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Background: To address concerns that healthy weight and lifestyle campaigns (HWLCs) could have unintended psychological or behavioral consequences, this study tested reactions to TV advertisements from two HWLCs: LiveLighter ® (employs graphic health effects messaging) and Swap It Don't Stop It (employs animation and light-hearted messaging)., Methods: An online between-subjects experiment tested reactions to one of five advertisements: "Toxic Fat"; "Sugary Drinks" (both from LiveLighter ); "Become a Swapper"; "How to Swap It" (both from Swap It ); and "HSBC Bank" (control) among 2,208 adults from Western Australia and Victoria, Australia. Responses assessed were cognitive and emotional reactions, behavioral intentions, internalized weight bias, antifat attitudes, self-esteem and body dissatisfaction., Results: The HWLC advertisements prompted favorable cognitive reactions and weak to neutral positive and negative emotional responses. HWLC advertisements promoted stronger intentions to engage in adaptive lifestyle behaviors compared with the control advertisement. Intention to engage in maladaptive behaviors (e.g., skipping meals) was low overall and did not differ by condition. Compared with the control condition, participants who saw LiveLighter "Sugary Drinks" showed weaker disagreement with antifat attitudes; however, mean antifat attitude scores were still at the low end of the scale. HWLC advertisements did not promote internalized weight bias, reduced self-esteem or body dissatisfaction compared with the control advertisement., Conclusions: Overall, HWLC advertisements performed favorably compared with the control advertisement and showed no clear evidence of adverse impacts. Findings suggest HWLC advertisements may not promote negative psychological and behavioral consequences and can continue to be used in obesity prevention efforts.

The LiveLighter® 2016 'Junk Food' campaign ran for 5 weeks in Western Australia (WA) and urged adults to reduce their junk food consumption to avoid weight gain and associated chronic disease. A cohort design assessed campaign impact on knowledge, beliefs and behaviour. Pre-campaign (n = 1501) and post-campaign (n = 737) telephone surveys of WA adults aged 25-49 were undertaken. A post-campaign-only sample (n = 501) controlled for pre-test effects. The campaign reached 57% of respondents and increased knowledge of the link between overweight and non-alcoholic fatty liver disease (78% cf. 87%; P < 0.01). Following campaign activity, respondents were more likely to avoid purchasing food from settings depicted in the advertisements (fast food outlets: 63% cf. 77%; service stations: 82% cf. 93%; vending machines: 87% cf. 96%; all P < 0.001), particularly among pre-campaign consumers of fast food and salty snacks (≤2 times/week). Weight-loss self-efficacy increased among adults with higher body weight and campaign exposure (89% cf. 97%; P < 0.01), and there was no increased endorsement of overweight stereotypes among the full sample. Support for fiscal disincentives and nutritional disclosure policies increased among healthy weight adults. LiveLighter® positively influenced knowledge, beliefs and behaviours, along with attitudes towards policies to encourage healthy eating, supporting LiveLighter® as an advocacy campaign., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Issue Addressed: The LiveLighter ® healthy weight and lifestyle social marketing campaign, developed in Western Australia, employs graphic advertising to communicate negative health effects of overweight and motivate behaviour change. This study extends prior evidence of the effectiveness of the LiveLighter ® campaign by evaluating its implementation in a new jurisdiction., Methods: A controlled cohort design was employed in intervention (Vic) and comparison states (SA), with and without campaign exposure. Population surveys conducted at baseline (BL) (n = 1000 each state), had 75% retention at follow-up (FU) (Vic: n = 715; SA: n = 787)., Results: Total campaign awareness was moderate (61.5%). Exposed respondents indicated the campaign was "believable" (91.0%), made a strong argument for reducing weight (87.3%), made them "stop and think" (70.1%), motivated action to reach/stay a healthy weight (59.1%) and was "relevant" (55.6%). The proportion of respondents indicating "toxic fat build up" was a health consequence of overweight increased significantly from BL to FU in Vic and to a lesser extent in SA (Vic:55.7% vs 75.9%; SA:58.1% vs 62.6%, interaction P < .001). The proportion indicating cancer is a health consequence of overweight increased significantly from BL to FU in Vic, but not in SA (Vic:77.1% vs 83.4%; SA:77.8% vs 78.1%, interaction P < .05)., Conclusions: This study extends the evidence base for the LiveLighter ® campaign. Sustained campaign activity with clear behavioural recommendations is required to translate improved knowledge into behaviour change., So What: Evidence-based mass media campaigns can positively impact health behaviours to address the unsustainable increasing burdens of unhealthy weight, dietary risk and inadequate physical activity. A National Obesity Campaign is needed and LiveLighter ® is a ready-made, relevant Australian resource., (© 2020 Australian Health Promotion Association.)

Point-of-sale (POS) interventions that prompt consumers to more critically evaluate sugary drinks could encourage reduced consumption of these drinks and reinforce public health campaign messages. This study tested whether: (i) POS nutrition information and health warnings about sugary drinks promote healthier drink choices and (ii) impacts of prominent POS signs on drink choices vary based on participants' self-reported prior exposure to a sugary drink public health campaign. In an online experiment, 3034 Australian adults aged 18-59 years who were past-week sugary drink consumers were randomly assigned to one of five POS signage conditions (no signage (control); sugar content of specific beverages; Health Star Rating of specific beverages; generic text health warning about sugary drinks; generic graphic health warning about sugary drinks) and shown their randomly assigned POS sign alone, then alongside a drinks product display and asked to select which drink they would choose to buy. The proportion selecting a sugary drink was significantly lower among participants who viewed either the sugar content (29%), Health Star Rating (33%) or graphic health warning (34%) signs compared to those who saw no sign (43%). These effects held for participants who did not recall previously seeing the campaign; however, for participants with self-reported prior exposure to the campaign, POS signs did not promote significant reductions in sugary drink choices. POS signage has the potential to shift consumers away from choosing sugary drinks and could complement mass media campaigns by reaching people who may not otherwise be exposed to sugary drink public health messages., Competing Interests: Declaration of competing interest All authors are currently employed by an organisation involved in public health research and advocacy., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

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.

Issue Addressed: Evaluation of the behavioural impact of Western Australia's LiveLighter healthy weight and lifestyle campaign focussed on decreasing consumption of sugar-sweetened beverages (SSBs) using graphic imagery, as well as monitoring unintended consequences., Methods: A cohort design with pre-campaign telephone survey of Western Australian adults aged 25-49 (Time 1 May/Jun 2013: N = 1504) undertaken and repeated following the campaign (Time 2 Aug/Sep 2013: N = 822)., Results: Post-campaign awareness was 67% with respondents in low socio-economic areas most likely to report viewing the campaign frequently. There was evidence of reduced SSB intake from baseline to follow-up among frequent (4+/week) SSB consumers (22% cf. 16%; P = 0.003) and some evidence among overweight (BMI 25+) weekly SSB consumers (56% cf. 48%; P = 0.013). There was also some evidence consumption of sweet food decreased (3+/week: 53% cf. 48%; P = 0.035) while fruit, vegetable and fast food consumption remained stable. Knowledge of potential health consequences of SSBs increased (70% cf. 82%; P < 0.001) with no change in knowledge of potential health consequences of overweight generally (86% cf. 89%). Importantly, there was no increase in endorsement of overweight stereotypes., Conclusions: The LiveLighter "Sugary Drinks" campaign positively impacted adults' knowledge and behaviour with regard to SSB consumption in a pattern specific to the campaign messaging and without adverse impact on weight-related stereotypes. SO WHAT?: Findings support the use of mass media for healthy lifestyle change. They suggest the public are receptive to undertaking the campaign's simple concrete lifestyle recommendation and provide an indication of the campaign dose required to achieve positive behaviour change., (© 2019 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Ltd on behalf of Australian Health Promotion Association.)

Issue Addressed: The reach and impact of the LiveLighter and Aboriginal sugar-sweetened beverage (SSB) advertisements among Aboriginal and Torres Strait Islander adults., Methods: The Aboriginal SSB advertisement launched online in January 2015 and aired on NITV in October/November 2015 as part of the Government-funded LiveLighter campaign. The advertisement was developed in Victoria and featured members of the Victorian Aboriginal community. Another LiveLighter advertisement targeting the general population was broadcast over the same period. Online surveys were completed by 150 Aboriginal and/or Torres Strait Islander adults in November/December 2015., Results: Around half of respondents reported seeing either the Aboriginal (47%) or the LiveLighter (56%) SSB advertisement, and the proportion was significantly greater in Victoria (Aboriginal: 60%, LiveLighter: 66%) than other states/territories (Aboriginal: 29%, LiveLighter: 43%). Compared to the LiveLighter advertisement, the Aboriginal campaign was seen to be more believable, to be more relevant and to have an important message for the Aboriginal community (P < 0.001). Participants from Victoria were significantly more likely to identify the sugar content of regular soft drink, compared with those from other states/territories (68% vs 40%, P < 0.001). Sixty per cent of participants who had seen the Aboriginal SSB advertisement reported they drank less SSBs compared with 48% of those not exposed, though the difference was not statistically significant (P > 0.05)., Conclusions: Results suggest the Aboriginal advertisement resonated with Aboriginal and Torres Strait Islander people and impacted knowledge about the sugar content of SSBs, particularly in Victoria where the campaign originated. SO WHAT?: This study highlights the importance of Aboriginal and Torres Strait Islander-led health promotion campaigns and tailoring health messages to the local Aboriginal and/or Torres Strait Islander community., (© 2018 Australian Health Promotion Association.)

Objective: High rates of population obesity have resulted in the dissemination of mass media campaigns that focus on achieving and maintaining a healthy weight. The aim of the present study was to analyse advertising techniques used in such campaigns to identify common and differential approaches in three countries with similar cultures and rates of obesity (Australia, the United Kingdom and the United States)., Methods: An Internet search was conducted to identify healthy weight television advertisements aired in the three countries. Seventy-two advertisements were located and coded according to the advertising techniques employed., Results: Despite the cultural similarity and comparable obesity rates of the three countries, there were few consistencies in advertising techniques employed. A main focus of the ads was diet, but disparate approaches were used to convey the message in each country., Conclusions: The identified wide variation in advertising techniques may suggest that campaign managers would benefit from greater certainty about which advertising approaches are most effective in encouraging lifestyle behaviours associated with a healthy weight. Implications for public health: A more robust evidence base would be useful to guide the development of healthy weight campaigns., (© 2017 The Authors.)

Issue Addressed: The study was designed to determine public acceptability of various forms of regulation to support a healthy eating environment., Methods: Telephone interviews were undertaken in June-July 2010 with a random sample of adults in Australia who were the main grocery buyer for their household., Results: Data were analysed for 1,511 adults. A clear majority of participants (80% or more) were in favour of traffic light and kilojoule menu labelling, reformulation to reduce the fat, salt and sugar content of processed foods, and regulation of broadcast and non-broadcast avenues used to market unhealthy food and drinks to children. Relatively less support (two-thirds or more), particularly among lower socioeconomic status participants, was shown for taxation policies and controls on food company sponsorship of sports and education programs. Despite the survey's focus on food marketing avenues and methods directed at children, for the most part non-parents were just as likely as parents to support restrictions., Conclusions: Overall, these findings indicate that there is strong public support for the introduction of policy initiatives aimed at creating a healthier food environment.

Background: To address concerns that healthy weight and lifestyle campaigns (HWLCs) could have unintended psychological or behavioral consequences, this study tested reactions to TV advertisements from two HWLCs--"LiveLighter"® (employs graphic health effects messaging) and "Swap It Don't Stop It" (employs animation and light-hearted messaging). Methods: An online between-subjects experiment tested reactions to one of five advertisements: "Toxic Fat"; "Sugary Drinks" (both from "LiveLighter"); "Become a Swapper"; "How to Swap It" (both from "Swap It"); and "HSBC Bank" (control) among 2,208 adults from Western Australia and Victoria, Australia. Responses assessed were cognitive and emotional reactions, behavioral intentions, internalized weight bias, antifat attitudes, self-esteem and body dissatisfaction. Results: The HWLC advertisements prompted favorable cognitive reactions and weak to neutral positive and negative emotional responses. HWLC advertisements promoted stronger intentions to engage in adaptive lifestyle behaviors compared with the control advertisement. Intention to engage in maladaptive behaviors (e.g., skipping meals) was low overall and did not differ by condition. Compared with the control condition, participants who saw "LiveLighter" "Sugary Drinks" showed weaker disagreement with antifat attitudes; however, mean antifat attitude scores were still at the low end of the scale. HWLC advertisements did not promote internalized weight bias, reduced self-esteem or body dissatisfaction compared with the control advertisement. Conclusions: Overall, HWLC advertisements performed favorably compared with the control advertisement and showed no clear evidence of adverse impacts. Findings suggest HWLC advertisements may not promote negative psychological and behavioral consequences and can continue to be used in obesity prevention efforts.

The LiveLighter® 2016 'Junk Food' campaign ran for 5 weeks in Western Australia (WA) and urged adults to reduce their junk food consumption to avoid weight gain and associated chronic disease. A cohort design assessed campaign impact on knowledge, beliefs and behaviour. Pre-campaign (n = 1501) and post-campaign (n = 737) telephone surveys of WA adults aged 25-49 were undertaken. A post-campaign-only sample (n = 501) controlled for pre-test effects. The campaign reached 57% of respondents and increased knowledge of the link between overweight and non-alcoholic fatty liver disease (78% cf. 87%; P < 0.01). Following campaign activity, respondents were more likely to avoid purchasing food from settings depicted in the advertisements (fast food outlets: 63% cf. 77%; service stations: 82% cf. 93%; vending machines: 87% cf. 96%; all P < 0.001), particularly among pre-campaign consumers of fast food and salty snacks ([less than or equal to]2 times/week). Weight-loss self-efficacy increased among adults with higher body weight and campaign exposure (89% cf. 97%; P < 0.01), and there was no increased endorsement of overweight stereotypes among the full sample. Support for fiscal disincentives and nutritional disclosure policies increased among healthy weight adults. LiveLighter® positively influenced knowledge, beliefs and behaviours, along with attitudes towards policies to encourage healthy eating, supporting LiveLighter® as an advocacy campaign.

Summary: Background: Policy makers benefit from insight into consumer perceptions of potential sugary drink policy measures. Adolescents are among the highest consumers in Australia, yet their perceptions are unknown. Objectives: To determine adolescents' perceptions of potential policies aimed at reducing sugary drink consumption and explore variation in perceptions. Methods: Data were collected via a nationally representative survey of Australian secondary school students (aged 12‐17) using a stratified two‐stage probability design (n = 9102). Survey questions assessed receptiveness to five policy options, sugary drink consumption, perceptions of health effects and demographics. Results: Low proportions (13%‐29%) were somewhat/strongly against policy options, 35% to 45% were neutral, and 27% to 52% were somewhat/strongly in favour. Highest support was observed for text warning labels on sugary drinks (52%), followed by tax with investment in healthy weight programmes (43%), standalone tax (36%), restricting school sales (30%) and restricting advertising to children (27%). Sex, sugary drink consumption and perceptions were significantly associated with most assessed policy options in bivariate analyses (P <.01). Significant associations between sex and consumption with selected policy options persisted in adjusted multilevel models. Conclusions: Opposition towards policy options was low overall and neutrality was common. This creates opportunity for early intervention to increase public support for addressing specific health issues. [ABSTRACT FROM AUTHOR]

The consumption of vegetables and fruit during adolescence is crucial to ensuring adequate intake of the nutrients required to meet the rapid growth that characterises this developmental period. However, significant reductions in vegetable and fruit intake during adolescence have been observed making the promotion of consumption an important health promotion challenge. To monitor progress in this population segment toward meeting recommended intake levels and identifying at-risk groups, the present study assessed changes in Australian adolescents' vegetable and fruit consumption over time and identified the demographic factors associated with meeting recommendations. As individuals who are aware of their diet deficiencies are likely to be more receptive to healthy eating interventions, the present study also assessed adolescents' perceptions of the adequacy of their vegetable and fruit intake and identified the demographic factors associated with correctly perceiving fruit and vegetable intake to be inadequate. Two cross-sectional samples of Western Australian secondary school students aged 12-17 years were surveyed in 2009-2010 (n = 1501) and 2012-2013 (n = 1406). Only 14% of students at Wave 1 and 13% at Wave 2 met the recommended guidelines for vegetable intake while 68% and 71% met the guidelines for fruit intake. Females had significantly greater odds of failing to meet guidelines for vegetable intake than males. Only 50% of students correctly identified their vegetable and fruit intake to be inadequate. The observed very low levels of compliance with vegetable intake recommendations suggest that addressing deficiencies in vegetable consumption should be a primary focus of future nutrition interventions. Efforts should also be made to increase adolescents' perceptions of the inadequacy of their intake to optimise the effectiveness of schemes designed to improve vegetable and fruit consumption in this population segment. [ABSTRACT FROM AUTHOR]