Summary Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, and newspapers. Exposure to ...such messages is, therefore, generally passive. Such campaigns are frequently competing with factors, such as pervasive product marketing, powerful social norms, and behaviours driven by addiction or habit. In this Review we discuss the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of community-based programmes, and policies that support behaviour change. Finally, we propose areas for improvement, such as investment in longer better-funded campaigns to achieve adequate population exposure to media messages.
Objective This review summarises the impact of mass media campaigns on promoting quitting among adult smokers overall and for subgroups; the influence of campaign intensity and different channels; ...the effects of different message types. Methods The present work updates two reviews published in 2008 by searching databases using a standard search string. Articles in languages other than English were excluded, as well as letters and editorials. Screening of abstracts yielded 194 potentially relevant articles. Abstracts were evaluated by 2 authors, excluding articles that focused on populations other than adults and according to other specified criteria, resulting in 26 studies reported in 29 articles. Studies were categorised as (a) population-based studies of campaign effects and (b) studies comparing message types, using either population-based or forced exposure methods. Findings of subgroup differences for each study were noted, as well as study strengths and limitations. Results Overall, the studies have strengthened the evidence that mass media campaigns conducted in the context of comprehensive tobacco control programmes can promote quitting and reduce adult smoking prevalence, but that campaign reach, intensity, duration and message type may influence success. Achievement of sufficient population exposure is vital, especially for lower socioeconomic status smokers, with television remaining the primary channel to effectively reach and influence adult smokers. Studies comparing different message types found negative health effects messages most effective at generating increased knowledge, beliefs, positive perceived effectiveness ratings, or quitting behaviour, while there was more mixed evidence for other message types. A few studies further suggest that negative health effects messages may also contribute to reductions in socioeconomic disparities in smoking. Conclusions Mass media campaigns to promote quitting are important investments as part of comprehensive tobacco control programmes to educate about the harms of smoking, set the agenda for discussion, change smoking attitudes and beliefs, increase quitting intentions and quit attempts, and reduce adult smoking prevalence. Jurisdictions should aim for high reach and consistent exposure over time with preference towards negative health effects messages.
Australia has one of the highest skin cancer rates in the world. 'SunSmart' is a multi-component, internationally recognised community-wide skin cancer prevention program implemented in Melbourne, ...Australia, since summer 1988-1989. Following recent reductions in melanoma rates among younger Australian cohorts, the extent of behaviour change and the potential contribution of prevention programs to this decline in melanoma rates are of interest. Sun protection is a multifaceted behaviour. Measures previously applied to monitor change over time in preventive behaviour for this population focused on individual behaviours. The omission of multiple behaviours that reduce exposure to ultraviolet radiation (UV) may have led to underestimates of behaviour change, meriting further analysis of long-term trends to contribute to this debate.
A population-based survey was conducted in Melbourne in the summer before SunSmart commenced (1987-1988) and across summers in 3 subsequent decades (1988-2017). During summer months, residents (14-69 years) were recruited to cross-sectional weekly telephone interviews assessing their tanning attitudes, sun protection behaviour, and sunburn incidence on the weekend prior to interview. Quotas were used to ensure the sample was proportional to the population by age and sex, while younger respondents were oversampled in some years. The majority of the respondents reported their skin was susceptible to sunburn. Changes in sun protection behaviour were analysed for N = 13,285 respondents in multivariable models, cumulating surveys within decades (1987-1988: N = 1,655; 1990s: N = 5,258; 2000s: N = 3,385; 2010s: N = 2,987) and adjusting for relevant ambient weather conditions and UV levels on weekend dates. We analysed specific and composite behaviours including a novel analysis of the use of maximal sun protection, which considered those people who stayed indoors during peak UV hours together with those people well-protected when outdoors. From a low base, use of sun protection increased rapidly in the decade after SunSmart commenced. The odds of use of at least 1 sun protection behaviours on summer weekends was 3 times higher in the 1990s than pre-SunSmart (adjusted odds ratio AOR 3.04, 95% CI 2.52-3.68, p < 0.001). There was a smaller increase in use of maximal sun protection including shade (AOR = 1.68, 95% CI 1.44-1.97, p < 0.001). These improvements were sustained into the 2000s and continued to increase in the 2010s. Inferences about program effects are limited by the self-reported data, the absence of a control population, the cross-sectional study design, and the fact that the survey was not conducted in all years. Other potential confounders may include increasing educational attainment among respondents over time and exposure to other campaigns such as tobacco and obesity prevention.
With an estimated 20-year lag between sun exposure and melanoma incidence, our findings are consistent with SunSmart having contributed to the reduction in melanoma among younger cohorts.
BackgroundTobacco companies may attempt to minimise the impact of tobacco tax increases on consumers by gradually passing on the price rise over several months. This study examined whether there was ...evidence of large Australian tobacco retailers engaging in this practice (known as cushioning) over a period including both routine indexation and large annual tobacco excise increases.MethodsAdvertised prices of nine factory-made cigarette (FMC) and nine roll-your-own tobacco (RYO) products were recorded from two stores monthly from December 2016 to December 2019. Per cent change in price from the previous month was analysed for FMC and RYO products, controlling for year, month, tobacco company and supermarket chain.ResultsSignificant main effects of month were observed for FMC and RYO products (both p<0.001). Large, significant average increases in per cent change in price were observed in September for FMC (6.51%) and RYO (11.45%) products, the month of the annual excise increase and prices also significantly increased in October (FMC: 3.01%; RYO: 1.91%). Significant increases were also observed in the months after the March annual routine indexation: by 1.10% in May for FMC products and by 1.09% in April for RYO products.ConclusionThis study has demonstrated evidence of cushioning of tax increases of FMC and RYO products in large Australian supermarkets. The monthly per cent change in price significantly increased several months after routine excise indexation and in the 2 months following a large annual excise increase. Further research with a larger sample of products and stores is needed to confirm these findings.
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.
We assessed which types of mass media messages might reduce disparities in smoking prevalence among disadvantaged population subgroups.
We followed 1491 adult smokers over 24 months and related ...quitting status at follow-up to exposure to antismoking ads in the 2 years prior to the baseline assessment.
On average, smokers were exposed to more than 200 antismoking ads during the 2-year period, as estimated by televised gross ratings points (GRPs). The odds of having quit at follow-up increased by 11% with each 10 additional potential ad exposures (per 1000 points, odds ratio OR=1.11; 95% confidence interval CI=1.00, 1.23; P<.05). Greater exposure to ads that contained highly emotional elements or personal stories drove this effect (OR=1.14; 95% CI 1.02, 1.29; P<.05), which was greater among respondents with low and mid-socioeconomic status than among high-socioeconomic status groups.
Emotionally evocative ads and ads that contain personalized stories about the effects of smoking and quitting hold promise for efforts to promote smoking cessation and reduce socioeconomic disparities in smoking.
Reviews published over the past decade confirm tobacco control campaigns can be effective for influencing adult and youth tobacco use behaviours, with strengthening evidence for high ...cost-effectiveness. Evidence is also accumulating for positive campaign effects on interpersonal discussions, social norms and policy support that can help motivate and sustain quitting and reduce uptake. Research needs over the next decade centre on the rapidly changing media environment and the equity of campaign effects among high smoking prevalence communities. The field needs specific evidence on: how to measure total campaign reach and frequency across the diverse range of media platforms and channels; the optimum mix of traditional, digital and social media to achieve behaviour change, especially among high smoking prevalence communities; the relative reach and impact of the wide variety of integrated, digital and social media message delivery methods; the relative effectiveness of messages that aim to build capacity to quit and optimum methods for combining motivational and capacity-building messages, especially for high prevalence groups who face additional barriers to staying quit; the ongoing effectiveness of traditional versus new versions of messages highlighting tobacco industry practices; the influence of e-cigarette use on tobacco control campaign effects; and the effectiveness of different types of campaigns aiming to prevent e-cigarette uptake and motivate e-cigarette cessation. Research is also needed to investigate the potential for campaigns to influence the public’s understanding and support for endgame tobacco control policies and for campaign elements that may influence the social and environmental contexts surrounding smokers that support and maintain behaviour change.
BackgroundCigarette pack inserts are small cards that highlight the benefits of quitting and promote use of smoking cessation support. With evidence from Canada that they increase self-efficacy to ...quit, quit attempts and sustained cessation, inserts are set to be introduced into tobacco packs sold in Australia. Some people have expressed concern that the introduction of inserts may create more litter if incorrectly disposed of on pack-opening.MethodsWe used a cross-sectional survey to assess self-reported pack-opening location and waste disposal behaviours of people who smoke to determine the potential for littering to occur when tobacco packs are first opened. We also visited a sample of supermarkets, convenience stores and tobacconists located throughout Melbourne, Australia, to discreetly collect observational data regarding pack-opening and waste disposal behaviours at the point of purchase.ResultsAmong participants in the cross-sectional study (N=369), the majority reported that they opened their most recent tobacco pack at home (70.9%) where there is little potential for littering, and this proportion was higher among those who smoke daily (78.6%) and men (74.3%). Self-reported behaviours that could result in littering were rare; 1.0% reported that they left tobacco packaging where they believed it would be collected for disposal. Of the 128 individuals observed at the point of purchase across 46 stores, 96.9% did not open the tobacco product immediately after purchase. One incident of littering was observed (0.8%).ConclusionThe introduction of cigarette pack inserts in Australia is unlikely to create a substantial amount of additional litter.
Non-alcoholic energy drinks ('energy drinks') are high in sugar, as well as caffeine, leading to concerns regarding their suitability for children and adolescents. Despite this, marketing of energy ...drinks is often directed at adolescents, and there are no age restrictions on the sale of these products in Australia. The current study aimed to examine patterns in consumption of energy drinks among Australian secondary school students and identify sociodemographic and behavioural correlates associated with regular consumption. Overall, 8% of students reported consuming energy drinks on a weekly basis ('regular consumers'). A further 16% indicated they consume less than one cup per week of these types of drinks, while around three-quarters (76%) reported they do not consume energy drinks. Regular consumption of energy drinks was independently associated with being male, having greater weekly spending money, high intakes of snack foods, fast food, other sugar-sweetened beverages and fruit juice, as well as short sleep duration. There was no independent association with other sociodemographic characteristics (i.e., year level, level of disadvantage, geographic location), consumption of vegetables and fruit, physical activity level, or sedentary recreational screen time. While most Australian adolescents do not consume energy drinks, regular consumption is more prevalent among males, and consumption appears to cluster with other unhealthy dietary behaviours and short sleep duration. Findings support the need for policies that will reach identified at-risk groups (e.g., increased regulation of the marketing and sale of energy drinks), as well as suggest opportunities for interventions targeting energy drink consumption alongside other unhealthy dietary behaviours.
Extrinsic information, such as packaging, branding and labeling, can significantly alter our experience of food and drink through a process of ‘sensation transfer’, in which extrinsic attributes are ...transferred to our sensory perception of a product. The aim of this review was to summarize the literature on sensation transfer for unhealthy food and drink and to investigate personal factors that may influence its occurrence. Seventy-eight studies in 69 articles, published between 1966 and 2014 were identified which evaluated sensation transfer. Sixty-five of the 78 studies found an effect of extrinsic information on taste and/or hedonic outcomes, providing strong evidence for sensation transfer. The majority of studies identified that specific extrinsic information influenced particular products or specific sensory outcomes. Study designs incorporating a measure of expectation allowed a tighter assessment of sensation transfer. The results of such studies confirm the hypothesis that these effects occur when extrinsic information elicits an expectation of product taste, which then forms a framework to guide sensory perception. These studies also support the hypothesis that where sensation transfer does not occur, this is likely due to a mismatch between the expectations elicited by the extrinsic information and the sensory characteristics being measured, or the failure of the extrinsic information to elicit an expectation of taste for that product.
•Review of the literature on sensation transfer.•Specific focus on packaging, branding and labeling; unhealthy food and drink.•78 studies published between 1966 and 2014 were identified.•Four methodological designs were identified.•Strong evidence that extrinsic information changes the taste of unhealthy products.
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