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Objective: This study aimed to explore factors influencing community service organisation (CSO) staff members’ willingness to provide tobacco cessation support to clients experiencing disadvantage. Methods: Face‐to‐face semi‐structured interviews were conducted with 29 staff members from seven services in the alcohol and other drugs, homelessness, and mental health sectors in Western Australia. Results: The primary barriers to providing cessation support were believing that addressing smoking was not a priority relative to other issues, being a current smoker, and the lack of a formal tobacco cessation program within the organisation. Factors that appeared to be most influential in enabling the delivery of cessation support were organisational processes requiring staff to routinely ask clients about tobacco use, confidence to provide support, and being a past smoker. Conclusions: The introduction of organisational procedures that include routine cessation care should be of high priority in CSOs to help reduce smoking rates among clients. Staff may also benefit from receiving training in the provision of cessation support and education about the importance and feasibility of addressing smoking concurrently with other issues. Implications for public health: The results may inform future efforts to increase the delivery of cessation care to groups of people experiencing disadvantage and comorbidity.

Objective: Several studies have examined the characteristics of anti‐smoking advertisements that are associated with quitting behaviour. Some studies use researchers or graduate students to code advertisement characteristics, while others recruit smokers or members of the general public. The aim of this study was to assist future campaign development by assessing whether anti‐smoking advertisement characteristics are coded differently by smokers and ‘experts’ (individuals with knowledge of health promotion, public health or advertising). Methods: A total of 49 smokers and 42 experts coded anti‐smoking advertisements according to four key characteristics (emotional/cognitive approach, negative/positive tone, message frame, and main message) and the use of eight executional techniques. Chi‐squared tests were used to measure differences in coding outcomes between smokers and experts. Results: There were significant differences between smokers and experts in the coding of all key characteristics and four of the eight executional techniques. Compared with smokers, experts were more likely to perceive advertisements as negative in tone and as inducing fear. Conclusions: Smokers and experts perceived the characteristics of anti‐smoking advertisements differently. Implications for public health: Differences between smokers and experts may need to be taken into account where studies use either of these groups to code advertisements for campaign development or evaluation purposes.

Introduction and aims A growing body of evidence suggests e-cigarette use increases the risk of conventional cigarette use. Assessing the factors associated with intentions to use e-cigarettes can inform programs designed to minimise uptake, potentially assisting in preventing a new population of smokers. This study developed and tested a model assessing the importance of various factors that may be associated with intentions to use e-cigarettes among young adults who have never used e-cigarettes or tobacco cigarettes. Design and methods A web-panel provider recruited 429 Australian 18- to 25-year-olds who had never used e-cigarettes or smoked tobacco cigarettes (56% female, mean age = 21.17 years). Various individual and social factors were assessed as potential direct and indirect predictors of e-cigarette use intentions. Results The developed model provided an excellent fit to the data and accounted for 49% of the variance in use intentions. Males had greater intentions to use e-cigarettes compared to females (β = -0.13). Having a greater number of friends who smoke tobacco cigarettes (β = 0.11) and curiosity about e-cigarette use (β = 0.58) were also directly associated with greater use intentions. Positive expectancies about e-cigarettes (β = 0.14), having family members who use e-cigarettes (β = 0.11), and having friends who smoke tobacco cigarettes (β = 0.07) were indirectly associated with intentions via curiosity. Discussion and conclusions Curiosity about e-cigarette use was strongly associated with use intentions. Aspects of the social environment were also important. Further research is needed to identify effective means of challenging positive e-cigarette expectancies given these were found to be strongly associated with intentions via curiosity.

Introduction and aims Despite substantial reductions in smoking prevalence in many countries, rates remain high among people who are experiencing disadvantage. This study aimed to explore attitudinal and behavioural responses to population-wide tobacco control policies among Australian smokers experiencing disadvantage. Design and methods Semi-structured qualitative interviews were conducted with 84 smokers attending community service organisations in the mental health, homelessness, and alcohol and other drug sectors. Interviewees discussed various tobacco control policies (tobacco taxes, smoke-free areas, plain packaging and graphic health warnings). The interview transcriptions were coded and thematically analysed. Results Responses to tobacco taxes were mixed. Some interviewees reported smoking less as a result of price increases, while others reallocated funds from other budget areas. Many perceived smoke-free area policies as effective, although some described strategies they use to circumvent this policy, thereby diminishing its effectiveness. Plain packaging and graphic warnings were perceived as being least effective. Discussion and conclusions While tobacco control policies can elicit intended attitudinal and behavioural responses, additional efforts are needed to enhance their effectiveness among smokers experiencing disadvantage. Future efforts to reduce smoking rates should address responses that diminish policy effectiveness among groups exhibiting high smoking prevalence. This could be achieved through strategies that address the specific needs of these groups, such as providing additional cessation support, enforcing existing smoke-free policies in ways that minimise inequitable effects, and addressing self-exempting beliefs.

Informing drinkers of the health risks associated with alcohol consumption via warning statements located on alcohol products can increase their capacity to make healthier choices. This study assessed whether exposing at-risk drinkers to warning statements relating to specific chronic diseases increases the extent to which alcohol is believed to be a risk factor for those diseases and influences consumption intentions. Australians drinking at levels associated with long-term risk of harm (n = 364; 72% male) completed an online survey assessing their drinking habits, beliefs in the link between alcohol and various diseases and drinking intentions. Respondents were then exposed to one of five statements advising of the potential risks associated with alcohol consumption (either cancer, liver damage, diabetes, mental illness or heart disease). Beliefs and drinking intentions were reassessed. Significant increases in the extent to which alcohol was believed to be a risk factor for diabetes, heart disease, mental illness and cancer were found. With the exception of the liver damage and heart disease statements, exposure to each statement was associated with a significant reduction in consumption intentions. Warning statements advising of the specific chronic diseases associated with alcohol consumption can produce favourable changes in drinking intentions among at-risk drinkers.

Adolescence is a critical time for disengagement from physical activity making young people a priority group for interventions. To determine whether existing initiatives are working in this population segment and help inform future programs, the present study sought to (i) examine prevalences and trends in physical activity and screen-based recreation among Australian adolescents and (ii) identify the barriers to adolescents meeting recommended guidelines. Two cross-sectional representative samples of Western Australian secondary school students aged 12 to 17years were surveyed in 2009-2010 (n=1505) and 2012-2013 (n=1406). Around a quarter (24%) of boys and just 9% of girls reported engaging in the recommended 60min of physical activity per day in 2012-2013. A minority (13% of boys, 17% of girls) adhered to guidelines for time spent engaging in screen-based recreation (≤2h of electronic media use for entertainment). These findings were comparable to 2009-2010 prevalence levels. Multivariable logistic regression analyses conducted on data from the most recent wave found individual-level barriers to be significantly associated with lower odds of meeting physical activity guidelines in both boys (Adj. OR=0.52, 95% CI=0.38, 0.72) and girls (Adj. OR=0.41, 95% CI=0.25, 0.66). The consistently high proportion of adolescents not meeting physical activity recommendations over time suggests that current efforts to increase physical activity may be failing to have an impact on population-level trends in compliance. While initiatives to improve the built environment may reduce barriers at the environmental level, these initiatives risk having little impact on physical activity if individual level barriers remain unaddressed.

Objective: To assess preferences for e‐cigarettes containing nicotine and flavourings among Australian young adult e‐cigarette users. Methods: An online survey was administered to 1,116 young adults (18–25 years), 104 of whom had used an e‐cigarette in the last 30 days and were the focus of this study. Among users, 53% also smoked tobacco cigarettes, 27% were non‐smokers and 20% had never smoked. Results: Nearly two‐thirds (64%) of e‐cigarette users preferred nicotine‐containing e‐cigarettes (71% of smokers, 56% of non‐smokers, 55% of never smokers). The vast majority (89%) preferred flavoured e‐cigarettes (92% of smokers, 82% of non‐smokers, 95% of never smokers), with fruit flavours the most popular. Conclusions: E‐cigarettes containing nicotine and flavourings were popular among users of these devices in this sample of young adults. Implications for public health: Previous research has documented potential harms associated with e‐liquid additives, flavourings, and nicotine. The present results showing strong preferences for nicotine and flavourings among the sampled e‐cigarette users suggest that: i) flavourings in e‐liquids should be regulated; and ii) existing prohibitions on the unauthorised supply of liquid nicotine should be better enforced. Population‐wide monitoring of the use of e‐cigarettes with different product characteristics is also warranted.

Background Recall bias is a potential source of misclassification in case-control studies. Studies have shown that the association between exposure and disease can differ according to participants’ beliefs or knowledge about the effect of that exposure on disease. We investigated the association between belief about breast cancer causation and self-reported shift work exposure in a case-control study. Methods Women completed a questionnaire asking whether they believed that shift work caused cancer either before or after reporting their history of shift work. We measured: whether belief modified the association between reported shift work and disease; whether belief was associated with reported shift work exposure; and whether being prompted to recall shift work exposure was associated with an increased likelihood of believing that shift work increased breast cancer risk. Results There was a significant association between believing shift work increased breast cancer risk and reporting exposure to shift work. Being prompted to recall shift work was not associated with a belief that shift work increased risk. Conclusion The association between pre-existing belief about breast cancer risk and reported shift work is likely to be due to exposed individuals believing that exposure increases risk, rather than resulting from recall bias.

Introduction and Aims Efforts to reduce excessive alcohol consumption need to take into account drinkers' perceptions of their risk of alcohol-related harm. The aim of the present study was to profile adult Australian drinkers according to their self-identification with various drinker prototypes to determine the extent to which these prototypes are associated with perceived and actual risk of alcohol-related harm. Design and Methods A large web panel provider disseminated an online survey to a national sample of 2168 drinkers aged 18+ years who consumed alcohol at least twice per month. Respondents reported whether they considered themselves to be a light, occasional, social, heavy or binge drinker. The nominated category was compared with perceived and actual risk of alcohol-related harm. Results The prototype most commonly nominated by respondents was ‘social drinker’ (45%), and the least common was ‘binge drinker’ (7%). Although the heaviest drinkers in terms of actual reported consumption typically selected prototypes indicative of harmful consumption, many of those selecting prototypes indicative of moderate consumption were at risk of alcohol-related harm. Discussion and Conclusions Many adult drinkers may be unaware of their risk of alcohol-related harm. The results suggest that there may be a need to recalibrate Australian drinkers' perceptions of high-risk drinking. [Pettigrew S, Jongenelis MI, Pratt IS, Slevin T, Chikritzhs T. Drinkers' identification with varying alcohol consumption prototypes. Drug Alcohol Rev 2017;36:464-467]

Objective: Protecting the skin from ultraviolet (UV) radiation is critical during adolescence to reduce the risk of developing skin cancer later in life, but adolescents tend to be less likely to engage in sun-protective behaviours than adults. The present study examined changes and trends (2001/02–2011/12) in sun-protection behaviours among adolescents living in Western Australia – a region with high levels of UV radiation. Methods: A cross-sectional survey was conducted during 10 summers between 2001/02 and 2011/12 to investigate how often adolescents engaged in various sun-protection behaviours, including outdoor protective measures (wearing a hat, wearing protective clothing, using sunscreen, wearing sunglasses, seeking shade) and avoidance of UV radiation by staying inside. Results: Hat use significantly decreased between 2001/02 and 2011/12, whereas use of sunscreen and wearing covering clothes were unchanged in most survey years relative to 2001/02. Use of sunglasses peaked in 2006/07 and 2007/08, but returned to first survey year levels in 2011/12, while staying inside was more frequently reported from 2006/07 onwards. Conclusions: New approaches are needed to minimise reactance responses in adolescents while fostering favourable attitudes to sun protection. Implications and opportunities for interventions to promote better sun-protection practices among adolescents are provided.

While protective behavioral strategies (PBSs) have the potential to reduce alcohol-related harm, there is a lack of understanding of the factors influencing adults' use of these strategies. The present study assessed the frequency of enactment of a range of PBSs among Australian adults and identified factors associated with their use and the implications for alcohol harm minimization. A sample of 2,168 Australian drinkers (1,095 males and 1,073 females) recruited via a web panel provider completed an online survey that included items relating to quantity and frequency of alcohol consumption, beliefs about the health consequences of alcohol consumption, use of 5 specific PBSs (e.g., counting drinks and eating while drinking), and demographic characteristics. In general, use of these PBSs was negatively associated with overall alcohol consumption. However, usage rates were relatively low, especially among the heaviest drinkers. Refusing unwanted drinks and alternating between alcoholic and nonalcoholic beverages were identified as especially important strategies in the Australian context, accounting for a substantial proportion of the variance in alcohol consumption. Greater efforts to increase awareness and use of PBSs are warranted. In particular, the results suggest that information relating to the importance of refusing unwanted drinks and alternating between alcoholic and nonalcoholic beverages should be actively disseminated to the drinking public. In addition, the reliance on specified numbers of standard drinks in national drinking guidelines suggests encouraging drinkers to count their drinks should be a further focus of interventions given low reported prevalence of this behavior. (PsycINFO Database Record(c) 2016 APA, all rights reserved). Language: en

Objective: The purpose of this study was to investigate whether making fruit boxes available in the workplace is a successful health promotion strategy. Design: A quasi-experimental study involving three conditions – free fruit, 50c per piece of fruit and $1 per piece of fruit – to investigate the effect of a contribution scheme on employees’ fruit purchase/consumption behaviours and willingness to contribute when in the paid conditions. Setting: Perth, Western Australia. Methods: In total, 36 workplaces participated and were randomly assigned to one of the three conditions. The results were analysed using generalised linear modelling. A qualitative follow-up was conducted with workplace representatives 6 weeks after the completion of the trial to investigate how many workplaces implemented the provision of fruit boxes after the trial and the factors influencing the decision to implement fruit boxes. Results: A significant difference in average fruit purchasing/consumption per person was found with respect to condition ( p Conclusion: Having a fruit box may be a feasible health promotion strategy, and the financial burden of this strategy could be alleviated by asking employees to contribute to the cost of fruit.

Background: This study investigated Australian drinkers’ alcohol-related beliefs according to their alcohol risk status. The primary aims were to assess drinkers’ awareness of the association between alcohol consumption and a range of health consequences and their understanding of the degree of risk represented by their own alcohol consumption.Method: An online survey was administered to 2168 drinkers who consume alcohol at least twice per month. Respondents reported their alcohol intake levels and their beliefs relating to the relationship between alcohol and shorter-term (proximal) risks (e.g., drink-driving) and longer-term (distal) risks (e.g., stroke and cancer).Results: Just over half (52%) of those drinking at high or very high risk levels did not perceive their drinking to be harmful. A large majority (85%) of the sample was aware of various short-term risks of excessive alcohol consumption, but only half appeared aware of the association between alcohol consumption and more distal health ...

Issue addressed: Online surveys are becoming increasingly popular in health research because of the low cost and fast completion time. A large proportion of online survey costs are allocated to setup and administration expenses, which suggests that conducting fewer, longer surveys would be a cost-effective approach. The current study assessed whether the incorporation of a health campaign evaluation survey within a longitudinal attitudes and behaviours tracking survey produced different outcomes compared with the separate administration of the evaluation survey.Methods: Data were collected via an online panel, with 688 respondents completing the combined survey and 657 respondents completing the evaluation-only survey. Regression analyses were conducted to examine whether survey type was related to the campaign evaluation results.Results: Those who completed the combined survey perceived the campaign advertisement to be more personally relevant than those completing the evaluation-only survey. There were no differences in results relating to campaign awareness and reported behavioural change as a result of campaign exposure.Conclusions: There were minimal differences between results obtained from combining an attitude/behaviour tracking survey with a campaign evaluation survey. Any priming or order effects were limited to respondents' cognitive responses to the advertisement.So what?: The results suggest that health practitioners with limited resources available for tracking and evaluation research may be able to maximise outcomes by administering fewer, longer surveys.

Background A large proportion of health promotion campaign evaluation research has historically been conducted via telephone surveys. However, there are concerns about the continued viability of this form of surveying in providing relevant and representative data. Online surveys are an increasingly popular alternative, and as such there is a need to assess the comparability between data collected using the two different methods to determine the implications for longitudinal comparisons. The present study compared these survey modes in the context of health promotion evaluation research. Methods Data were collected via computer-assisted telephone interviewing and an online panel. In total, 688 and 606 respondents aged between 14 and 45 years completed the online and telephone surveys, respectively. Results Online respondents demonstrated higher awareness of the advertisement, rated the advertisement as more personally relevant and had better behavioural outcomes compared with the telephone respondents. Conclusion The results indicate significant differences between the telephone and online surveys on most measures used to assess the effectiveness of a health promotion advertising campaign. Health promotion practitioners could consider the combination of both methods to overcome the deterioration in telephone survey response rates and the likely differences in respondent outcomes.

The Western Australian (WA) ‘LiveLighter’ (LL) mass media campaign ran during June–August and September–October 2012. The principal campaign ad graphically depicts visceral fat of an overweight individual (‘why’ change message), whereas supporting ads demonstrate simple changes to increase activity and eat healthier (‘how’ to change message). Cross-sectional surveys among population samples aged 25–49 were undertaken pre-campaign (N = 2012) and following the two media waves (N = 2005 and N = 2009) in the intervention (WA) and comparison state (Victoria) to estimate the population impact of LL. Campaign awareness was 54% after the first media wave and overweight adults were more likely to recall LL and perceive it as personally relevant. Recall was also higher among parents, but equal between socio-economic groups. The ‘why’ message about health-harms of overweight rated higher than ‘how’ messages about lifestyle change, on perceived message effectiveness which is predictive of health-related intention and behaviour change. State-by-time interactions showed population-level increases in self-referent thoughts about the health-harms of overweight (P < 0.05) and physical activity intentions (P < 0.05). Endorsement of stereotypes of overweight individuals did not increase after LL aired. LL was associated with some population-level improvements in proximal and intermediate markers of campaign impact. However, sustained campaign activity will be needed to impact behaviour.

Objective This study aimed to: i) explore potential sources of cessation support as nominated by disadvantaged smokers; and ii) identify factors influencing decisions to use these sources. Methods Semi-structured interviews were conducted with 84 smokers accessing community service organisations from the alcohol and other drugs, homeless, and mental health sectors. Transcripts were coded and thematically analysed. Results Doctors emerged as the most commonly recognised source of cessation support, followed by Quitline, community service organisation staff; and online resources. The main factors contributing to the possible use of these sources of support were identified as awareness, perceived usefulness and anticipated emotional support. Conclusions The results suggest that doctors are an important group to consider when developing cessation interventions for disadvantaged smokers due to their recognised ability to provide practical and emotional support. However, efforts are needed to ensure doctors are aware of the benefits of cessation for these groups. Community service organisations appear to be another potentially effective source of cessation support for disadvantaged smokers. Implications for public health The results indicate that cessation interventions among high-priority groups should endeavour to provide personalised emotional and practical support. Doctors and community service organisation staff appear to be well-placed to deliver this support.

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

ISSUE ADDRESSED: Up to one-third of incident cancers in Australia are attributable to modifiable factors. Understanding the general public's awareness of cancer risk and protective factors is important for identifying knowledge gaps and informing the development of effective and targeted health promotion strategies. METHODS: In a telephonic survey of 355 Western Australian adults aged 18-54 years (48% male), with a sample skewed towards low-socio-economic status areas, respondents rated the effect on cancer risk of 11 established cancer risk factors and seven established cancer protective factors. RESULTS: Most respondents correctly recognised the increased cancer risk from sun tanning (94%), asbestos (92%), pesticide use (92%) and being overweight or obese (86%), and the protective effect of being physically active (82%). Half (52%) of respondents incorrectly believed that red wine decreased or had no effect on cancer risk. One in five respondents (19%) incorrectly believed that sunscreen use increased cancer risk. Only 18% of respondents were aware that human papillomavirus (HPV) vaccination confers a protective effect, while 17% believed it increases risk. CONCLUSIONS: Although the majority of respondents were aware of certain established cancer risk and protective factors, a sizeable proportion held misconceptions about the cancer risk associated with red wine consumption, sunscreen use and HPV vaccination. SO WHAT?: Health promotion programs designed to educate the public about modifiable cancer risk factors may need to increase public awareness of the safety of preventive factors such as HPV vaccination and sunscreen, and the increased cancer risk from consumption of all alcoholic beverage types, including red wine.

An extensive body of evidence indicates that e-cigarette use is highest among young adults, prompting concerns about the potential renormalization of smoking behaviors in a population segment that is particularly vulnerable to tobacco smoking initiation. Increasing levels of e-cigarette use among young adults are likely a reflection of favorable beliefs about the benefits and risks associated with use, but research assessing perceptions of e-cigarettes in this population segment is limited. The aim of the present study was to assess young adults' perceptions of (i) the absolute and relative harm associated with e-cigarette use and (ii) the efficacy of these devices for smoking cessation. In a sample of 1116 Australian 18 to 25 year olds, three-quarters believed e-cigarettes have some level of harm (72%), just over half believed them to be addictive (57%), and substantial minorities reported that they did not know whether these products are harmful (20%) or addictive (34%). Two-fifths believed e-cigarettes are effective at helping people quit smoking (42%). Differences were observed by smoking status and e-cigarette user status on several variables, with a general trend of more positive perceptions towards e-cigarettes among smokers and users, particularly in relation to cessation efficacy. Results suggest that a substantial minority of young adults are unaware of the harms that may be associated with e-cigarettes, underscoring the importance of public health efforts that aim to provide accurate information about these devices.

Issue addressed: Electronic nicotine delivery systems (ENDS) continue to grow in popularity, particularly among young adults. Understanding by whom various ENDS are being used and why within this population segment can assist the development of appropriate interventions targeting those most vulnerable to use and inform policy decisions in this area. Accordingly, this study assessed the demographic characteristics associated with ENDS use among Australian young adults, and reasons for current e-cigarette use. Methods: An online survey was administered to 1116 Australians aged 18-25 years (59% female). Results: Smokers were more likely than non-smokers to report (a) ever use of ENDS (67% vs 28%), (b) ever use of an e-cigarette (64% vs 24%), e-cigar (17% vs 8%) or ehookah (15% vs 8%) and (c) current use of e-cigarettes (19% vs 6%). Male smokers were more likely than female smokers to be current e-cigarette users. The most common reason for current e-cigarette use was enjoyment. Conclusions: Young male adults appear to be particularly vulnerable to becoming regular e-cigarette users. This demographic group may need to be a primary focus of prevention and intervention efforts. Contrary to popular belief, smoking cessation was not a primary reason for e-cigarette use. So what?: Greater efforts are needed to educate young adults on the harms associated with ENDS use, especially if use is being driven by the perception that they are a harmless means of amusement. Maintaining existing regulations limiting the accessibility of these products is crucial to ensuring widespread use is minimised.

Despite substantial reductions in smoking prevalence in many countries, rates remain high among people who are experiencing disadvantage. This study aimed to explore attitudinal and behavioural responses to population-wide tobacco control policies among Australian smokers experiencing disadvantage.Semi-structured qualitative interviews were conducted with 84 smokers attending community service organisations in the mental health, homelessness, and alcohol and other drug sectors. Interviewees discussed various tobacco control policies (tobacco taxes, smoke-free areas, plain packaging and graphic health warnings). The interview transcriptions were coded and thematically analysed.Responses to tobacco taxes were mixed. Some interviewees reported smoking less as a result of price increases, while others reallocated funds from other budget areas. Many perceived smoke-free area policies as effective, although some described strategies they use to circumvent this policy, thereby diminishing its effectiveness. Plain packaging and graphic warnings were perceived as being least effective.While tobacco control policies can elicit intended attitudinal and behavioural responses, additional efforts are needed to enhance their effectiveness among smokers experiencing disadvantage. Future efforts to reduce smoking rates should address responses that diminish policy effectiveness among groups exhibiting high smoking prevalence. This could be achieved through strategies that address the specific needs of these groups, such as providing additional cessation support, enforcing existing smoke-free policies in ways that minimise inequitable effects, and addressing self-exempting beliefs.

Strategies to protect against excessive exposure to ultraviolet (UV) radiation are required to reduce the risk of melanoma, non-melanoma skin cancers, and eye diseases. The programs that have been most effective in reducing sun exposure involve combinations of education intended to change individual beliefs and behavior, tools for personal protection from the sun, and the creation of environments that support sun protection. Specific strategies include community-wide media campaigns, school-based interventions, counseling by healthcare providers about sun protection, education on the appropriate use of protective clothing and sunscreen, and policies to restrict access to indoor tanning beds. Sun protection strategies are most effective when introduced in childhood, although interventions in adulthood can also reduce skin cancer incidence. There are health risks of complete sun avoidance, so a balance between inadequate and excessive sun protection is necessary.

Background Reflecting the increasing prevalence of online media, many mass media health campaigns are now delivered using both television (TV) and online media formats. The aim of this study was to evaluate a smoking cessation mass media campaign according to the cost-effectiveness of the various combinations of TV and online media formats to inform future media buying decisions. Methods A quasi-experimental interrupted time series approach was employed. The campaign was delivered in seven 1-week bursts using TV, online video (OV), or online display (OD) (e.g., banner ads) formats in isolation and in various combinations over a 13-week period. Campaign bursts were separated by “off-weeks” in which no campaign materials were delivered. Assessed outcomes were the number of campaign response “events” recorded (campaign web page views, calls to a smoking cessation telephone service, and registrations for smoking cessation services). The cost-effectiveness of each individual and combined media format condition in terms of these outcome variables was calculated using attributed production and broadcasting costs. Results Overall, OD alone was found to be the most cost-effective means of achieving the nominated campaign outcomes, followed by a combination of OV and OD and a combination of TV and OV. The use of TV in isolation was the least cost-effective. Conclusion The results of this evaluation indicate that online media constitute a promising means of enhancing the cost-effectiveness of smoking cessation campaigns. Future research assessing a broader range of outcomes, especially smoking cessation, is needed to provide a more comprehensive account of the cost-effectiveness of various campaign media.

Objective Our study sought to ascertain women's beliefs about breast cancer risk factors and whether these beliefs differed by demographic factors and personal and family history of breast cancer. Methods Participants in a case–control study of breast cancer rated the effect of 37 exposures on the risk of being diagnosed with breast cancer. Chi-square tests were undertaken to measure differences in responses between cases and controls for each exposure. Logistic regression was undertaken to ascertain whether demographic factors and personal and family history of breast cancer affected participants' ability to correctly identify known breast cancer risk factors. Results A total of 2742 participants completed the questionnaire, comprising 1109 cases and 1633 controls. Significant differences (p

Cancer will continue to be a leading cause of ill health and death unless we can capitalize on the potential for 30-40% of these cancers to be prevented. In this light, cancer prevention represents an enormous opportunity for public health, potentially saving much of the pain, anguish, and cost associated with treating cancer. However, there is a challenge for governments, and the wider community, in prioritizing cancer prevention activities, especially given increasing financial constraints. This paper describes a method for identifying cancer prevention priorities. This method synthesizes detailed cancer statistics, expert opinion, and the published literature for the priority setting process. The process contains four steps: assessing the impact of cancer types; identifying cancers with the greatest impact; considering opportunities for prevention; and combining information on impact and preventability. The strength of our approach is that it is straightforward, transparent and reproducible for other settings. Applying this method in Western Australia produced a priority list of seven adult cancers which were identified as having not only the biggest impact on the community but also the best opportunities for prevention. Work conducted in an additional project phase went on to present data on these priority cancers to a public consultation and develop an agenda for action in cancer prevention.

Testing the effectiveness of warning statements designed to encourage healthy lifestyle behaviours is largely done by showing the messages to study participants in the absence of ‘real world’ social and physical contexts. This approach does not factor in the impact of the medium of the message. A virtual, 360-degree environment (Messaging360) was developed that online participants can explore and be exposed to messages in a variety of different social and physical contexts: through advertising in a newspaper, labels on products and from a small child and a doctor avatar. The platform allows for large numbers of participants to be tested in a way that models real-life contexts for the messages and so may represent a more effective way of assessing their impact in delivering the health information.

Objectives: To estimate the impact of various expansion scenarios of the National Bowel Cancer Screening Program (NBCSP) on the number of bowel cancer deaths prevented; and to investigate the impact of the expansion scenarios on colonoscopy demand. Design: MISCAN-Colon, a well established, validated computer simulation model for bowel cancer screening, was adjusted to reflect the Australian situation. In July 2013, we simulated the effects of screening over a 50-year period, starting in 2006. The model parameters included rates of participation in screening and follow-up, rates of identification of cancerous and precancerous lesions, bowel cancer incidence, mortality and the outcomes of the NBCSP. Five implementation scenarios, based on biennial screening using an immunochemical faecal occult blood test, were developed and modelled. A sensitivity analysis that increased screening participation to 60% was also conducted. Participants: Australian residents aged 50 to 74 years. Main outcome measures: Comparison of the impact of five implementation scenarios on the number of bowel cancer deaths prevented and demand for colonoscopy. Results: MISCAN-Colon calculated that in its current state, the NBCSP should prevent 35169 bowel cancer deaths in the coming 40 years. Accelerating the expansion of the program to achieve biennial screening by 2020 would prevent more than 70 000 deaths. If complete implementation of biennial screening results in a corresponding increase in participation to 60%, the number of deaths prevented will increase across all scenarios. Conclusions: The findings strongly support the need for rapid implementation of the NBCSP. Compared with the current situation, achieving biennial screening by 2020 could result in 100% more bowel cancer deaths (about 35 000) being prevented in the coming 40 years.

Issue addressed: People's perceptions of risk may influence health-related behaviours. The aim of this study was to investigate the perception of cancer risk factors among Western Australian adults in order to inform health promotion policies. Methods: Cross-sectional surveys of 2094 adults were undertaken in 2007/2008 in which respondents were asked whether they thought factors increased or decreased the risk of cancer. Factors included both established and unestablished risk factors for cancer. The distribution of perceptions was compared according to age and sex. Results: The study found high levels of endorsement for some unestablished risk factors (74-91%) and comparatively lower levels of endorsement for many established risk factors (33-80%). The established risk factors of smoking and asbestos received high levels of endorsement (94-98%). Conclusion: It appears that the alignment between scientifically established risk factors and the Western Australian public's perception of cancer risk factors could be improved. So what? Health promotion strategies are needed to improve the public's awareness of cancer risk factors. The high levels of endorsement attributed to unestablished risk factors highlight the need to dispel myths surrounding cancer and to reinforce the key factors in cancer prevention. Ongoing assessment of the alignment between community perceptions of cancer risk and the scientific evidence for cancer risk is important for guiding prioritisation within public health organisations.

Objective: To assess the relative cost‐effectiveness of various non‐television advertising media in encouraging 25–39 year‐old male smokers to respond to a cessation‐related call to action. Information about how new electronic media compare in effectiveness is important to inform the implementation of future tobacco control media campaigns. Methods: Two testimonial advertisements featuring members of the target group were developed for radio, press and online media. Multiple waves of media activity were scheduled over a period of seven weeks, including an initial integrated period that included all three media and subsequent single media phases that were interspersed with a week of no media activity. The resulting Quit website hits, Quitline telephone calls, and registrations to online and telephone counselling services were compared to advertising costs to determine the relative cost‐effectiveness of each media in isolation and the integrated approach. Results: The online‐only campaign phase was substantially more cost‐effective than the other phases, including the integrated approach. Conclusions: This finding is contrary to the current assumption that the use of a consistent message across multiple media simultaneously is the most cost‐effective way of reaching and affecting target audiences. Implications: Online advertising may be a highly cost‐effective channel for low‐budget tobacco control media campaigns.