1.9% in 2013 (p=0.46). In 2013, 2.6% of cigarette smokers reported having purchased one or more packets of cigarettes in non-compliant packaging in the past 3 months; 1.7% had purchased one or more packets from an informal seller in the past year. Conclusions: One year after implementation, this study found no evidence of the major unintended consequences concerning loss of smoker patrons from small retail outlets, flooding of the market by cheap Asian brands and use of illicit tobacco predicted by opponents of plain packaging in Australia. [ABSTRACT FROM AUTHOR]

Objective We sought to determine the relative frequency and nature of personal display of cigarette packs by smokers in two Australian cities where 30% front-of-pack and 90% back-of-pack health warnings have been used since 2006 and comprehensive tobacco marketing restrictions apply. Methods An observational study counted patrons, active smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack orientation and use of cigarette cases were also noted. Results Overall, 18 954 patrons, 1576 active smokers and 2153 packs were observed, meaning that one out of every 12.0 patrons was actively smoking, and one of every 8.8 patrons displayed a pack. Packs were more frequently observed in lower socio-economic neighbourhoods, reflecting the higher prevalence of smoking in those regions. Packs were displayed less often in venues where children were present, suggesting a greater tendency not to smoke around children. Most packs (81.4%) were oriented face-up, permitting prominent brand display. Only 1.5% of observed packs were cigarette cases, and 4.2% of packs were concealed by another item, such as a phone or wallet. Conclusions Tobacco packs are frequently seen on table-tops in café strips, providing many opportunities for other patrons and passers-by to be incidentally exposed to cigarette brand names and imagery. Use of cigarette cases is rare, suggesting that smokers eventually habituate to pictorial warnings on branded packs and/or find repeated decanting of each newly purchased branded pack into a case to be inconvenient. [ABSTRACT FROM AUTHOR]

Aims: The portrayal of alcohol in the news media, including newspapers, plays an important role in influencing societal norms and setting public agendas. We present the first large-scale examination of news coverage of alcohol-related issues in Australian newspapers. Method: Content analysis was performed on a sample of alcohol-related newspaper articles (n = 4217) published across Australia from 2000 to 2011. Articles were coded for type, theme, prominence, topic slant, opinion slant and sources/spokesperson. Results: Across the period, the most common themes were promotion (21%), drink-driving (16%) and restrictions/policy (16%). Themes of restrictions/policy and responsible beverage services became more common over time. Promotion and business-related articles significantly declined over time. Overall, the topic slant of the majority of news related articles disapproved of alcohol use. Disapproval increased over time while approval of alcohol use decreased. While the slant of opinion pieces was predominantly approving of alcohol, this decreased over time. Presence of an alcohol industry representative in articles declined over time. Conclusion: The presentation of alcohol use in Australian newspapers became more disapproving over time, which may suggest that harmful alcohol use has become less acceptable among the broader Australian community. [ABSTRACT FROM AUTHOR]

Aims: The portrayal of alcohol in the news media, including newspapers, plays an important role in influencing societal norms and setting public agendas. We present the first large-scale examination of news coverage of alcohol-related issues in Australian newspapers. Method: Content analysis was performed on a sample of alcohol-related newspaper articles (n = 4217) published across Australia from 2000 to 2011. Articles were coded for type, theme, prominence, topic slant, opinion slant and sources/spokesperson. Results: Across the period, the most common themes were promotion (21%), drink-driving (16%) and restrictions/policy (16%). Themes of restrictions/policy and responsible beverage services became more common over time. Promotion and business-related articles significantly declined over time. Overall, the topic slant of the majority of news related articles disapproved of alcohol use. Disapproval increased over time while approval of alcohol use decreased. While the slant of opinion pieces was predominantly approving of alcohol, this decreased over time. Presence of an alcohol industry representative in articles declined over time. Conclusion: The presentation of alcohol use in Australian newspapers became more disapproving over time, which may suggest that harmful alcohol use has become less acceptable among the broader Australian community. [ABSTRACT FROM PUBLISHER]

Aims We tested whether prevalence of cigarette pack display and smoking at outdoor venues and pack orientation changed following the introduction of plain packaging and larger pictorial health warnings in Australia. Methods Between October and April 2011-12 (pre-plain packaging, pre- PP) and 2012-13 (post-plain packaging, post- PP), we counted patrons, smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack type (fully branded, plain or unknown) and orientation were noted. Rates of pack display, smoking and pack orientation were analysed using multi-level Poisson regression. Results Pack display declined by 15% [adjusted incident rate ratio ( IRR) = 0.85, 95% confidence interval ( CI) = 0.79-0.91, P < 0.001], driven by a 23% decline in active smoking ( IRR = 0.77, 95% CI = 0.71-0.84, P < 0.001) between phases. The decline in pack display coincided with the full implementation of plain packaging from December 2012, was stronger in venues with children present and was limited to mid and high socio-economic status ( SES) areas. The proportion of packs orientated face-up declined from 85.4% of fully branded packs pre- PP to 73.6% of plain packs post- PP ( IRR = 0.87, 95% CI = 0.79-0.95, P = 0.002). Alternatively, the proportions concealed by telephones, wallets or other items (4.4% of fully branded packs pre- PP and 9.5% of plain packs post- PP; IRR = 2.33, 95% CI = 1.72-3.17, P < 0.001) and in an external case (1.5-3.5% of all packs; IRR = 2.79, 95% CI = 1.77-4.40, P < 0.001) increased. Low SES areas evidenced the greatest increase in pack concealment and the greatest decline in face-up pack orientation. Conclusions Following Australia's 2012 policy of plain packaging and larger pictorial health warnings on cigarette and tobacco packs, smoking in outdoor areas of cafés, restaurants and bars and personal pack display (packs clearly visible on tables) declined. Further, a small proportion of smokers took steps to conceal packs that would otherwise be visible. Both are promising outcomes to minimize exposure to tobacco promotion. [ABSTRACT FROM AUTHOR]

Aims We tested whether prevalence of cigarette pack display and smoking at outdoor venues and pack orientation changed following the introduction of plain packaging and larger pictorial health warnings in Australia. Methods Between October and April 2011-12 (pre-plain packaging, pre- PP) and 2012-13 (post-plain packaging, post- PP), we counted patrons, smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack type (fully branded, plain or unknown) and orientation were noted. Rates of pack display, smoking and pack orientation were analysed using multi-level Poisson regression. Results Pack display declined by 15% [adjusted incident rate ratio ( IRR) = 0.85, 95% confidence interval ( CI) = 0.79-0.91, P < 0.001], driven by a 23% decline in active smoking ( IRR = 0.77, 95% CI = 0.71-0.84, P < 0.001) between phases. The decline in pack display coincided with the full implementation of plain packaging from December 2012, was stronger in venues with children present and was limited to mid and high socio-economic status ( SES) areas. The proportion of packs orientated face-up declined from 85.4% of fully branded packs pre- PP to 73.6% of plain packs post- PP ( IRR = 0.87, 95% CI = 0.79-0.95, P = 0.002). Alternatively, the proportions concealed by telephones, wallets or other items (4.4% of fully branded packs pre- PP and 9.5% of plain packs post- PP; IRR = 2.33, 95% CI = 1.72-3.17, P < 0.001) and in an external case (1.5-3.5% of all packs; IRR = 2.79, 95% CI = 1.77-4.40, P < 0.001) increased. Low SES areas evidenced the greatest increase in pack concealment and the greatest decline in face-up pack orientation. Conclusions Following Australia's 2012 policy of plain packaging and larger pictorial health warnings on cigarette and tobacco packs, smoking in outdoor areas of cafés, restaurants and bars and personal pack display (packs clearly visible on tables) declined. Further, a small proportion of smokers took steps to conceal packs that would otherwise be visible. Both are promising outcomes to minimize exposure to tobacco promotion. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to test the potential impact of plain packaging for cigarettes on brand appeal among highly socioeconomically disadvantaged smokers using the new design for cigarettes implemented in Australia, which combines plain packaging with larger health warning labels. Design: A 2x2 factorial design trial embedded within a cross-sectional computer touchscreen survey. Data were collected between March and December 2012. Setting: Socially disadvantaged welfare aid recipients were recruited through a large Social and Community Service Organisation in New South Wales, Australia. Participants: N=354 smokers. The majority of the sample had not completed high school (64%), earned less than $A300/week (55%) and received their income from Government payments (95%). Interventions: Participants were randomised to one of the four different pack conditions determined by brand name: Winfield versus Benson & Hedges, and packaging type: branded versus plain. Participants were required to rate their assigned pack on measures of brand appeal and purchase intentions. Results: Plain packaging was associated with significantly reduced smoker ratings of 'positive pack characteristics' (p<0.001), 'positive smoker characteristics' (p=0.003) and 'positive taste characteristics' (p=0.033) in the Winfield brand name condition only. Across the four pack conditions, no main differences were found for 'negative smoker characteristics' (p=0.427) or 'negative harm characteristics' (p=0.411). In comparison to plain packaging, the presentation of branded packaging was associated with higher odds of smokers' purchase intentions (OR=2.18, 95% CI 1.34 to 3.54; p=0.002). Conclusions: Plain packs stripped of branding elements, featuring larger health warning labels, were associated with reduced positive cigarette brand image and purchase intentions among highly socioeconomically disadvantaged smokers. [ABSTRACT FROM AUTHOR]

Objective: To determine whether smokers smoking from packs required under Australia's plain packaging law had different smoking beliefs and quitting thoughts, compared with those still smoking from branded packs. Design: Cross-sectional survey during the roll-out phase of the law, analysed by timing of survey. Setting: Australian state of Victoria, November 2012. Participants: 536 cigarette smokers with a usual brand, of whom 72.3% were smoking from a plain pack and 27.7% were smoking from a branded pack. Primary outcome measures: Perceived quality and satisfaction of cigarettes compared with 1 year ago, frequency of thoughts of smoking harm, perceived exaggeration of harms, frequency of thoughts of quitting, quitting priority in life, intention to quit, approval of large graphic health warnings and plain packaging. Results: Compared with branded pack smokers, those smoking from plain packs perceived their cigarettes to be lower in quality (adjusted OR (AdjOR)=1.66, p=0.045), tended to perceive their cigarettes as less satisfying than a year ago (AdjOR=1.70, p=0.052), were more likely to have thought about quitting at least once a day in the past week (AdjOR=1.81, p=0.013) and to rate quitting as a higher priority in their lives (F=13.11, df=1, p<0.001). Plain pack smokers were more likely to support the policy than branded pack smokers (AdjOR=1.51, p=0.049). Branded and plain pack smokers did not differ on measures of less immediate smoking intentions, frequency of thoughts about harms or perceived exaggeration of harms. Appeal outcomes, but not other outcomes, were sensitive to the extent of roll-out, with responses from branded pack smokers approaching those of plain pack smokers, once 80% of survey respondents were smoking from plain packs 1-2 weeks before the December implementation date. Conclusions: The early indication is that plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers. [ABSTRACT FROM AUTHOR]

Introduction: Communicating the health risks of smoking remains a primary objective of tobacco-control policy. Articles 11 and 12 of the World Health Organization’s Framework Convention on Tobacco Control establish standards for two important forms of communication: packaging regulations (Article 11), and mass media campaigns (Article 12). Methods: A narrative review approach was used to identify existing evidence in the areas of package labeling regulations (including health warnings, constituent and emission messages, and prohibitions on misleading information) and communication activities (including mass media campaigns and news media coverage). When available, recent reviews of the literature were used, updated with more recent high-quality studies from published literature. Results: Implementation of Articles 11 and 12 share several important research priorities: (a) identify existing consumer information needs and gaps, (b) research on the message source to identify effective types of content for health warnings and media campaigns, (c) research on how messages are processed and the extent to which the content and form of messages need to be tailored to different cultural and geographic groups, as well as subgroups within countries, and (d) research to identify the most cost-effective mix and best practices for sustaining health communications over time. Conclusion: A unifying theme of effective health communication through tobacco packaging and mass media campaigns is the need to provide salient, timely, and engaging reminders of the consequences of tobacco use in ways that motivate and support tobacco users trying to quit and make tobacco use less appealing for those at risk of taking it up. [ABSTRACT FROM AUTHOR]

Objective: To determine whether greater mass media campaign exposure may assist recent quitters to avoid relapse. Method: Using date of data collection and postcode, media market estimates of televised tobacco-control advertising exposure measured by gross ratings points (GRPs) were merged with a replenished cohort study of 443 Australians who had quit in the past year. Participants’ demographic and smoking characteristics prior to quitting, and advertising exposure in the period after quitting, were used to predict relapse 1 year later. Results: In multivariate analysis, each increase in exposure of 100 GRPs (i.e., 1 anti-smoking advertisement) in the three-month period after the baseline quit was associated with a 5% increase in the odds of not smoking at follow-up (OR = 1.05, 95% CI 1.02–1.07, p < 0.001). This relationship was linear and unmodified by length of time quit prior to the baseline interview. At the mean value of 1081 GRPs in the 3 months after the baseline-quit interview, the predicted probability of being quit at follow-up was 52%, whereas it was 41% for the minimum (0) and 74% for the maximum (3,541) GRPs. Conclusion: Greater exposure to tobacco-control mass media campaigns may reduce the likelihood of relapse among recent quitters. [ABSTRACT FROM AUTHOR]