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CORK Bibliography: Advertising

76 citations. 2010 to present

Prepared: June 2012

Auger N; Daniel M; Knauper B; Raynault MF; Pless B. Children and youth perceive smoking messages in an unbranded advertisement from a NIKE marketing campaign: A cluster randomised controlled trial. BMC Pediatrics 11: e26, 2011. (30 refs.)

Background: How youth perceive marketing messages in sports is poorly understood. We evaluated whether youth perceive that the imagery of a specific sports marketing advertisement contained smoking-related messages. Methods: Twenty grade 7 to 11 classes (397 students) from two high schools in Montreal, Canada were recruited to participate in a cluster randomised single-blind controlled trial. Classes were randomly allocated to either a NIKE advertisement containing the phrase "LIGHT IT UP" (n = 205) or to a neutral advertisement with smoking imagery reduced and the phrase replaced by "GO FOR IT" (n = 192). The NIKE logo was removed from both advertisements. Students responded in class to a questionnaire asking open-ended questions about their perception of the messages in the ad. Reports relating to the appearance and text of the ad, and the product being promoted were evaluated. Results: Relative to the neutral ad, more students reported that the phrase "LIGHT IT UP" was smoking-related (37.6% vs. 0.5%) and that other parts of the ad resembled smoking-related products (50.7% vs. 10.4%). The relative risk of students reporting that the NIKE ad promoted cigarettes was 4.41 (95% confidence interval: 2.64-7.36; P < 0.001). Conclusions: The unbranded imagery of an advertisement in a specific campaign aimed at promoting NIKE hockey products appears to have contained smoking-related messages. This particular marketing campaign may have promoted smoking. This suggests that the regulation of marketing to youth may need to be more tightly controlled.

Baum F. From Norm to Eric: Avoiding lifestyle drift in Australian health policy. (editorial). Australian and New Zealand Journal of Public Health 35(5): 404-406, 2011. (22 refs.)

There is no doubt that the Australian Labor Party Government has made a strong commitment to preventing disease, as shown by the Council of Australian Governments' (COAG) National Partnership Agreement on Preventive Health (NPAPH), the commissioning of the National Preventative Health Taskforce (NPHT) and the Commonwealth Government's response to that Taskforce report. Each of these initiatives stresses the importance of preventing chronic disease by encouraging people to adopt appropriate lifestyles. These lifestyles involve not smoking, drinking in moderation, eating a healthy diet and taking enough exercise. Similar messages were evident in the lifestyle push of the 1980s when the 'Life be in it' campaign promoted Norm as a model of a coach potato who did not heed the lifestyle advice. The face of the lifestyle campaign this time around is Eric, an obese-looking balloon man, and his family who urge people to swap an unhealthy lifestyle habit for a more healthy one. The large lifestyle campaigns of the 1970s and 1980s have been shown to have had little, if any, impact on population health, and if anything act to increase inequities. The programs that did work were those that were implemented alongside a program of policy and structural change (such as changing the food supply), the Finnish North Karelia experiment being an example. In the past decade the power of the social determinants of health in shaping overall population health and the distribution of health within populations has received considerable attention, most prominently in the work of the Commission on the Social Determinants of Health. Why haven't we learned from this evidence? A crucial reason for the failure to learn from the evidence is that, politically, action on the social determinants of health is generally less palatable than instituting a lifestyle advice program.

Burton S; Clark L; Jackson K. The association between seeing retail displays of tobacco and tobacco smoking and purchase: Findings from a diary-style survey. Addiction 107(1): 169-175, 2012. (25 refs.)

Aims: To assess the impact of retail displays of tobacco on tobacco smoking and purchase by smokers and attempting quitters. Setting NSW, Australia. Participants: A total of 998 smokers and 111 attempting quitters. Measurements: Demographic measures and 4-hourly records over 4 days: number of cigarettes smoked and bought; exposure to cigarette smoking by friends/family or other smokers; and exposure to retail displays of tobacco. Findings: Subjects reported seeing cigarettes for sale in more than 40% of the time-periods when they were outside their home. After allowing for factors which are known to increase smoking, people who saw cigarettes for sale were more likely to smoke, and smoked more cigarettes, even if they did not buy cigarettes in the same time-period. There was marginally significant evidence that people exposed to retail displays of tobacco in one time-period were more likely to buy in the following time-period. Conclusions: In an environment which permits point-of-sale displays, smokers were found to see tobacco displays in more than 40% of the 4-hour periods that they were outside the home. Exposure to such tobacco displays was associated with a higher probability of smoking, and with higher levels of smoking, even when subjects did not purchase cigarettes.

Capella ML; Webster C; Kinard BR. A review of the effect of cigarette advertising. (review). International Journal of Research In Marketing 28(3): 269-279, 2011. (180 refs.)

Because of the inconsistency in the findings from past decades of research and the lack of consensus regarding the relationship between advertising exposure and cigarette consumption, the large body of extant research on the effectiveness of cigarette advertising has generated equivocal conclusions on this subject. Therefore, we conducted a comprehensive meta-analysis of cigarette advertising research to determine what impact, if any, cigarette advertising has on cigarette consumption. Unlike previous attempts to synthesize the cigarette advertising literature, this study examined three specific levels of the criterion (i.e., initiation, continuation, and brand behavior) rather than examining only aggregate consumption.

Carter OBJ; Donovan R; Jalleh G. Using viral E-mails to distribute tobacco control advertisements: An experimental investigation. Journal of Health Communication 16(7): 698-707, 2011. (15 refs.)

The authors' objective was to conduct a trial of viral e-mail marketing as a distribution method for tobacco control advertisements. University students (n = 200) in the state of Western Australia were randomly allocated to receive 1 of 2 e-mails with hyperlinks to tobacco control advertisements ("Toilet'' and "Rubbish'') emphasizing the disgusting nature of smoking. Recipients followed a hyperlink to a Web page playing Toilet or Rubbish on endless loop. Viewers were encouraged to forward the e-mail to their friends and invited to complete an online survey about the advertisement. Unique downloads for each advertisement were identified by internet provider (IP) location and tallied by date and geographical location to assess subsequent dissemination beyond the initial 200 students. There were 826 unique viewings of the advertisements averaging 26.9 viewings per day for the first fortnight, followed by a lower average of 4.1 hits per day for the next 3.5 months. IP addresses identified hits from 3 other Australian states and 7 other countries. Online surveys were completed by 103 respondents (12.5% of total hits) but included few smokers (n = 9). Significantly more respondents rated Toilet as "funny'' compared with Rubbish (40% vs. 11%; p <. 05), likely explaining why the former accounted for significantly more viewings than the latter (487 vs. 339; p <. 001). There was a greater than fourfold return in dissemination for each initial e-mail sent but daily hits rapidly deteriorated over time. Entertainment appears to facilitate viral e-mails being forwarded onwards but only exceptionally compelling tobacco control materials are ever likely to become self-perpetuating.

Chapman S. Why the tobacco industry fears plain packaging. (editorial). Medical Journal of Australia 195(5): 255-255, 2011. (3 refs.)

Charoenca N; Mock J; Kungskulniti N; Preechawong S; Kojetin N; Hamann SL. Success counteracting tobacco company interference in Thailand: An example of FCTC implementation for low- and middle-income countries. International Journal of Environmental Research and Public Health 9(4): 1111-1134, 2012. (72 refs.)

Transnational tobacco companies (TTCs) interfere regularly in policymaking in low- and middle-income countries (LMICs). The WHO Framework Convention for Tobacco Control provides mechanisms and guidance for dealing with TTC interference, but many countries still face 'how to' challenges of implementation. For more than two decades, Thailand's public health community has been developing a system for identifying and counteracting strategies TTCs use to derail, delay and undermine tobacco control policymaking. Consequently, Thailand has already implemented most of the FCTC guidelines for counteracting TTC interference. In this study, our aims are to describe strategies TTCs have used in Thailand to interfere in policymaking, and to examine how the public health community in Thailand has counteracted TTC interference. We analyzed information reported by three groups with a stake in tobacco control policies: Thai tobacco control advocates, TTCs, and international tobacco control experts. To identify TTC viewpoints and strategies, we also extracted information from internal tobacco industry documents. We synthesized these data and identified six core strategies TTCs use to interfere in tobacco control policymaking: (1) doing business with 'two faces', (2) seeking to influence people in high places, (3) 'buying' advocates in grassroots organizations, (4) putting up a deceptive front, (5) intimidation, and (6) undermining controls on tobacco advertising, promotion and sponsorship. We present three case examples showing where TTCs have employed multiple interference strategies simultaneously, and showing how Thai tobacco control advocates have successfully counteracted those strategies by: (1) conducting vigilant surveillance, (2) excluding tobacco companies from policymaking, (3) restricting tobacco company sales, (4) sustaining pressure, and (5) dedicating resources to the effective enforcement of regulations. Policy implications from this study are that tobacco control advocates in LMICs may be able to develop countermeasures similar to those we identified in Thailand based on FCTC guidelines to limit TTC interference.

Cho JH; Shin E; Moon SS. Electronic-cigarette smoking experience among adolescents. Journal of Adolescent Health 49(5): 542-546, 2011. (15 refs.)

Objectives: To investigate the level of awareness and contact routes to electronic cigarette (e-cigarette), and to identify significant factors that may affect adolescent use of e-cigarettes; this study explores the experience of e-cigarettes among adolescents. Methods: Using the data from the 2008 Health Promotion Fund Project in Korea, we used a hierarchical logistic regression analysis to evaluate gender, level of school, family smoking, perception of peer influence, satisfaction in school life, and cigarette smoking experience as predictors of trying e-cigarettes among adolescents in five schools in Korea. Results: Overall, 444 (10.2%) students responded as having seen or heard of e-cigarettes. Twenty-two (.5%) students reported as having used an e-cigarette. The contact routes of information on e-cigarettes were the Internet (249, 46.4%), friends (150, 27.9%), television (59, 11.0%), books (50, 9.3%), and others (29, 5.4%). The following factors were determined to be statistically significant predictors of e-cigarette experience: male gender, perception of peer influence, satisfaction in school life, and cigarette smoking experience. Conclusions: In light of this fact, continuous attention needs to be paid on the marketing of e-cigarettes on Internet sites to prevent adolescents from being exposed to unsupported claims about e-cigarettes and to provide appropriate information on health effects.

Cohen EL; Caburnay CA; Rodgers S. Alcohol and tobacco advertising in black and general audience newspapers: Targeting with message cues? Journal of Health Communication 16(6): 566-582, 2011. (65 refs.)

This study content analyzed 928 tobacco-and alcohol-related advertisements from a 3-year national sample of Black (n = 24) and general audience (n = 11) newspapers from 24 U. S. cities. The authors compared the frequency of tobacco and alcohol product and control advertising in Black versus general audience newspapers, as well as the presence of 5 message cues: model ethnicity, presence of health official, referral to resources, personal behavior mobilization, and localization. Results within health issues show that Black newspapers had more alcohol product advertising than did general audience newspapers. In contrast, Black newspapers had less alcohol and tobacco control advertising than general audience newspapers. Black newspapers' tobacco/alcohol product advertisements had more African American models than did general audience newspapers' tobacco/alcohol advertising, whereas general audience newspapers' tobacco control advertisements were significantly more likely to feature public health officials than ads in Black newspapers. Fewer message cues such as personal behavior mobilization, referral to resources, and localization were present in Black versus general audience newspapers. Results suggest that Black newspapers may have greater dependency than do general audience newspapers on these risk-related advertisements that target African American consumers. Given the current advertising environment, public health initiatives are needed to counter unhealthy alcohol product advertising messages that target vulnerable populations.

Cohen JE; Planinac L; Lavack A; Robinson D; O'Connor S; DiNardo J. Changes in retail tobacco promotions in a cohort of stores before, during, and after a tobacco product display ban. American Journal of Public Health 101(10): 1879-1881, 2011. (18 refs.)

We used a longitudinal design to investigate the impact of a government policy banning the display of tobacco products at the point of sale. The extent of tobacco promotions in 481 randomly selected stores was documented at 4 points in time (2005-2009). Tobacco promotions were greatly reduced after implementation of the display ban. A ban on the display of tobacco products and other signage and promotions at retail is a critical tobacco-control policy to reduce people's exposure to tobacco marketing.

Comello MLG; Slater MD. Effects of adverts from a drug and alcohol prevention campaign on willingness to engage in alcohol-related risky behaviors. Journal of Health Psychology 16(8): 1268-1276, 2011. (26 refs.)

Behavioral willingness is conceptualized as a pathway to behavior that is non-deliberative, yet traditional measures require thoughtful deliberation to complete. This study explored non-deliberative measures of alcohol-related willingness to complement recent work on marijuana-related willingness. The study also examined whether adverts from a field-tested drug and alcohol prevention campaign may have operated by influencing alcohol-related willingness. Participants viewed campaign adverts or consumer adverts (control). Outcomes were reaction times to make speeded judgments about whether one would engage in risky alcohol-related behaviors. Results showed that campaign advertisements lowered willingness to play drinking games and (for males) to drive while intoxicated.

Cordaro FG; Lombardo S; Cosentino M. Selling androgenic anabolic steroids by the pound: Identification and analysis of popular websites on the Internet. Scandinavian Journal of Medicine & Science in Sports 21(6): E247-E259, 2011. (34 refs.)

Internet websites offering androgenic anabolic steroids (AAS) were identified and available products were examined. Keywords for the website search were: "anabolic steroids," "anabolic steroids buy," "anabolic steroid purchase." The first 10 websites offering AAS in the first 10 pages of results were considered. At least two AAS-containing products per website were selected. Thirty AAS-selling websites were identified, mainly located in the United States (46.7%) and Europe (30%). Most websites sold other anabolic/ergogenic products (clenbuterol, 76.7%; GH/IGF, 60.0%; thyroid hormones, 46.7%; erythropoietin, 30.0%; insulin, 20.0%) or products for AAS-related adverse effects (mainly: estrogen antagonists, 63.3%; products for erectile dysfunction, 56.7%; 5 alpha-reductase inhibitors, 33.3%; anti-acne products, 33.3%). AAS were sold as medicines (69.6%) or as dietary supplements (30.4%). AAS in medicines were mainly: nandronole (20.4%), methandrostenolone (18.4%), and testosterone (12.2%). Dietary supplements contained mainly DHEA and included several fake compounds. Manufacturers were declared for 97.9% of medicines and 66.7% of dietary supplements; however, several manufacturers were not found on the Internet. Described benefits were usually few adverse effects and no estrogenicity. Toxicity was seldom reported and presented as mild. Recommended doses were two-fourfold higher than current medical recommendations. In conclusion, misleading information and deceiving practices were common findings on AAS-selling websites, indicating their deleterious potential for public health.

Corelli RL; Aschebrook-Kilfoy B; Kim G; Ambrose PJ; Hudmon KS. Availability of tobacco and alcohol products in Los Angeles community pharmacies. Journal of Community Health 37(1): 113-118, 2012. (32 refs.)

The availability of tobacco and alcohol products in community pharmacies contradicts the pharmacists' Code of Ethics and presents challenges for a profession that is overwhelmingly not in favor of the sale of these products in its practice settings. The primary aim of this study was to estimate the proportion of pharmacies that sell tobacco products and/or alcoholic beverages and to characterize promotion of these products. The proportion of pharmacies that sell non-prescription nicotine replacement therapy (NRT) products as aids to smoking cessation also was estimated. Among 250 randomly-selected community pharmacies in Los Angeles, 32.8% sold cigarettes, and 26.0% sold alcohol products. Cigarettes were more likely to be available in traditional chain pharmacies and grocery stores than in independently-owned pharmacies (100% versus 10.8%; P < 0.001), and traditional chain drug stores and grocery stores were more likely to sell alcoholic beverages than were independently-owned pharmacies (87.5% vs. 5.4%; P < 0.001). Thirty-four (41.5%) of the 82 pharmacies that sold cigarettes and 47 (72.3%) of the 65 pharmacies that sold alcohol also displayed promotional materials for these products. NRT products were merchandised by 58% of pharmacies. Results of this study suggest that when given a choice, pharmacists choose not to sell tobacco or alcohol products.

Cotter T; Hung WT; Perez D; Dunlop S; Bishop J. Squeezing new life out of an old Sponge: how to modernise an anti-smoking media campaign to capture a new market. Australian and New Zealand Journal of Public Health 35(1): 75-80, 2011. (20 refs.)

Objectives: The iconic Sponge anti-smoking television advertisement was first made in Sydney, Australia, in 1979. In 2007, it was re-made for a new generation of smokers. This paper examines the impact of the re-made Sponge advertisement. Methods: Qualitative evaluation of the original Sponge ad by younger and older smokers (n=51) was followed by an online pre-test survey of the modernised version (n=301). A continuous tracking telephone survey of smokers and recent quitters (quit in past 12 months) over 18 years monitored performance of the modernised version while on air in late 2007 (total n=453; seen ad n=380). Results: Qualitative research found that the concept of the original Sponge ad may motivate younger smokers - who had not previously seen the ad - to quit. Online pre-testing demonstrated that the modernised version provided new information to 54% of 18-24 year olds (compared to 31% of older smokers). Tracking survey results indicated that believability of the modernised version was highest among 18-24 year olds (92%), that the ad was 'attention-grabbing' (86%), and that it was effective at influencing quitting intentions. Effects were amplified by the generation of pressure from family and friends. Implications: The re-made Sponge advertisement had a positive impact on smokers, and was particularly effective among the new market of smokers aged less than 40 years. Adapting successful mass media campaign material can be an effective and economical strategy to influence smokers.

Curry LE; Pederson LL; Stryker JE. The changing marketing of smokeless tobacco in magazine advertisements. Nicotine & Tobacco Research 13(7): 540-547, 2011. (34 refs.)

Concerns about secondhand smoke, increasing indoor smoking bans, and health concerns regarding cigarettes are contributing to the development of new smokeless tobacco (ST) products by the tobacco industry and the repositioning of traditional ST products. The objective of this research was to systematically document the changing advertising strategies and themes of the ST industry. Using descriptive content analysis, this study analyzed 17 nationally circulated magazines for ST advertisements (ads) from 1998-1999 and 2005-2006, recording both magazine and advertisement characteristics (e.g., themes, selling proposition, people portrayed, and setting/surroundings.) Ninety-five unique ads were found during the two time periods-occurring with total frequency of 290 ad placements in 816 issues. One hundred ninety-one ads were found in the 2005-2006 sample, while 99 were found in the 1998-1999 magazines. Significant differences in ST ads were identified between time periods and magazine types. A greater percentage of ads were found in the latter time period, and the average number of ads per issue increased (0.24 in 1998-1999 and 0.49 in 2005-2006, p < .001). More recent magazines and general adult magazines contained a greater proportion of flavored products, "alternative to cigarette" messages, and indoor settings when compared with earlier magazines and men's magazines, respectively. While continuing to advertise in men's magazines with themes appealing to men and "traditional" ST users, the ST industry appears to be simultaneously changing its message placement and content in order to include readers of general adult magazines who may not currently use ST.

Cussen A; McCool J. Tobacco promotion in the Pacific: The current state of tobacco promotion bans and options for accelerating progress. Asia-Pacific Journal of Public Health 23(1, special issue): 70-78, 2011. (27 refs.)

Tobacco consumption is a major contributor to the burden of chronic noncommunicable disease within the Pacific region. Low and lower-middle income countries are acutely vulnerable to exploitation by the tobacco industry as they often lack the resources and capacity to implement protective tobacco control policies. The Framework Convention on Tobacco Control, which has been signed by 14 Pacific Island Countries and Territories, was introduced in 2004 to guide the priorities for tobacco control policy implementation. Legislation, tobacco industry documents, and peer-reviewed journals were evaluated to assess the current status of tobacco advertising bans of the 8 low and lower-middle income countries within the Pacific region. Results identified that of the 8 Pacific countries reviewed, 3 had comprehensive tobacco advertising bans that prohibit tobacco advertisements in 5 to 7 forms of media, and the remaining 5 countries have weak tobacco advertising bans that provide no protection for youth against tobacco advertising. This research reveals the need for resources to support the introduction of effective policies around tobacco advertising in the low and lower-middle income countries within the Pacific region.

Dewhirst T. Commentary on Burton et al. (2012): The influence of tobacco retail merchandising on tobacco consumption. (editorial). Addiction 107(1): 176-177, 2012. (17 refs.)

Falk EB; Berkman ET; Whalen D; Lieberman MD. Neural activity during health messaging predicts reductions in smoking above and beyond self-report. Health Psychology 30(2): 177-185, 2011. (62 refs.)

Objective: The current study tested whether neural activity in response to messages designed to help smokers quit could predict smoking reduction, above and beyond self-report. Design: Using neural activity in an a priori region of interest (a subregion of medial prefrontal cortex [MPFC]), in response to ads designed to help smokers quit smoking, we prospectively predicted reductions in smoking in a community sample of smokers (N = 28) who were attempting to quit smoking. Smoking was assessed via expired carbon monoxide (CO; a biological measure of recent smoking) at baseline and 1 month following exposure to professionally developed quitting ads. Results: A positive relationship was observed between activity in the MPFC region of interest and successful quitting (increased activity in MPFC was associated with a greater decrease in expired CO). The addition of neural activity to a model predicting changes in CO from self-reported intentions, self-efficacy, and ability to relate to the messages significantly improved model fit, doubling the variance explained (R-self-report(2) = .15, R-self-report(2) (+ neural activity) = .35, R-change(2) = .20). Conclusion: Neural activity is a useful complement to existing self-report measures. In this investigation, we extend prior work predicting behavior change based on neural activity in response to persuasive media to an important health domain and discuss potential psychological interpretations of the brain behavior link. Our results support a novel use of neuroimaging technology for understanding the psychology of behavior change and facilitating health promotion.

Flynn BS; Worden JK; Bunn JY; Connolly SW; Dorwaldt AL. Evaluation of smoking prevention television messages based on the elaboration likelihood model. Health Education Research 26(6): 976-987, 2011. (26 refs.)

Progress in reducing youth smoking may depend on developing improved methods to communicate with higher risk youth. This study explored the potential of smoking prevention messages based on the Elaboration Likelihood Model (ELM) to address these needs. Structured evaluations of 12 smoking prevention messages based on three strategies derived from the ELM were conducted in classroom settings among a diverse sample of non-smoking middle school students in three states (n = 1771). Students categorized as likely to have higher involvement in a decision to initiate cigarette smoking reported relatively high ratings on a cognitive processing indicator for messages focused on factual arguments about negative consequences of smoking than for messages with fewer or no direct arguments. Message appeal ratings did not show greater preference for this message type among higher involved versus lower involved students. Ratings from students reporting lower academic achievement suggested difficulty processing factual information presented in these messages. The ELM may provide a useful strategy for reaching adolescents at risk for smoking initiation, but particular attention should be focused on lower academic achievers to ensure that messages are appropriate for them. This approach should be explored further before similar strategies could be recommended for large-scale implementation.

Gallopel-Morvan K; Gabriel P; Le Gall-Ely M; Rieunier S; Urien B. The use of visual warnings in social marketing: The case of tobacco. Journal of Business Research 64(1, special issue): 7-11, 2011. (42 refs.)

Despite strong interest on the part of tobacco health practitioner, the effect of graphic warnings inserted on cigarette packs is unclear on several levels. First the most effective themes for such messages have not been clearly identified by researchers. Second no research has identified the ideal combination of self efficacy and fear appeal warnings that should be inserted on cigarette packs according to Protection Motivation Model principles. The exploratory study we conducted with French consumers to test the effectiveness of new graphic warnings proposed by the European Union in 2004 clearly demonstrate that visual messages as opposed to text warnings are more effective. This study also enabled us to identify the most effective themes of the European set health warnings and social messages. Regarding future public health applications if fear appeals are used they need to be combined with self efficacy and cessation support messages since they provoke avoidance reactions.

Goel RK. Persistence of cigarette advertising across media and smoking rates. Applied Economics Letters 18(7): 611- 619, 2011. (27 refs.)

This article uses state-level US panel data to examine the effects of cigarette advertising on smoking. We disaggregate cigarette advertising into (1) print, (2) outdoor, (3) entertainment and (4) store. How does advertising persist over time across advertising media? Are there differences in effectiveness of advertising across different smoking rates? Results show that the price elasticity of cigarette demand is negative and within the range of recent estimates, whereas border price elasticities and income elasticities are positive. All elasticities, however, are uniquely sensitive to smoking rates, as is the effectiveness of the Master Settlement Agreement. Current aggregate advertising increases cigarette demand, whereas accompanying negative advertising takes hold in the third year. Upon disaggregation, current store advertising increases smoking in most cases. However, store advertising has a negative effect by the third year, especially in states with smoking rates at or above the median. Other advertising media have weak or no effects.

Goldfarb A; Tucker C. Advertising bans and the substitutability of online and offline advertising. Journal of Marketing Research 48(2): 207-227, 2011. (48 refs.)

The authors examine whether the growth of the Internet has reduced the effectiveness of government regulation of advertising. They combine nonexperimental variation in local regulation of offline alcohol advertising with data from field tests that randomized exposure to online advertising for 275 different online advertising campaigns to 61,580 people. The results show that people are 8% less likely to say that they will purchase an alcoholic beverage in states that have alcohol advertising bans compared with states that do not. For consumers exposed to online advertising, this gap narrows to 3%. There are similar effects for four changes in local offline alcohol advertising restrictions when advertising effectiveness is observed both before and after the change. The effect of online advertising is disproportionately high for new products and for products with low awareness in places that have bans. This suggests that online advertising could reduce the effectiveness of attempts to regulate offline advertising channels because online advertising substitutes for (rather than complements) offline advertising.

Gordon R; Harris F; Mackintosh AM; Moodie C. Assessing the cumulative impact of alcohol marketing on young people's drinking: Cross-sectional data findings. Addiction Research & Theory 19(1): 66-75, 2011. (41 refs.)

As alcohol marketing remains a highly debated and politically charged issue, we examine the cumulative impact of alcohol marketing on alcohol initiation and drinking behaviour among youth (12-14 years). Cross-sectional data come from a cohort of 920 second year school pupils from Scotland. Regression models, with multiple control variables, were employed to examine the relationship between awareness of, and involvement with, a range of alcohol marketing communications, and drinking behaviour and intentions. Marketing variables were constructed for 15 different types of alcohol marketing, including marketing in new media. Drinking behaviour measures included drinking status and future drinking intentions. Significant associations were found between awareness of, and involvement with, alcohol marketing and drinking behaviour and intentions to drink alcohol in the next year. Given these associations, our study suggests the need for a revision of alcohol policy: one limiting youth exposure to these seemingly ubiquitous marketing communications.

Hall PC; Lindsay GB; West JH. Alcohol and tobacco counter-ads: Stealing a page from billboard utilizing graffitists against unhealthy promotions. Journal of School Health 81(6): 359-363, 2011. (3 refs.)

This article directed to teachers presents teaching activities to address media literacy in respect to unhealthy promotions to high school students in respect to alcohol and tobacco. [In 1979, Billboard Utilizing Graffitists Against Unhealthy Promotions (BUGAUP) was a group of advocates in Australia who used spray paint at night to cleverly alter tobacco billboards and ridicule the deceptiveness of tobacco advertisements. BUGAUP's creative vandalism helped shift public opinion regarding tobacco marketing.] Although health education efforts today should not encourage students to use graffiti for health promotion, teaching them to "talk back" to deceptive and harmful media messages through the use of counter-ads is recommended.3 As advertisers have long targeted teens' sense of youthful rebellion, this teaching technique ironically allows students to channel this rebellious spirit with pens and markers toward the alcohol and tobacco companies who exploit them. The article outlines the needed materials, activities and strategies, drawing upon the BUNGE experience.

Hammond D; Doxey J; Daniel S; Bansal-Travers M. Impact of female-oriented cigarette packaging in the United States. Nicotine & Tobacco Research 13(7): 579-588, 2011. (28 refs.)

Cigarette packaging is among the most prominent forms of tobacco marketing. This study examined the impact of cigarette pack design among young women in the United States. A national sample of 18- to 19-year-old females in the United States completed an online survey in February 2010. Participants were randomized to view eight cigarette packs designed according to one of four experimental conditions: fully branded female packs, same packs without descriptors (e.g., "slims"), same packs without brand imagery or descriptors ("plain" packs), and branded non-female brands. Participants rated packs on measures of appeal and health risk and completed a behavioral pack selection task. Fully branded female packs were rated significantly more appealing than the same packs without descriptors, "plain" packs, and non-female-branded packs. Female-branded packs were associated with a greater number of positive attributes including glamour, slimness, and attractiveness and were more likely to be perceived as less harmful. Approximately 40% of smokers and nonsmokers requested a pack at the end of the study; female-branded packs were 3 times more likely to be selected than plain packs. Plain packaging and removing descriptors such as "slims" from cigarette packs may reduce smoking susceptibility among young women.

Hanewinkel R; Isensee B; Sargent JD; Morgenstern M. Cigarette advertising and teen smoking initiation. Pediatrics 127(2): E271-E278, 2011. (31 refs.)

OBJECTIVE: To test the specificity of the association between cigarette advertising and adolescent smoking initiation. METHODS: A longitudinal survey of 2102 adolescents, aged 10 to 17 years at baseline, who never smoked was conducted by using masked images of 6 cigarette advertisements and 8 other commercial products with all brand information digitally removed. The exposure variable was a combination of contact frequency and cued recall of brands for cigarette and other advertisements. Multilevel mixed-effects Poisson regressions were used to assess smoking initiation 9 months after the baseline assessment as a function of cigarette-advertisement exposure, other advertisement exposure, and baseline covariates. RESULTS: Thirteen percent (n = 277) of students initiated smoking during the observation period. Although the incidence of trying smoking was associated with increased exposure to cigarette advertisements (10% in the low, 12% in the medium, and 19% in the high cigarette-advertisement exposure tertile initiated smoking), exposure to other advertisements did not predict smoking initiation. Compared with low exposure to cigarette advertisements, high exposure remained a significant predictor of adolescent smoking initiation after controlling for baseline covariates (adjusted relative risk: 1.46 [95% confidence interval: 1.08-1.97]; P < .05). CONCLUSIONS: Our results support the notion of a content-related effect of cigarette advertisements and underlines the specificity of the relationship between tobacco marketing and teen smoking; exposure to cigarette advertisements, but not other advertisements, is associated with smoking initiation.

Henningfield JE; Hatsukami DK; Zeller M; Peters E. Conference on abuse liability and appeal of tobacco products: Conclusions. and recommendations. (editorial). Drug and Alcohol Dependence 116(1-3): 1-7, 2011. (54 refs.)

The rate of initiation and progression to dependence and premature mortality are higher for tobacco products than for any other dependence producing substance. This is not explained simply by the addictiveness ("abuse liability") or by enticing product designs ("product appeal") alone, but rather by both of these factors in combination with marketing and social influences that also influence "product appeal". A working meeting of leading experts in abuse liability (AL) and product appeal was convened to examine how these disciplines could be more effectively applied to the evaluation of tobacco products for the purposes of regulation that would include setting standards for designs and contents intended to reduce the risk of initiation and dependence. It was concluded that abuse liability assessment (ALA) is a validated approach to testing pharmaceutical products but has not been extensively applied to tobacco products: such application has demonstrated feasibility, but special challenges include the diverse range of products, product complexity, and the absence of satisfactory placebo products. Consumer testing for product appeal is widely used by consumer product marketers as well as by researchers in their efforts to understand consumer product preferences and use but has not been extensively applied to tobacco products except by the tobacco industry. Recommendations for testing, methods development, and research were developed. A major recommendation was that tobacco products should be tested for AL and product appeal, and the results integrated and evaluated so as to more accurately predict risk of initiation, dependence, and persistence of use.

Henriksen L. Comprehensive tobacco marketing restrictions: Promotion, packaging, price and place. (review). Tobacco Control 21(2): 147-153, 2012. (91 refs.)

Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers.

Henriksen L; Schleicher NC; Dauphinee AL; Fortmann SP. Targeted advertising, promotion, and price for menthol cigarettes in California high school neighborhoods. Nicotine & Tobacco Research 14(1): 116-121, 2012. (26 refs.)

Objectives: To describe advertising, promotions, and pack prices for the leading brands of menthol and nonmenthol cigarettes near California high schools and to examine their associations with school and neighborhood demographics. Methods: In stores (n = 407) within walking distance (0.8 km [1/2 mile]) of California high schools (n = 91), trained observers counted ads for menthol and nonmenthol cigarettes and collected data about promotions and prices for Newport and Marlboro, the leading brand in each category. Multilevel modeling examined the proportion of all cigarette advertising for any menthol brand, the proportion of stores with sales promotions, and the lowest advertised pack price in relation to store types and school/neighborhood demographics. Results: For each 10 percentage point increase in the proportion of Black students, the proportion of menthol advertising increased by 5.9 percentage points (e. g., from an average of 25.7%-31.6%), the odds of a Newport promotion were 50% higher (95% CI = 1.01, 2.22), and the cost of Newport was 12 cents lower (95% CI = -0.18, -0.06). By comparison, the odds of a promotion and the price for Marlboro, the leading brand of nonmenthol cigarettes, were unrelated to any school or neighborhood demographics. Conclusions: In high school neighborhoods, targeted advertising exposes Blacks to more promotions and lower prices for the leading brand of menthol cigarettes. This evidence contradicts the manufacturer's claims that the availability of its promotions is not based on race/ethnicity. It also highlights the need for tobacco control policies that would limit disparities in exposure to retail marketing for cigarettes.

Hernandez M; DeGraff S; Suciu G; Perez A; Dodds J; Burton K. The Alcohol Perception (AP) Project: A study of the perceptions of adolescents toward alcohol. Journal of Child & Adolescent Substance Abuse 20(4): 351-357, 2011. (12 refs.)

Four million individuals under the age of 21 admit to consuming alcohol in any given month. This is a significant statistic considering alcohol is responsible for most health problems related to drugs among adolescents. Research has shown that the high influence of alcohol advertising may encourage adolescents to emulate the behaviors seen in alcohol commercials. Further, those who begin drinking before age 13 are seven times more likely to consume 4+ drinks at least 6 times a month. The authors sought to show causality between the positive social perception of alcohol and the ability to influence drinking behavior. Survey findings of the study suggest that adolescents are more likely to be influenced by those who drink than those who do not. Therefore, measures to change this perception (in order to avert addiction and disease) must be put in place at an early age, much as they are (at both the academic and professional level) for combating tobacco.

Jiang N; Ling PM. Reinforcement of smoking and drinking: Tobacco marketing strategies linked with alcohol in the United States. American Journal of Public Health 101(10): 1942-1954, 2011. (177 refs.)

Objectives. We investigated tobacco companies' knowledge about concurrent use of tobacco and alcohol, their marketing strategies linking cigarettes with alcohol, and the benefits tobacco companies sought from these marketing activities. Methods. We performed systematic searches on previously secret tobacco industry documents, and we summarized the themes and contexts of relevant search results. Results. Tobacco company research confirmed the association between tobacco use and alcohol use. Tobacco companies explored promotional strategies linking cigarettes and alcohol, such as jointly sponsoring special events with alcohol companies to lower the cost of sponsorships, increase consumer appeal, reinforce brand identity, and generate increased cigarette sales. They also pursued promotions that tied cigarette sales to alcohol purchases, and cigarette promotional events frequently featured alcohol discounts or encouraged alcohol use. Conclusions. Tobacco companies' numerous marketing strategies linking cigarettes with alcohol may have reinforced the use of both substances. Because using tobacco and alcohol together makes it harder to quit smoking, policies prohibiting tobacco sales and promotion in establishments where alcohol is served and sold might mitigate this effect. Smoking cessation programs should address the effect that alcohol consumption has on tobacco use.

Jones SC; Magee CA. Exposure to alcohol advertising and alcohol consumption among Australian adolescents. Alcohol and Alcoholism 46(5): 630-637, 2011. (42 refs.)

Aims: Underage drinking is a major problem in Australia and may be influenced by exposure to alcohol advertising. The objective of the present study was to collect data on 12-17 year old Australian adolescents' exposure to different types of alcohol advertising and examine the association between exposure to advertising and alcohol consumption. Methods: A cross-sectional survey of 1113 adolescents aged 12-17 years recruited with a variety of methods to gain a cross-section of participants across metropolitan, regional and rural New South Wales (including independent schools, mall intercepts and online). Participants answered a series of questions assessing adolescents' exposure to alcohol advertising across eight media (including television, Internet and point-of-sale). Alcohol consumption was assessed using three questions (initiation, recent consumption and frequency of consumption in the previous 12 months). Results: The majority indicated that they had been exposed to alcohol advertisements on television, in newspapers and magazines, on the Internet, on billboards/posters and promotional materials and in bottleshops, bars and pubs; exposure to some of these types of alcohol advertisements was associated with increased alcohol consumption, with differences by age and gender. Conclusion: The results are consistent with studies from other countries and suggest that exposure to alcohol advertisements among Australian adolescents is strongly associated with drinking patterns. Given current high levels of drinking among Australian youth, these findings suggest the need to address the high levels of young people's exposure to alcohol advertising.

Jones SC; Smith KM. The effect of point of sale promotions on the alcohol purchasing behaviour of young people in metropolitan, regional and rural Australia. Journal of Youth Studies 14(8): 885-900, 2011. (54 refs.)

This study, part of a larger project examining marketing and alcohol, looked specifically at the effects of point of sale (POS) promotions on young people, with a view to providing evidence which could be used to inform policy and regulation in this area. A series of focus groups were conducted in three different locations with young people aged 16-25 years, separated by age and gender, with a total of 85 participants. Participants were asked questions about their recollection of various POS promotions and the effect of these promotions on their alcohol purchasing and consumption behaviour. The majority of participants indicated a strong link between POS promotions and alcohol purchasing and consumption behaviour. A majority of participants demonstrated a strong recall of previous promotions and almost all participants indicated they had been influenced to buy more or a particular brand of alcohol because of a promotion. Specifically, the results of the study indicate that POS promotions involving price or volume discounts have a strong impact on young people, and are particularly effective in encouraging the purchase of increased volumes of alcohol, suggesting a need for regulation in this area.

Kaleta D; Usidame B; Polanska K. Tobacco advertisements targeted on women: Creating an awareness among women. Central European Journal of Public Health 19(2): 73-78, 2011. (30 refs.)

It has been always believed that men smoke more than women, but the trend of smoking in women is increasing nowadays. In some countries there are even more female smokers than male smokers. This is a major health risk because women are present and future mothers, and increasing number of smoking women will enlarge the number of exposed children. Relatively few women are aware of gender-specific health risks, including cervical cancer, osteoporosis, poor pregnancy outcome and early menopause. Tobacco related diseases are on the rise in women, considering the fact that more women now die of lung cancer than breast cancer. Tobacco companies have invented various ways to target women through tobacco advertising despite the various bans. This inevitably leads to the increase in female smoking rates. There are various recommendations from the World Health Organization which include the need for governments to pay particular attention to protect women from the tobacco companies' attempts to lure them into lifetimes of nicotine dependence and to take up counter advertisements against the tobacco companies.

Kasza KA; Hyland AJ; Brown A; Siahpush M; Yong HH; McNeill AD et al. The effectiveness of tobacco marketing regulations on reducing smokers' exposure to advertising and promotion: Findings from the International Tobacco Control (ITC) Four Country Survey. International Journal of Environmental Research and Public Health 8(2): 321-340, 2011. (20 refs.)

Exposure to tobacco product marketing promotes the initiation, continuation, and reuptake of cigarette smoking and as a result the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) has called upon member Parties to enact comprehensive bans on tobacco advertising and promotion. This study examines the immediate and long term effectiveness of advertising restrictions enacted in different countries on exposure to different forms of product marketing, and examines differences in exposure across different socioeconomic status (SES) groups. Nationally representative data from the United Kingdom, Canada, Australia, and the United States, collected from adult smokers between 2002 and 2008 using the International Tobacco Control Four Country Survey (ITC-4), were used in this study (N = 21,615). In light of the specific marketing regulation changes that occurred during the course of this study period, changes in awareness of tobacco marketing via various channels were assessed for each country, and for different SES groups within countries. Tobacco marketing regulations, once implemented, were associated with significant reductions in smokers' reported awareness of pro-smoking cues, and the observed reductions were greatest immediately following the enactment of regulations. Changes in reported awareness were generally the same across different SES groups, although some exceptions were noted. While tobacco marketing regulations have been effective in reducing exposure to certain types of product marketing there still remain gaps, especially with regard to in-store marketing and price promotions.

Kelly B; Baur LA; Bauman AE; King L. Tobacco and alcohol sponsorship of sporting events provide insights about how food and beverage sponsorship may affect children's health. Health Promotion Journal of Australia 22(2): 91-96, 2011. (48 refs.)

Issue addressed: Determining children's exposure to food and beverage company sponsorship, and the effect of this exposure, is important in establishing the extent to which there may be health and societal consequences. This paper aimed to provide preliminary evidence on the scope and potential effects on children of unhealthy food and beverage sponsorship. Methods: A review of published literature and media and marketing reports was conducted to determine the types of food and beverage sponsorship campaigns that children are exposed to, and the effect of corporate sponsorship (including tobacco and alcohol) on children and adolescents. Results: A large range of food and beverage sponsorship activities, in Australia and internationally, were identified for both school and sport settings. In particular, food and beverage companies have attempted to develop a marketing presence at all levels of professional and community sport. No information was identified measuring the effect of food and beverage company sponsorship on children and adolescents. However, empirical evidence from consumer studies relating to tobacco and alcohol sponsorship has repeatedly demonstrated that sponsorship has an impact on children's product recall and product-related attitudes and behavioural intentions. Conclusions: While there is no available research on the direct effect of food and beverage sponsorship, the demonstrated effects of tobacco and alcohol sponsorship on children's product awareness, preferences and consumption are likely to be applicable to food companies.

Killos LF; Hancock LC; McGann AW; Keller AE. Do "Clicker" educational sessions enhance the effectiveness of a social norms marketing campaign? Journal of American College Health 59(3): 228-230, 2011. (5 refs.)

Objective: Social norms campaigns are a cost-effective way to reduce high-risk drinking on college campuses. This study compares effectiveness of a "standard" social norms media (SNM) campaign for those with and without exposure to additional educational sessions using audience response technology ("clickers"). Methods: American College Health Association's National College Health Assessment questions are used to evaluate actual and perceived use. Additional survey questions assess individual exposure to the interventions. Results: The authors find "clicker" technology to be more effective than social norms poster media alone in reducing misperceptions of normative alcohol use for those students who attended clicker sessions. Conclusion: Poster SNM campaigns may be most effective when supported by group "clicker" heath-related sessions.

King JP; Davis TC; Bailey SC; Jacobson KL; Hedlund LA; Di Francesco L et al. Developing consumer-centered, nonprescription drug labeling: A study in acetaminophen. American Journal of Preventive Medicine 40(6): 593- 598, 2011. (19 refs.)

Background: In the U. S., acetaminophen overdose has surpassed viral hepatitis as the leading cause of acute liver failure, and misuse contributes to more than 30,000 hospitalizations annually. Half to two thirds of acetaminophen overdoses are unintentional, suggesting the root cause is likely poor understanding of medication labeling or failure to recognize the consequences of exceeding the recommended maximum daily dosage. Purpose: Elicit subject feedback about active ingredient and dosing information on over-the-counter (OTC) acetaminophen and elicit feedback on proposed plain-language text and icons. Methods: Six focus groups, preceded by individual interviews, were conducted in April 2010 among 45 adults in two cities from two clinics and an adult basic education center. The individual interviews evaluated knowledge of OTC pain relievers, attention to product label information and literacy level while the group discussion elicited preference for label messages and icons. Analyses were conducted from April to June 2010. Results: Forty-four percent read at or below the 6th-grade level. Individual interviews revealed that <50% of participants routinely examine product label information. Only 31% know acetaminophen is in Tylenol (R). The groups achieved consensus on a preferred icon for acetaminophen, desired explicit statement of potential liver damage in the warning against simultaneous use of acetaminophen products, and indicated preference for an icon and wording for maximum dose. Conclusions: With the high prevalence of OTC use, a consumer-centered approach to developing icons and messages to promote awareness and safe use of acetaminophen could benefit consumers.

Kotz D; Stapleton JA; Owen L; West R. How cost-effective is 'No Smoking Day'? Tobacco Control 20(4): 302-304, 2011. (10 refs.)

Objective. To obtain a more rigorous estimate of the cost-effectiveness of No Smoking Day (NSD), an annual UK-wide campaign to encourage smokers to quit, than has been possible hitherto. Design. Comparison of reported quit attempts in the month following NSD for three consecutive years with adjacent months using repeated national surveys of quit attempts. Setting. England. Participants. A total of 1309 adults who had smoked in the past year who responded to the surveys in the month following NSD (April 2007-2009) and a comparison group of 2672 adults who smoked in the past year who responded to the survey in the two adjacent months (March and May 2007-2009). Main outcome measures. The number of additional smokers who quit permanently in response to NSD was estimated from the survey results. The incremental cost-effectiveness ratio (ICER) was calculated by combining this estimate with established estimates of life years gained and the known costs of NSD. Results. The rate of quit attempts was 2.8 percentage points higher in the months following NSD (120/1309) compared with the adjacent months (170/2672; 95% CI 0.99% to 4.62%), leading to an estimated additional 0.07% of the 8.5 million smokers in England quitting permanently in response to NSD. The cost of NSD per smoker was (sic)0.088. The discounted life years gained per smoker in the modal age group 35-44 years was 0.00107, resulting in an ICER of (sic)82.24 (95% CI 49.7 to 231.6). ICER estimates for other age groups were similar. Conclusions. NSD emerges as an extremely cost-effective public health intervention.

Lovato C; Watts A; Stead LF. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. (review). Cochrane Database of Systematic Reviews 10: CD003439, 2011. (139 refs.)

Background: The tobacco industry denies that their marketing is targeted at young nonsmokers, but it seems more probable that tobacco advertising and promotion influences the attitudes of nonsmoking adolescents, and makes them more likely to try smoking. Objectives: To assess the effects of tobacco advertising and promotion on nonsmoking adolescents' future smoking behaviour. Search strategy We searched the Cochrane Tobacco Group specialized register, the Cochrane Central Register of Controlled Trials, MEDLINE, the Cochrane Library, Sociological Abstracts, PsycLIT, ERIC, WorldCat, Dissertation Abstracts, ABI Inform and Current Contents to August 2011. Selection criteria: We selected longitudinal studies that assessed individuals' smoking behaviour and exposure to advertising, receptivity or attitudes to tobacco advertising, or brand awareness at baseline, and assessed smoking behaviour at follow ups. Participants were adolescents aged 18 or younger who were not regular smokers at baseline. Data collection and analysis. Studies were prescreened for relevance by one reviewer. Two reviewers independently assessed relevant studies for inclusion. Data were extracted by one reviewer and checked by a second. Main results: Nineteen longitudinal studies that followed up a total of over 29,000 baseline nonsmokers met inclusion criteria. The studies measured exposure or receptivity to advertising and promotion in a variety of ways, including having a favourite advertisement or an index of receptivity based on awareness of advertising and ownership of a promotional item. One study measured the number of tobacco advertisements in magazines read by participants. All studies assessed smoking behaviour change in participants who reported not smoking at baseline. In 18 of the 19 studies the nonsmoking adolescents who were more aware of tobacco advertising or receptive to it, were more likely to have experimented with cigarettes or become smokers at follow up. There was variation in the strength of association, and the degree to which potential confounders were controlled for. Authors' conclusions: Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the likelihood that adolescents will start to smoke. Based on the strength and specificity of this association, evidence of a dose-response relationship, the consistency of findings across numerous observational studies, temporality of exposure and smoking behaviours observed, as well as the theoretical plausibility regarding the impact of advertising, we conclude that tobacco advertising and promotion increases the likelihood that adolescents will start to smoke.

Luke DA; Ribisl KM; Smith C; Sorg AA. Family Smoking Prevention and Tobacco Control Act banning outdoor tobacco advertising near schools and playgrounds. American Journal of Preventive Medicine 40(3): 295-302, 2011. (15 refs.)

Background: The tobacco industry has challenged new FDA rules restricting outdoor tobacco advertising near schools and playgrounds on First Amendment grounds, arguing that they would lead to a near complete ban on tobacco advertising in dense urban areas. Purpose: To examine how the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) rules banning outdoor tobacco advertising near schools and playgrounds would affect tobacco retailers. Methods: GIS spatial analyses of two different states (Missouri, New York), along with more detailed analyses of two urban areas within those states (St. Louis, New York City), were conducted in 2010. The percentage of tobacco retailers falling within 350-, 500-, and 1000-foot buffer zones was then calculated. Results: 22% of retailers in Missouri and 51% in New York fall within 1000-foot buffers around schools. In urban settings, more retailers are affected, 29% in St. Louis and 79% in New York City. Sensitivity analyses demonstrate that smaller buffers decrease the proportion of affected retailers. That is, 350-foot buffers affect only 6.7% of retailers in St. Louis and 29% in New York City. Conclusions: The effects of new outdoor tobacco advertising restrictions vary by location and population density. In Missouri and New York, outdoor tobacco advertising would still be permitted in many locations if such advertising was prohibited in a 1000-foot buffer zone around schools and playgrounds. Much smaller buffer zones of 350 feet may result in almost no reduction of outdoor advertising in many parts of the country.

Lyons A; McNeill A; Gilmore I; Britton J. Alcohol imagery and branding, and age classification of films popular in the UK. International Journal of Epidemiology 40(5): 1411-1419, 2011. (51 refs.)

Background: Exposure to alcohol products in feature films is a risk factor for use of alcohol by young people. This study was designed to document the extent to which alcohol imagery and brand appearances occur in popular UK films, and in relation to British Board of Film Classification (BBFC) age ratings intended to protect children and young people from harmful imagery. Methods Alcohol appearances (classified as 'alcohol use, inferred alcohol use, other alcohol reference and alcohol brand appearances') were measured using 5-min interval coding of 300 films, comprising the 15 highest grossing films at the UK Box Office each year over a period of 20 years from 1989 to 2008. Results: At least one alcohol appearance occurred in 86% of films, at least one episode of alcohol branding in 35% and nearly a quarter (23%) of all intervals analysed contained at least one appearance of alcohol. The occurrence of 'alcohol use and branded alcohol appearances' was particularly high in 1989, but the frequency of these and all other appearance categories changed little in subsequent years. Most films containing alcohol appearances, including 90% of those including 'alcohol brand appearances', were rated as suitable for viewing by children and young people. The most frequently shown brands were American beers: Budweiser, Miller and Coors. Alcohol appearances were similarly frequent in films originating from the UK, as from the USA. Conclusion: Alcohol imagery is extremely common in all films popular in the UK, irrespective of BBFC age classification. Given the relationship between exposure to alcohol imagery in films and use of alcohol by young people, we suggest that alcohol imagery should be afforded greater consideration in determining the suitability of films for viewing by children and young people.

Mart SM. Alcohol marketing in the 21st Century: New methods, old problems. Substance Use & Misuse 46(7): 889-892, 2011. (19 refs.)

Marketing and advertising for alcoholic beverages is abundant throughout the United States and the rest of the world. Despite the fact that alcohol advertising is related to earlier initiation of drinking, higher rates of consumption, and positive expectancies among youth populations, alcohol companies continue to design new products and related campaigns with youth-friendly attributes. Alcopops and caffeinated alcoholic beverages are two particularly dangerous types of products, and new social networking technologies make direct promotion easy and voluminous. In order to stop the harm from these alcohol products and promotion, advocacy from the research community is imperative.

McNeill A; Lewis S; Quinn C; Mulcahy M; Clancy L; Hastings G et al. Evaluation of the removal of point-of-sale tobacco displays in Ireland. Tobacco Control 20(2): 137-143, 2011. (36 refs.)

Aim: To evaluate the short-term impacts of removing point-of-sale tobacco displays in Ireland, implemented in July 2009. Methods: Retailer compliance was assessed using audit surveys in 2007, 2008 and 2009. Using a monthly survey of 1000 adults carried out since 2002, changes in smoking prevalence were assessed; attitudes were measured using extra questions added for a 10-month period before and after the law. Youth responses were assessed using a cohort of 180 13-15 year olds, interviewed in June and August 2009. Results Immediately following implementation, compliance was 97%. Support for the law increased among adults after implementation (58% Apr-Jun vs 66% Jul-Dec, p<0.001). Recall of displays decreased significantly for adults (49% to 22%; p<0.001), more so among teenagers (81% to 22%; p<0.001). There were no significant short-term changes in prevalence among youths or adults. The proportion of youths believing more than a fifth of children their age smoked decreased from 62% to 46%, p<0.001). Post-legislation, 14% of adult smokers thought the law had made it easier to quit smoking and 38% of teenagers thought it would make it easier for children not to smoke. Conclusions: Compliance was very high and the law was well supported. Recall of displays dropped significantly among adults and teenagers post-legislation and there were encouraging signs that the law helped de-normalise smoking.

Miller PG; de Groot F; McKenzie S; Droste N. Vested interests in addiction research and policy: Alcohol industry use of social aspect public relations organizations against preventative health measures. Addiction 106(9): 1560-1567, 2011. (40 refs.)

Aim: It has been proposed that alcohol industry 'social aspects/public relations' organizations (SAPROs) serve the agenda of lending credibility to industry claims of corporate responsibility while promoting ineffective industry-friendly interventions (such as school-based education or TV advertising campaigns) and creating doubt about interventions which have a strong evidence base (such as higher taxes on alcoholic beverages). This paper investigated whether submissions to Australia's National Preventative Health Taskforce (NPHT) from alcohol industry bodies regarding the Australian SAPRO, Drinkwise, have used this organization to demonstrate corporate responsibility while promoting industry-friendly interventions. Method: Submissions to the Australian National Preventative Health Taskforce (NPHT) discussion paper Australia, the healthiest country by 2020 (n = 375) were examined to identify those with primary alcohol content. A thematic analysis of the resulting 33 submissions was conducted to determine which organization, institution or individual discussed Drinkwise. Setting: Australia. Findings Nine of the 33 submissions discussed Drinkwise; all were submitted by the alcohol industry or its affiliates. Every industry submission referred to Drinkwise either as providing evidence of social responsibility or by suggesting the industry-friendly actions of Drinkwise as alternatives to those recommended by the NPHT report. Conclusions: Drinkwise has been used by the alcohol industry to create an impression of social responsibility while promoting interventions that maintain profits and campaigning against effective interventions such as higher taxes on alcohol.

Miller CL; Quester PG; Hill DJ; Hiller JE. Smokers' recall of Australian graphic cigarette packet warnings & awareness of associated health effects, 2005-2008. BMC Public Health 11: e238, 2011. (32 refs.)

Background: In 2006, Australia introduced graphic cigarette packet warnings. The new warnings include one of 14 pictures, many depicting tobacco-related pathology. The warnings were introduced in two sets; Set A in March and Set B from November. This study explores their impact on smokers' beliefs about smoking related illnesses. This study also examines the varying impact of different warnings, to see whether warnings with visceral images have greater impact on smokers' beliefs than other images. Methods: Representative samples of South Australian smokers were interviewed in four independent cross-sectional omnibus surveys; in 2005 (n = 504), 2006 (n = 525), 2007 (n = 414) and 2008 (n = 464). Results: Unprompted recall of new graphic cigarette warnings was high in the months following their introduction, demonstrating that smokers' had been exposed to them. Smokers also demonstrated an increase in awareness about smoking-related diseases specific to the warning messages. Warnings that conveyed new information and had emotive images demonstrated greater impact on recall and smokers' beliefs than more familiar information and less emotive images. Conclusions: Overall graphic pack warnings have had the intended impact on smokers. Some have greater impact than others. The implications for policy makers in countries introducing similar warnings are that fresh messaging and visceral images have the greatest impact.

Morgenstern M; Isensee B; Sargent JD; Hanewinkel R. Attitudes as mediators of the longitudinal association between alcohol advertising and youth drinking. Archives of Pediatrics & Adolescent Medicine 165(7): 610-616, 2011. (26 refs.)

Objective: To test the hypothesis that changes in alcohol-related attitudes and expectancies mediate the effect of alcohol advertising on youth drinking. Design: Longitudinal survey with a 9-month interval. Setting: Twenty-nine public schools in 3 German states. Participants: A total of 2130 sixth-to eighth-grade students (age range, 11-17 years; mean, 12.2 years) who were nondrinkers at baseline. Main Exposures: Exposure to alcohol and nonalcohol advertising was measured at baseline with masked images of 17 commercial advertisements with all brand information digitally removed; students indicated contact frequency and brand names. Outcome Measures: Positive attitudes toward alcohol, current alcohol use, lifetime binge drinking. Results: A total of 581 of the students (28%) started to drink alcohol during the observation period. Alcohol use initiation was positively related to baseline alcohol advertisement exposure. This effect of alcohol advertisement exposure on alcohol use was partially mediated by a change in alcohol-related attitudes, which explained about 35% of the total effect after controlling for baseline covariates and exposure to other advertising contents. The analysis revealed similar results for binge-drinking initiation. Conclusion: More favorable attitudes about alcohol may be one path through which alcohol advertising exerts behavioral influence.

Munafo MR; Roberts N; Bauld L; Leonards U. Plain packaging increases visual attention to health warnings on cigarette packs in non-smokers and weekly smokers but not daily smokers. Addiction 106(8): 1505-1510, 2011. (12 refs.)

Aims: To assess the impact of plain packaging on visual attention towards health warning information on cigarette packs. Design: Mixed-model experimental design, comprising smoking status as a between-subjects factor, and package type (branded versus plain) as a within-subjects factor. Setting University laboratory. Participants Convenience sample of young adults, comprising non-smokers (n = 15), weekly smokers (n = 14) and daily smokers (n = 14). Measurements Number of saccades (eye movements) towards health warnings on cigarette packs, to directly index visual attention. Findings Analysis of variance indicated more eye movements (i.e. greater visual attention) towards health warnings compared to brand information on plain packs versus branded packs. This effect was observed among non-smokers and weekly smokers, but not daily smokers. Conclusion: Among non-smokers and non-daily cigarette smokers, plain packaging appears to increase visual attention towards health warning information and away from brand information.

Nelson JP. Alcohol marketing, adolescent drinking and publication bias in longitudinal studies: A critical survey using meta-analysis. Journal of Economic Surveys 25(2): 191-232, 2011. (85 refs.)

This paper presents a meta-analysis of prospective cohort (longitudinal) studies of alcohol marketing and adolescent drinking, which accounts for publication bias. The paper provides a summary of 12 primary studies of the marketing-drinking relationship. Each primary study surveyed a sample of youth to determine baseline drinking status and marketing exposure, and re-surveyed the youth to determine subsequent drinking outcomes. Logistic analyses provide estimates of the odds ratio for effects of baseline marketing variables on adolescent drinking at follow-up. Using meta-regression analysis, two samples are examined in this paper: 23 effect-size estimates for drinking onset (initiation); and 40 estimates for other drinking behaviours (frequency, amount, bingeing). Marketing variables include ads in mass media, promotion portrayals, brand recognition and subjective evaluations by survey respondents. Publication bias is assessed using funnel plots that account for 'missing' studies, bivariate regressions and multivariate meta-regressions that account for primary study heterogeneity, heteroskedasticity, data dependencies, publication bias and truncated samples. The empirical results are consistent with publication bias, omitted variable bias in some studies, and lack of a genuine effect, especially for mass media. The paper also discusses 'dissemination bias' in the use of research results by primary investigators and health policy interest groups.

Niederdeppe J; Farrelly MC; Nonnemaker J; Davis KC; Wagner L. Socioeconomic variation in recall and perceived effectiveness of campaign advertisements to promote smoking cessation. Social Science & Medicine 72(5): 773- 780, 2011. (38 refs.)

There are large disparities in cigarette smoking rates by socioeconomic status (SES) in many countries. There is mixed evidence about the relative effectiveness of smoking cessation media campaigns in promoting quitting between lower and higher SES populations, and studies suggest that some types of ad content may have differential effects by SES. We analyzed data from five waves of the New York Media Tracking Survey Online (MTSO), a web survey involving over 7000 adult smokers conducted between 2007 and 2009, to assess SES variation in response to smoking cessation ads. Smokers with low levels of education and income less often recalled ads focused on how to quit, and perceived them as less effective, than ads using graphic imagery or personal testimonials to convey why to quit. Contrary to predictions offered by the Stages of Change Model, we found no evidence that variation in readiness to quit smoking explained patterns of response by education. Results offer guidance for theorists and campaign planners in developing campaigns that are likely to promote cessation among less educated populations.

Niesen M. Public enemy number one: The US Advertising Council's first drug abuse prevention campaign. Substance Use & Misuse 46(7): 872-881, 2011. (27 refs.)

This article explores the Advertising Council's first national drug abuse prevention campaign in the 1970s. Scholarship thus far has demonstrated the ways in which the issue of drug abuse represented a chief political strategy for President Nixon. Evidence from major trade press publications, congressional hearings, and an array of archival sources suggest that this campaign was also part of a public relations crusade on behalf of the advertising industry in response to public criticism of its role in abetting a culture of drug dependence. These institutional and political pressures helped shape drug abuse prevention in the 1970s and for the decades that followed.

O'Brien KS; Miller PG; Kolt GS; Martens MP; Webber A. Alcohol industry and non-alcohol industry sponsorship of sportspeople and drinking. Alcohol and Alcoholism 46(2): 210-213, 2011. (33 refs.)

Aims: To examine the relationship between direct alcohol and non-alcohol sponsorship and drinking in Australian sportspeople. Methods: Australian sportspeople (N = 652; 51% female) completed questionnaires on alcohol and non-alcohol industry sponsorship (from bars, cafes etc.), drinking behaviour (Alcohol Use Disorders Identification Test (AUDIT)) and known confounders. Results: 31% reported sponsorship (29.8% alcohol industry; 3.7% both alcohol and non-alcohol industry and 1.5% non-alcohol industry only) Multivariate regression showed that receipt of alcohol industry sponsorship was predictive of higher AUDIT scores (beta(adj) = 1.67, 95% confidence interval (CI): 0.56-2.78), but non-alcohol industry sponsorship and combinations of both were not (beta(adj) = 0.18, 95% CI: -2.61 to 2.68; and beta(adj) = 2.58, 95% CI: -0.60 to 5.76, respectively). Conclusion: Governments should consider alternatives to alcohol industry sponsorship of sport. Hypothecated taxes on tobacco have been used successfully for replacing tobacco sponsorship of sport in some countries, and may show equal utility for the alcohol industry's funding of sport.

Park HS; Smith SW; Klein KA; Martell D. College students' estimation and accuracy of other students' drinking and believability of advertisements featured in a social norms campaign. Journal of Health Communication 16(5): 504-518, 2011. (52 refs.)

Social norms campaigns, which are based on correcting misperceptions of alcohol consumption, have frequently been applied to reduce college students' alcohol consumption. This study examined estimation and accuracy of normative perceptions for students during everyday drinking occasions. Students who reported having 4 or fewer drinks underestimated the percentage of other students who had 4 or fewer drinks, while those who drank 5 or more drinks overestimated the percentage of other students who had 5 or more drinks. Believability of advertisements featured in social norms campaigns also played a crucial role in this process. Those who believed the ad more closely estimated alcohol consumption by their peers while ad believability moderated the relation between drinking behaviors and accuracy.

Planinac LC; Cohen JE; Reynolds J; Robinson DJ; Lavack A; Korn D. Lottery promotions at the point-of-sale in Ontario, Canada. Journal of Gambling Studies 27(2): 345-354, 2011. (27 refs.)

We documented the extent of point-of-sale (POS) lottery promotions in Ontario, Canada and the relationship between lottery promotions and store and city characteristics. This is the first quantitative study of POS lottery promotions. A total of 366 stores-independent and chain convenience stores, gas stations and grocery stores-were visited across 20 cities in Ontario. Data collectors unobtrusively observed the type of lottery promotions in each store and completed a data collection checklist. A lottery promotion index was created and hierarchical linear modeling (HLM) was conducted to examine the relationship between extent of lottery promotions and independent variables such as neighbourhood socioeconomic status and city prevalence of lottery ticket purchasing. POS lottery promotions were widespread across Ontario, with the highest level of promotion found in independent convenience stores. In the multivariable HLM model, none of the remaining independent variables remained statistically significant, except for store type. Lottery promotions are extensive at the POS in Ontario. These findings can help initiate discussions around the appropriateness and possible future regulation of this form of advertising.

Quinn C; Lewis S; Edwards R; McNeill A. Economic evaluation of the removal of tobacco promotional displays in Ireland. Tobacco Control 20(2): 151-155, 2011. (25 refs.)

Aim: To evaluate the short-term economic impact of legislation removing point of sale tobacco promotional displays (ie, tobacco displays and other point of sale tobacco advertising) in Ireland, implemented July 2009, on cigarette sales across a range of categories of retail outlets. Methods: Cigarette sales were evaluated using scanning (weekly data since January 2006) and audit data (bimonthly since November 2007) within different retail categories using data sourced from AC Nielsen, Ireland. Visual inspection and time-series regression techniques were used where appropriate to assess changes in sales over time and in relation to the legislation. Results: No change was observed in sales data in any retail category over and above seasonal patterns and an underlying downward trend over time. Similarly, where available data enabled statistical analysis, there was no significant effect in the short term (up to 12 months after implementation) on retail sales of tobacco products, over and above seasonal and long-term trends. Conclusions: Recent claims of substantial revenue losses and closures of small retailers as a direct result of the removal of point of sale tobacco promotional displays in Ireland are not borne out by these data. The removal of point of sale displays is aimed at reducing the pernicious effects of tobacco advertising on children and is therefore likely to have an impact on sales over a much more protracted time period. This should enable retailers to adapt over time, perhaps using such regulations as an opportunity to play a role in promoting healthier products in the local community.

Ridner SL; Myers JA; Hahn EJ; Ciszewski TN. College students' exposure to tobacco marketing in nightclubs and bars. Journal of American College Health 59(3): 159-164, 2011. (33 refs.)

Objective: To examine whether a college student's exposure to tobacco marketing in nightclubs and bars was affected by the presence of a smoke-free law. Participants: A random sample (N = 478) of students participated in the survey (no smoke-free law, n = 240; smoke-free law, n = 238). The analysis was limited to students who reported being in nightclubs and bars (n = 171). Methods: A nonexperimental, cross-sectional, 2-group design was used. Results: Students in the smoke-free law city were more likely to be approached by tobacco marketers (34.7% versus 20.2%, p = .02), offered free gifts (41.7% versus 24.2%, p = .02), and take free gifts for themselves (34.7% versus 19.2%, p = .02). They were more likely to be exposed to direct marketing strategies (1.83 versus 1.12, p = .02). There was no difference on indirect tobacco marketing by site. Conclusions: Tobacco marketing is pervasive in nightclubs and bars. Smoke-free laws may protect against exposure to secondhand smoke but not the "pro" smoking messages students encounter.

Ross L. Sustaining youth participation in a long-term tobacco control initiative: Consideration of a social justice perspective. Youth & Society 43(2, special issue): 681- 704, 2011. (45 refs.)

This article presents an in-depth case study of the Healthy Options for Prevention and Education Coalition's Teens Tackle Tobacco initiative, a 3-year community-based participatory research (CBPR) project about the distribution of tobacco vendors and tobacco advertising in Worcester, Massachusetts. Using two theoretical frameworks, positive youth development (PYD) and social justice youth development (SJYD), the case reveals personal and community conditions that drove youth to get engaged in this project, how CBPR guided the group's research and action strategy, and results of the work to date. Analysis of this case highlights factors that facilitate and pose barriers to active youth involvement in a long-term, tobacco-related community change initiative. Specifically, to affect oppressive community conditions, a blend of PYD's focus on individual skill building, participation, and empowerment-joined with SJYD emphasis on community organizing and building youth's self-awareness of how race, class, and other dimensions of power affect their lives on a daily basis-is needed.

Sandberg H; Gidlof K; Holmberg N. Children's exposure to and perceptions of online advertising. International Journal of Communication 5: 21-50, 2011. (41 refs.)

The popularity of the Internet and marketers' increased investments in Internet advertising have raised some questions concerning a marketer's power to influence children and young people's consumption through new media technology. This article, based on a recent explorative study of 15-year-old Swedish teenagers, aims to discuss their exposure-potential, actual, and perceived-to online advertising. Eye movements of these teenagers were measured while surfing the Internet for 15 minutes. The results suggest that teenagers are exposed to 10% of all the potential advertisements, but they are mainly unaware of this actual exposure. Food advertisements had the highest impact in this study. Our research also indicates substantial gender differences in actual exposure to advertising. Boys are exposed between 30% and 60% more to advertisements in some categories (gambling, ad links, lifestyle, and recreation) than girls.

Sawyer AL; Wolfenden L; Kennedy VJ; Kingsland M; Young KG; Tindall J et al. Alcohol sponsorship of community football clubs: The current situation. Health Promotion Journal of Australia 23(1): 70-72, 2012. (23 refs.)

Issue addressed: There is accumulating evidence supporting a link between alcohol industry sponsorship and alcohol-related problems in both community and elite-level sports. Little is known, however, about the current status of such sponsorship, particularly of community sport. This study aimed to assess associations between alcohol industry sponsorship and different community football clubs in Australia. Methods: The study involved 101 community football clubs across New South Wales, Australia. One representative from each club took part in a cross-sectional telephone survey designed to assess club (football code, number of players, socioeconomic and geographic descriptors) and alcohol industry sponsorship (money, equipment, free alcohol or discounted alcohol) characteristics. Chi-square analysis was used to test associations between club characteristics, and: i) any alcohol industry sponsorship; and H) type of sponsorship. Results: Eighty-eight per cent of clubs reported receiving sponsorship from the alcohol industry, and most clubs (82%) were sponsored by a licensed premises. There were no significant associations between club characteristics and source of alcohol industry sponsorship. However, small clubs were found to be significantly more likely to receive free or discounted alcohol sponsorship than larger clubs (p=0.05). Conclusions: This exploratory study suggests a significant presence of alcohol industry sponsorship among community football clubs in Australia.

Schoffl I; Kothmann JF; Schoffl V; Rupprecht HD; Rupprecht T. "Vodka Energy": Too much for the adolescent nephron? Pediatrics 128(1): E227-E231, 2011. (20 refs.)

We report here the case of a 17-year-old boy who suffered acute renal failure after consuming 3 L of energy drink (ED) in combination with 1 L of vodka amounting to 4600 mg of taurine and 780 mg of caffeine mixed with 380 g of alcohol. The consumption of this mixture is extremely popular in adolescents, because the joint effects of caffeine and taurine reduce the effect of alcohol. Although there have been case reports of deaths linked to the consumption of EDs with and without alcohol, awareness of the possible dangers is still low. The fact that athletes and major sports events are sponsored by ED manufacturers implies that they may even be healthy and performance-enhancing.

Shahrir S; Wipfli H; Avila-Tang E; Breysse PN; Samet JM; Navas-Acien A. Tobacco sales and promotion in bars, cafes and nightclubs from large cities around the world. Tobacco Control 20(4): 285-290, 2011. (22 refs.)

Context. Little is known about tobacco promotion activities in low and middle-income countries. Information on tobacco sales, advertisement and promotion in bars, cafes and nightclubs is needed to develop interventions to reduce smoking initiation and relapse, particularly among youths and young adults. Objective. To evaluate cigarette sales and tobacco advertisement and promotion in bars, cafes and nightclubs using a volunteer survey approach in large cities throughout the world. Methods. Between 2007 and 2009, we administered an interview-based survey to 231 bar/cafe/nightclub owners/managers in 24 large cities in Africa, the Americas, Asia and eastern Europe. Results. Cigarette sales and tobacco advertisement and promotions were found in bars/cafes/nightclubs in most cities. Examples of promotions included cigarette giveaways and event sponsorship. Establishments that allowed smoking were more likely to sell cigarettes compared to smoke-free establishments (OR 8.67, 95% CI 3.25 to 23.1). Larger establishments (maximum occupancy >= 100 vs <100 customers) were more likely to have tobacco advertising (OR 4.35, 95% CI 2.04 to 9.24) and to receive promotional items from tobacco companies (OR 3.18, 95% CI 1.41 to 7.17). Conclusions. Cigarette sales and tobacco promotions were common in bars, cafes and nightclubs in the majority of cities. Socialising and hospitality venues must be covered by legislation banning tobacco sales and promotions to limit exposure among populations at high risk of tobacco initiation and relapse from quitting.

Stacy S. Relaxation drinks and their use in adolescents. Journal of Child and Adolescent Psychopharmacology 21(6): 605-610, 2011. (46 refs.)

Objectives: A new class of beverages called relaxation drinks advertises calming effects and an easy way to wind down when life gets stressful. This article examines these drinks in the context of their use in adolescents. Methods: A review of the literature relevant to relaxation drinks and their functional ingredients was conducted. Results: The beverages contain ingredients such as melatonin, valerian, kava, tryptophan, and other products traditionally thought to play a role in sleep, sedation, or neurocognitive function. Studies of the efficacy and safety of these supplements are limited and many have significant methodological limitations. Despite appropriate warnings placed on the labels of relaxation drinks, marketing is cleverly designed to appeal to young consumers and often evokes the experiences produced by alcohol and drug use. Conclusion: Although moderate consumption of these beverages by healthy individuals is likely safe, an objective reduction in stress is improbable and associated adverse effects are possible.

Stewart HS; Bowden JA; Bayly MC; Sharplin GR; Durkin SJ; Miller CL et al. Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers. Health Education Research 26(6): 961-975, 2011. (33 refs.)

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average, Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.

Terry-McElrath YM; Emery S; Szczypka G; Johnston LD. Potential exposure to anti-drug advertising and drug-related attitudes, beliefs, and behaviors among United States youth, 1995-2006. Addictive Behaviors 36(1-2): 116-124, 2011. (32 refs.)

Using nationally representative data from the Monitoring the Future Study on United States middle and high school students, we related exposure to anti-drug television advertising as measured by Nielsen Media Research ratings points, to student self reported drug-related outcomes from 1995 to 2006. Multivariate analyses controlling for key socio-demographics and accounting for the complex survey design included 337,918 cases. Results indicated that attitudes beliefs and behaviors regarding substance use were significantly related to such advertising exposure over the six months prior to the date the youth were surveyed. However the observed relationships varied by grade level over time and by advertising tagline and marijuana focus. Findings differed markedly between middle and high school students across the study. Interval One factor that may partially explain observed differences may be variation in the degree to which the ads focused on marijuana. Putting a concerted effort into increasing anti-drug advertising will likely increase the exposure to and recall of such ads among youth. However the likelihood that such advertising will result in youth being less likely to use drugs seems to depend heavily on the type of advertising utilized and how it relates to different ages and characteristics of targeted youth.

Tobler AL; Livingston MD; Komro KA. Racial/ethnic differences in the etiology of alcohol use among urban adolescents. Journal of Studies on Alcohol and Drugs 72(5): 799-810, 2011. (61 refs.)

Objective: We examined relations between neighborhood context, home and family management practices, deviant peer affiliations, beliefs favorable to use, and alcohol use among urban African American and Hispanic adolescents. Method: The sample comprised 4,027 African American and Hispanic adolescents who were 50% boys and 75% low income. Participants completed surveys in 2002-2005 and 2008-2009. Structural equation modeling assessed direct and indirect relations between neighborhood context in 6th grade, home and family management practices in 7th grade, deviant peer affiliations and beliefs favorable to use in 8th grade, and alcohol use in 12th grade. Results: There was significant variation in structural models across race/ethnicity but not gender. Differences included the influence of neighborhood and school strength and, where similarities existed, differences in effect magnitude. Similarities included significant correlations among measurement components; the indirect influence of alcohol advertisement exposure, gender, area deprivation, and home alcohol access on alcohol use; direct influence of deviant peer affiliations and beliefs favorable to use on alcohol use; and indirect effects highlighting the importance of preventing home alcohol access, deviant peer affiliations, and beliefs favorable to use and promoting protective family management practices. Conclusions: Neighborhood and school strength may be particularly important in preventing alcohol use among African Americans, whereas preventing early onset of alcohol use among Hispanics remains important. Preventive efforts may wish to focus on neighborhood deprivation, exposure to alcohol advertisements, and home risks and protective factors because they have direct and indirect effects on intrapersonal factors and alcohol use.

Vallone DM; Duke JC; Cullen J; McCausland KL; Allen JA. Evaluation of EX: A national mass media smoking cessation campaign. American Journal of Public Health 101(2): 302-309, 2011. (28 refs.)

Objectives. We used longitudinal data to examine the relationship between confirmed awareness of a national, branded, mass media smoking cessation campaign and cessation outcomes. Methods. We surveyed adult smokers (n=4067) in 8 designated market areas ("media markets") at baseline and again approximately 6 months later. We used multivariable models to examine campaign effects on cognitions about quitting, quit attempts, and 30-day abstinence. Results. Respondents who demonstrated confirmed awareness of the EX campaign were significantly more likely to increase their level of agreement. on a cessation-related cognitions index from baseline to follow-up (odds ratio [OR]=1.6; P=.046). Individuals with confirmed campaign awareness had a 24% greater chance than did those who were not aware of the campaign of making a quit attempt between baseline and follow-up (OR=1.24; P=.048). Conclusions. A national, branded, mass media smoking cessation campaign can change smokers' cognitions about quitting and increase quit attempts. We strongly recommend that federal and state governments provide funding for media campaigns to increase smoking cessation, particularly for campaigns that have been shown to impact quit attempts and abstinence.

Villanti A; Boulay M; Juon HS. Peer, parent and media influences on adolescent smoking by developmental stage. Addictive Behaviors 36(1-2): 133-136, 2011. (32 refs.)

Previous studies of social influences on adolescent smoking have focused on peers and parents using data collected prior the 1998 Master Settlement Agreement. This study used the 2004 wave of the National Youth Tobacco Survey to examine associations between peer smoking, smoking at home, tobacco related media exposure, and smoking behavior during early and middle adolescence. Findings indicate that peer smoking and smoking at home remain strongly associated with current smoking among early and middle adolescents controlling for gender race/ethnicity and exposure to tobacco industry and anti-tobacco media. The magnitude of the association between peer smoking and current smoking decreases from early adolescence to middle adolescence while the association between smoking at home and current smoking is static across developmental stage. Exposure to tobacco-related media is associated with increased current and former smoking in both early and middle adolescence.

Vollstadt-Klein S; Kobiella A; Buhler M; Graf C; Fehr C; Mann K et al. Severity of dependence modulates smokers' neuronal cue reactivity and cigarette craving elicited by tobacco advertisement. Addiction Biology 16(1): 166-175, 2011. (38 refs.)

Smoking-related cues elicit craving and mesocorticolimbic brain activation in smokers. Severity of nicotine dependence seems to moderate cue reactivity, but the direction and mechanisms of its influence remains unclear. Although tobacco control policies demand a ban on tobacco advertising, cue reactivity studies in smokers so far have not employed tobacco advertisement as experimental stimuli. We investigated whether tobacco advertisement elicits cue reactivity at a behavioral (subjective craving) and a neural level (using functional magnetic resonance imaging) in 22 smokers and 21 never-smokers. Moreover, we studied the influence of severity of dependence on cue reactivity. In smokers, tobacco advertisement elicited substantially more craving than control advertisement whereas never-smokers reported no cue induced craving. Surprisingly, neuronal cue reactivity did not differ between smokers and never-smokers. Moderately dependent smokers' craving increased over the course of the experiment, whereas highly dependent smokers' craving was unaffected. Moderately dependent smokers' brain activity elicited by tobacco advertisement was higher in the amygdala, hippocampus, putamen and thalamus compared with highly dependent smokers. Furthermore, limbic brain activation predicted picture recognition rates after the scanning session, even in never-smokers. Our findings show that tobacco advertisement elicits cigarette craving and neuronal cue reactivity primarily in moderately dependent smokers, indicating that they might be particularly responsive towards external smoking-related cues. On the other hand, neuronal cue reactivity and cigarette craving in highly dependent smokers is more likely triggered by internal cues such as withdrawal symptoms. Tobacco advertisement seems to likewise appeal to smokers and non-smokers, clarifying the potential danger especially for young non-smokers.

Wackowski OA; Lewis MJ; Delnevo CD. Qualitative analysis of Camel Snus' website message board-users' product perceptions, insights and online interactions. Tobacco Control 20(2): E1-E5, 2011. (26 refs.)

Background: In 2006, RJ Reynolds began test-marketing Camel Snus, a new smokeless tobacco (SLT) product. Promotion included use of a brand website, a relatively new marketing channel used by tobacco companies, which allowed visitors to learn about the product and discuss it with others on the website's message board. Our study aimed to examine early experiences with and perceptions of Camel Snus as described by board contributors and also to consider the use and benefits of the message board for both consumers and the company. Methods: We conducted a qualitative analysis, coding each message in Atlas. Ti and analysing it for emerging themes and patterns. Messages were also coded for demographic information where evident, such as tobacco use status and geographical location. Descriptive data and illustrative quotes are presented. Results: Board participants described being introduced to Camel Snus through free samples. Favourable evaluations were posted by current smokers who had never tried SLT before as well as current users of other SLT brands. Messages indicated both initiation of dual product use among smokers and product substitution. Participants used the board to advise each other on how to use the product, where to get more, suggest ways RJ Reynolds could improve the product and to encourage RJ Reynolds to release it nationally. Discussion: Camel Snus has appeal for at least some smokers and SLT users. Camel Snus' website message board may have been a doubly beneficial marketing feature in both connecting product users and providing product feedback to the company during test-marketing.

Wade B; Merrill RM; Lindsay GB. Cigarette pack warning labels in Russia: How graphic should they be? European Journal of Public Health 21(3): 366-372, 2011. (37 refs.)

Methods: Nationally representative data were collected from 1778 participants in the Russian Federation in October 2009. A cross-sectional survey was conducted through person-to-person household interviews with respondents aged epsilon 14 years. Survey questions included standard demographic queries and three study-specific questions. Participants rated the strength of 13 cigarette warning labels according to their effectiveness to deter from smoking. Smoking status and the population's acceptance of similar warning labels was also measured. Results: A dose-response pattern is apparent between the degree of graphic content of cigarette warning labels and the public's perception regarding the warning label's ability to discourage smoking. Approximately 87% of all respondents thought Russian authorities should require tobacco manufacturers to place graphic warning labels on cigarette packs, while 80% of current smokers wanted their government to enact such enforcement. Conclusion: The Russian population would strongly support government policy that would require graphic warning labels to be placed on cigarette packs in their country. In order to best deter from smoking, future cigarette warning labels in Russia should be as graphic as possible.

Wakefield MA; Spittal MJ; Yong HH; Durkin SJ; Borland R. Effects of mass media campaign exposure intensity and durability on quit attempts in a population-based cohort study. Health Education Research 26(6): 988-997, 2011. (33 refs.)

Methods: Using advertising gross rating points (GRPs), we estimated exposure to tobacco control and nicotine replacement therapy (NRT) advertising in the 3, 4-6, 7-9 and 10-12 months prior to follow-up of a replenished cohort of 3037 Australian smokers during 2002-08. Using generalized estimating equations, we related the intensity and timing of advertising exposure from each source to the likelihood of making a quit attempt in the 3 months prior to follow-up. Results: Tobacco control advertising in the 3-month period prior to follow-up, but not in more distant past periods, was related to a higher likelihood of making a quit attempt. Each 1000 GRP increase per quarter was associated with an 11% increase in making a quit attempt [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.03-1.19, P = 0.009)]. NRT advertising was unrelated to quit attempts. Conclusions: Tobacco control advertising emphasizing the serious harms of smoking is associated with short-term increases in the likelihood of smokers making a quit attempt. Repeated cycles of higher intensity tobacco control media campaigns are needed to sustain high levels of quit attempts.

West R. Preventing tobacco companies from advertising using their packaging could be an important component of comprehensive tobacco control: A commentary on Australia's plain packaging of cigarettes. (editorial). Drug and Alcohol Review 30(6): 681-682, 2011. (8 refs.)

Widome R; Brock B; Klein EG; Forster JL. Smokeless tobacco advertising at the point of sale: Prevalence, placement, and demographic correlates. Nicotine & Tobacco Research 14(2): 217-223, 2012. (26 refs.)

We aimed to describe the prevalence, in-store location, and neighborhood predictors of point-of-sale smokeless tobacco advertising. In 2007, we conducted assessments of smokeless tobacco advertising at the point of sale in 484 establishments, which held tobacco licenses and sold tobacco products in a Midwest metropolitan area. Associations between store characteristics, neighborhood characteristics (based on U.S. 2000 census block groups), and smokeless tobacco advertising were calculated. Advertisements for smokeless tobacco were found in 21% (n = 103) of stores. Approximately, 12% (n = 58) of stores had ads within 6 feet of the counter, 3% (n = 14) had ads less than 3 feet from the ground, and 2% (n = 9) had advertisement less than 1 foot from candy or snacks. The racial/ethnic composition and number of households on public assistance within the block group in which a store was situated were related to the amount of smokeless advertising in stores. For instance, having a higher proportion of the population identifying as White was associated with more advertising. Gas stations/convenience stores had more advertising than any other store types. Chain stores had double the amount of advertising as independent stores (p < .05) even after adjustment for other factors. Smokeless tobacco advertising is not uncommon even in an urban metropolitan community. These products are being advertised in a way that youth, especially those living in neighborhoods with certain demographic characteristics, can encounter. With Food and Drug Administration regulation, there are new opportunities to regulate advertising at the point of sale.

Wray RJ; Jupka K; Berman S; Zellin S; Vijaykumar S. Young adults' perceptions about established and emerging tobacco products: Results from eight focus groups. Nicotine & Tobacco Research 14(2): 184-190, 2012. (24 refs.)

In order to sustain their market, tobacco producers target young adults through novel product design and marketing strategies. Public health professionals need to understand young adults' risks perceptions about and use of new tobacco products to best inform tobacco control interventions. In 2009, researchers conducted 8 focus groups with 67 young adults stratified by self-reported tobacco use and nonuse, residence in rural and urban areas, and living in a state with or without a statewide smoking restriction policy. Participants provided feedback about their knowledge and risk perceptions about and use of tobacco products and marketing. Participants reported a high level of familiarity with a wide range of novel tobacco products. A great deal of confusion and disagreement appeared with regard to absolute and relative risk of different tobacco products. Participants readily discussed using smokeless tobacco products as alternatives to smoking when smoking is prohibited. Fewer differences in tobacco-related knowledge risk perceptions and use were found between urban and rural participants and those in smoke-free policy and nonpolicy states than between user and nonuser groups. Both users and nonusers were familiar with and skeptical about tobacco marketing and prevention efforts. Young adults are familiar with many tobacco products, but they convey little understanding of relative risks of new or trendy tobacco products, such as snus or hookah. Mindful of industry innovation, tobacco control advocates must continuously update prevention efforts, seeking new strategies to limit promotion, marketing, and use of new and conventional products.

Yang CW; Trumbull WN; Cushing BJ; Hwang MJ. Do price increases while demand is falling indicate collusion? Journal of Competition Law & Economics 7(2): 481-495, 2011. (20 refs.)

Because of difficulties in identifying direct evidence of collusive activity on the part of suspected firms under antitrust law, the courts in the past have been forced to rely heavily on indirect evidence, such as pricing behavior, in rendering their decisions. Recently, with the smoking-induced health costs and related class-action litigation against the tobacco industry, the courts have become an important forum for regulating tobacco products. The purpose of this article is to investigate theoretically the pricing behavior of a cartel (or price leader) under conditions of decreasing demand and falling costs with a formal proof and numerical simulations. In particular, this article generalizes and examines both the normal case and unusual case under these circumstances. The model thus derived can be used as a more general theoretical basis for antitrust enforcement. It applies directly to the tobacco industry in which promotional activities, rather than prices, are regulated.

Zaidi SMA; Bikak AL; Shaheryar A; Imam SH; Khan JA. Perceptions of anti-smoking messages amongst high school students in Pakistan. BMC Public Health 11: article 117, 2011. (20 refs.)

Background: Surveys have provided evidence that tobacco use is widely prevalent amongst the youth in Pakistan. Several reviews have evaluated the effectiveness of various tobacco control programs, however, few have taken into account the perceptions of students themselves regarding these measures. The aim of this study was to determine the most effective anti-smoking messages that can be delivered to high-school students in Pakistan, based on their self-rated perceptions. It also aimed to assess the impact of pictorial/multi-media messages compared with written health warnings and to discover differences in perceptions of smokers to those of non-smokers to health warning messages. Methods: This study was carried out in five major cities of Pakistan in private English-medium schools. A presentation was delivered at each school that highlighted the well-established health consequences of smoking using both written health warnings and pictorial/multi-media health messages. Following the presentation, the participants filled out a graded questionnaire form, using which they rated the risk-factors and messages that they thought were most effective in stopping or preventing them from smoking. The Friedman test was used to rank responses to each of the questions in the form. The Wilcoxon Signed Rank test used to analyze the impact of pictorial/multi-media messages over written statements. The Mann Whitney U test was used to compare responses of smokers with those of non-smokers. Results: Picture of an oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator, were perceived to be the most effective anti-smoking messages by students. Addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective messages. Pictorial/multi-media messages were perceived to be more effective than written health warnings. Health warnings were perceived as less effective amongst smokers compared to non-smokers. Conclusion: Graphic pictorial/multi-media health warnings that depict cosmetic and functional distortions were perceived as effective anti-smoking messages by English-medium high school students in Pakistan. Smokers demonstrated greater resistance to health promotion messages compared with non-smokers. Targeted interventions for high school students may be beneficial.