Youth behavioural responses to regulated alcohol advertising content: Results from a mixed-methods study in France.

OBJECTIVES: The World Health Organization advocates measures regulating alcohol advertising content, as illustrated by the French Évin law. However, how people react to such regulation has been under-investigated. The research reported here has two objectives: to analyze how different advertising contents (regulated or not) affect the persuasion process from attention to behavioural responses, and whether young people are protected; to examine how alcohol warnings perform depending on their salience and the advertising content displayed (regulated or not). MATERIALS AND METHODS: This study surveyed French people aged 15-30 using a mixed-methods design. In-depth interviews were conducted on 26 respondents to understand how non-regulated (NRA) and regulated (RA) alcohol advertising influence the persuasion process. An experiment on 696 people assessed the influence of RA vs. NRA on intentions to buy and drink alcohol, and whether less vs. more salient warnings displayed in the RA or NRA setting have differential effects on behavioural responses. RESULTS: NRA (vs. RA) had a greater influence on young people's desire to buy and drink alcohol, which we explain by different psychological processes. NRA appeared to trigger a heuristic process that involves affective reactions (e.g. image, symbolism) and product-oriented responses (e.g. quality), whereas RA appeared to trigger a more systematic process that had less influence. The protective effect of content regulations was strong for the youngest participants but fades as age increases, reaching its limits at age 22 years. Salience of the warnings had no influence on desire to buy and drink alcohol, whatever the ad content. CONCLUSION: Advertising content regulations need to be implemented to protect young people, particularly the youngest. Our results on alcohol health warnings highlighted that text-only labels similar to those adopted in many countries are ineffective at decreasing young people's intentions to buy and drink alcohol.

Tobacco-free university campus policies: A systematic review.

Objective: This systematic review aims to provide an update of the scientific evidence regarding tobacco-free/smoke-free campus policies (TFC/SFC), using a complex interventions approach. PARTICIPANTS/METHODS: We searched the PubMed, Scopus and Web of Science databases using a combination of 'tobacco-free' or 'smoke-free', 'campus', 'university or college' and 'policy' search terms on all indexed articles published up until June 2023. Studies were included if they presented research on pre-/post-implementation of TFC/SFC or policy components. Two coders extracted and synthesized the data and assessed the risk of bias. RESULTS: A total of 113 studies were included, reporting data from 2005 to 2023 across 17 countries. The data was categorized into three of the four phases of the Medical Research Council (MRC) framework, i.e. "feasibility (n=24), "implementation" (n=34), and "evaluation" (n=69). This review finds that a policy draft, communication, enforcement strategies, and cessation services are critical policy components. TCF/SFC are effective for reducing tobacco use and secondhand smoke exposure, but they also increase vaping. Little research has investigated the effect of TFC/SFC on smokeless tobacco use. CONCLUSION: This review addresses remaining uncertainties in evidence on the TFC/SFC implementation process. We go on to provide a series of recommendations for university administrators.

#Bartender: portrayals of popular alcohol influencer's videos on TikTok©.

BACKGROUND: Despite widespread use of the short-video social media platform TikTok©, limited research investigates how alcohol is portrayed on the platform. Previous research suggests that a driver of alcohol content on TikTok©, in part, comes from bartenders demonstrating how to make drinks. This study aims to explore the characterizing patterns of how bartender influencers on TikTok© feature and incorporate alcohol in their videos. METHODS: We identified the global top 15 most followed bartenders on TikTok© in 2021 (cumulative 29.7 million subscribers) and the videos they posted in November and December 2021, the period just before Christmas and New Year, when alcohol tends to be more marketed than in other periods. The videos were coded based on five criteria: (1) the presence of alcohol or not; (2) alcohol categories; (3); alcohol brand(s) if visible; (4) the presence of candies and other sweet products; (5) presence of cues that refer to young people's interests. RESULTS: In total, we identified 345 videos, which received 270,325,600 views in total, with an average of 18,021,707 views per video. Among these 345 videos, 92% (n = 317) displayed alcohol in their cocktail recipes (249,275,600 views, with an average of 786,358 views). The most common types of alcohol present in videos were liquor, vodka, rum, and whiskey, all of which are high-ABV beverages. 73% (n = 230) displayed or mentioned an alcohol brand. 17% (n = 55) associated alcohol with sweet products such as different types of candy (53,957,900 views, with an average of 981,053 views per video). 13% (n = 43) contained cues appealing to young people (e.g., cartoons, characters) (15,763,300 views, with an average of 366,588 views per video). CONCLUSIONS: Our findings suggest a large presence of positively framed alcohol content posted by popular bartenders on TikTok©. As exposure to digital marketing is related to an increase in alcohol consumption, particularly among young people, regulations are needed to protect the public from alcohol-related harms.

Restricting the content of alcohol advertising and including text health warnings: A between-group online experiment with a non-probability adult sample in the United Kingdom.

BACKGROUND: Statutory options for restricting alcohol advertising include limiting it to product-orientated information and requiring health warnings. We assess the impact of removing positive contextual factors from alcohol advertising and including a health warning among adults in the United Kingdom (UK). METHODS: We conducted a 2 × 2 online between-group experiment with adults (18+) (n = 2421) recruited from a non-probability research panel in the United Kingdom. Participants were randomized to see an alcohol (vodka) advertisement (advert) which varied by context (no context vs. imagery depicting positive social interactions around alcohol) and message (multiple text health warning vs. "drink responsibly"). The multiple text health warning, based on recent legislation in Ireland, comprised three separate warnings (liver disease, cancers, drinking during pregnancy) and a web address for alcohol-related information and support. The "drink responsibly" control reflected the self-regulatory messages commonly used by alcohol companies. Participants rated the advert on 7-point scales for advert attractiveness, product appeal, trial intentions, perceived harm, and whether it made drinking alcohol seem enjoyable. RESULTS: Removing the positive social context reduced positive advert and product reactions (difference in estimated marginal means [EMM]: -1.57 [makes drinking alcohol seem enjoyable] to -0.23 [intention to try]). Including the multiple text health warning also reduced positive advert and product reactions (difference in EMM: -0.55 [advert attractiveness] to -0.25 [intention to try]) and increased perceived product harm (difference in EMM: +0.25). There were no interactions between advert context and message for any outcome. CONCLUSIONS: Restricting content and including a multiple text health warning (compared to a "drink responsibly" message) may attenuate the persuasive impact of alcohol advertising and increase perceived product harm. Further research is needed to examine different degrees of content restrictions, alternative warning content and design, generalizability to different alcohol products and advert formats, and whether the impact of content controls varies among population subgroups.

What are the effects of smoke-free and tobacco-free university campus policies, and how can they be assessed? A systematic review.

OBJECTIVE: This article looks at the evaluation of smoke-free (SF) and tobacco-free (TF) university campus policies that ban smoking (and often vaping) both indoors and outdoors. To assess the effectiveness of these policies, we performed a systematic literature review to answer the following questions: what is the effect of SF/TF policies on campus users' behaviors/norms/perceptions around smoking? Are the SF/TF policies an effective measure for reducing smoking among young adults? What methods and indicators can we use to assess the impact of SF/TF campus policies? What is the theoretical model underpinning the influence of SF/TF policies on the behavior of campus users? METHODS: Three databases (PubMed, Scopus, and Web of Science) were searched over the period from January 2005 to December 2022. The article selection process included 54 articles published in scientific journals that analyzed the post-implementation impact of SF/TF campus policies. The quality of these articles was analyzed using six ad hoc indicators based on the Critical Appraisal Skills Program checklist and Joanna Briggs Institute scoping tools. RESULTS: Most of the research on SF/TF campus policies has been conducted in the United States using quantitative methodologies. Most of these studies show that SF/TF policies reduce positive beliefs about smoking and its acceptability, influence smoking behavior (reducing smoking initiation and increasing the number of quits and quit attempts), and reduce exposure to passive smoking and pollution from cigarette butts. User acceptability of SF/TF policies is generally high. Limitations of SF/TF campus policies include difficulty for smokers to comply with them, persistence of passive smoking around campuses, and limited uptake of on-campus cessation support services provided to smokers. DISCUSSION: The various mediating and moderating variables identified in the literature have made it possible to propose a model of the potential influence of SF/TF policy on campus users, based on the theory of planned behavior. Based on this review, we provide health professionals and higher education institutions wishing to implement a SF/TF campus policy with a set of indicators that can serve to assess the impact of a SF/TF campus policy (attitudes, acceptability, beliefs, norms, exposure to passive smoking and pollution, changes in smoking behavior). CONCLUSION: Based on scientific evidence, the implementation of SF/TF campus policies in France is an important measure to help combat smoking in young adults.

Lobbying against tobacco tax increases in France: arguments and strategies of the tobacco industry and tobacconists analysed through their trade press.

INTRODUCTION: Raising taxes is one of the most cost-effective measures to reduce tobacco use. France has a unique profile: it has high tobacco use prevalence and a state monopoly on tobacco sales for tobacconists who are both agents of the customs administration and a recognised tobacco industry (TI) front group. In this paper, we investigate the lobbying tactics and arguments against tobacco taxation mobilised by the TI and tobacconists in France. METHODS: We conducted a quantitative and qualitative analysis of the two leading French tobacco trade media outlets (La Revue des Tabacs and Le Losange) between 2000 and 2020. We performed a manual thematic content analysis based on existing conceptual models of TI political activity, including the policy dystopia model. RESULTS: Tobacconists actively lobbied against tobacco taxation, using traditional arguments highlighted in conceptual models (ie, the claim that 'taxation increases illicit trade and is ineffective'), but also France-centric arguments (ie, tobacconists denounced the impact of cross-border shopping and highlighted their role as pivotal to community life in rural areas). We also found lobbying strategies mirroring those identified previously (ie, coalition, information management and direct influence in public policy). CONCLUSIONS: Tobacconists in France hold a specific status that gives them privileged access to government bodies that can be exploited to successfully lobby against tobacco taxation. NGOs need to expose these lobbying activities and alert the public authorities to Article 5.3 of the WHO Framework Convention on Tobacco Control that requires countries to protect policies from TI interests.

Health protective behaviours during the COVID-19 pandemic: Risk adaptation or habituation?

Many epidemiological works show that human behaviours play a fundamental role in the spread of infectious diseases. However, we still do not know much about how people modify their Health Protective Behaviours (HPB), such as hygiene or social distancing measures, over time in response to the health threat during an epidemic. In this study, we examined the role of the epidemiological context in engagement in HPB through two possible mechanisms highlighted by research into decision-making under risk: risk adaptation and risk habituation. These two different mechanisms were assumed to explain to a large extent the temporal variations in the public's responsiveness to the health threat during the COVID-19 pandemic. To test them, we used self-reported data collected through a series of 25 cross-sectional surveys conducted in France among representative samples of the adult population, from March 2020 to September 2021 (N = 50,019). Interestingly, we found that both mechanisms accounted relatively well for the temporal variation in the adoption of social distancing during the pandemic, which is remarkable given their different assumptions about the underlying social cognitive processes involved in response to a health threat. These results suggest that strengthening the incentives to encourage people to maintain health protective behaviours and to counter risk habituation effects is crucial to disease control and prevention over time.

Analyzing arguments on tobacco tax increases. Focus on French parliamentary questions and responses, 2000-2020.

INTRODUCTION: Tax increases are the most effective but still the least-used tobacco control measure. The tobacco industry (TI) employs lobbying strategies to oppose the implementation of tax policies on its products. Over the past two decades, French tobacco tax policies have been characterized by a relative inconsistency. This research aims to understand why, by analyzing the arguments of French policymakers (MPs and government) between 2000 and 2020 in favor or against tax increases. METHODS: To capture parliamentary debates, we performed an advanced term search on the French National Assembly website, using the keyword 'tobacco'. The search returned 5126 available documents out of which 1106 (12.6%, 645 questions, 461 responses) covered price and taxation and were included. They were analyzed using descriptive statistics and thematic content analysis (NVivo) and were compared, when relevant, to arguments raised in the international literature on TI lobbying against taxation increases. RESULTS: We found 3176 arguments on tobacco taxation: 77.2% were against tobacco tax increases and 22.7% were in favor of tax policies. Arguments varied depending on the source: 92.4% of MPs' arguments were against tax increases, while 52.1% of arguments from government responses were in favor. The anti-tax arguments were similar to those identified in the international literature that singled out negative economic and social consequences (illicit trade, penalizing tobacconists). Other arguments that were more specific to the French context, highlighted the key economic and social role played by tobacconists in France. Pro-tax arguments highlighted the health, economic and social benefits of tax policies. CONCLUSIONS: This is the first French tobacco research on parliamentary documents, although Parliament is a place of direct TI lobbying. It will enable public health actors to better understand the arguments used by the TI in order to counter them in front of MPs, and to better monitor debates in Parliament.

How Do Young Adult Drinkers React to Varied Alcohol Warning Formats and Contents? An Exploratory Study in France.

Research on alcohol warnings has increased in the last decade, providing key evidence to governments on warning format and contents. The bulk of this research, however, has been conducted in Anglosphere countries, whereas fewer studies have focused on other countries which have high per capita alcohol consumption, and where the high social acceptability of drinking is liable to affect how people accept and react to prevention measures. Since France has one of the highest per capita alcohol consumption rates in the world according to the World Health Organization (WHO), we therefore explore how young adults in France react to warnings on alcoholic beverage advertisements. We conducted 25 in-depth interviews, in 2017, with 18-25-year-old drinkers in France. Respondents were asked open-ended questions on the perceived impact of various warning contents (i.e., on health risk, social-cost risk, and on short- vs. long-term risk) and formats (text only vs. larger text combined with colored pictograms). Warnings that targeted youth-relevant risks (i.e., road accidents or sexual assault) were considered to be the most meaningful and credible, although warnings communicating longer term risks (i.e., brain, cancer) were also thought to be influential. Less familiar risks, such as marketing manipulation and calorie intake, elicited the most negative reactions. Larger text-and-pictogram warnings were considered to be the most effective format in capturing attention and increasing awareness. Regardless of format and content, however, these warnings were not perceived as effective for decreasing alcohol consumption.

Have Restrictions on Alcohol Advertising in Ireland Affected Awareness Among Adults? A Comparative Observational Study Using Nonprobability Repeat Cross-Sectional Surveys.

OBJECTIVE: Since November 2019, Ireland has restricted alcohol advertising at the cinema and outdoors (e.g., near schools) and banned alcohol advertising on public transport. Although awareness of such advertising had decreased 1 year after the restrictions, measures to limit COVID-19 transmission complicated interpretation. We examined (a) changes in awareness 2 years after restrictions, when COVID-19 mitigation measures had eased, and (b) how changes in Ireland compared with Northern Ireland, where the restrictions did not apply. METHOD: Repeat cross-sectional surveys were conducted with adults recruited from nonprobability online panels, with three waves in Ireland (October 2019 [before restrictions] and October 2020/2021 [after restrictions]; n = 3,029) and two in Northern Ireland (October 2020/2021; n = 1,011). Participants self-reported past-month awareness of 13 alcohol marketing activities, including public transport, cinema, and outdoor advertising (coded as any past-month awareness, no awareness, or not sure). RESULTS: In Ireland, the odds of reporting no past-month awareness (vs. any) were higher in both 2021 and 2020 versus 2019 for all restricted advertising activities (e.g., 2021 vs. 2019 for public transport: adjusted OR = 1.88, 95% CI [1.53, 2.32]). Interactions between wave and jurisdiction indicated that in 2021, compared with 2020, the odds of reporting no past-month awareness of public transport and cinema advertising (vs. any) were higher in Ireland than in Northern Ireland, despite increased opportunities for exposure in both jurisdictions through eased pandemic mitigation measures. There was no interaction for outdoor advertising, suggesting between-wave trends did not differ by jurisdiction. CONCLUSIONS: Ireland's restrictions have reduced past-month awareness of alcohol advertising at the cinema and on public transport but not outdoors. Continued monitoring is required.

Effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms and low-risk drinking guidelines, and in lowering alcohol consumption.

AIMS: To evaluate the effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms (LTH) and low-risk drinking guidelines (LRDG), as well as in lowering alcohol consumption. DESIGN: An 8-month longitudinal survey from February to October 2019, with three waves of on-line data collection (T0 before the campaign, T1 just after it ended and T2 6 months after it ended). SETTING: France. PARTICIPANTS: A total of 2538 adult drinkers (aged 18-75 years). MEASUREMENTS: The main outcomes' variables were LTH knowledge (cancer, hypertension, brain haemorrhage), LRDG knowledge (two guidelines: 'maximum of two drinks a day' and 'minimum of 2 days without alcohol per week'), intention to reduce alcohol consumption and self-declared consumption with respect to the French LRDG. At T1, exposure to the campaign was measured using self-reported campaign recall. FINDINGS: In T1, we observed significant positive interactions between exposure group based on campaign recall and survey waves on knowledge of (i) the 'maximum two drinks a day' guideline [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.08-1.62, P = 0.008], (ii) brain haemorrhage (aOR = 1.80, 95% CI = 1.44-2.25, P < 0.001) and (iii) hypertension (aOR = 1.41, 95% CI = 1.09-1.81, P = 0.008) risks. Campaign exposure was also associated with a significant decrease in at-risk drinking in women (aOR = 0.67, 95% CI = 0.50-0.88, P = 0.004). No significant interaction was observed at T1 for the knowledge of the 'minimum of 2 days without alcohol a week' guideline, or of cancer risk. At T2, no significant interaction was observed for the main outcomes' variables. CONCLUSIONS: There appears to be an association between exposure to a 2019 French mass-media campaign to raise knowledge of long-term alcohol-related harms and low-risk drinking guidelines and reduce alcohol consumption and (i) improved knowledge of the 'maximum two drinks per day guideline', (ii) knowledge of the risks of hypertension and brain haemorrhage and (iii) a reduction in the proportion of people exceeding low-risk drinking guidelines (in the general population only). These associations were only observed over the short term and, in some cases, only for certain segments of the population.

Tobacco Tax Increases: A Discourse Analysis of the French Print and Web News Media from 2000 to 2020.

Lobbying led by the tobacco industry and tobacconists is a barrier to reducing smoking prevalence in France. Here, we analyze the discourse of the tobacco industry and other key actors (public health agencies, politicians, etc.) in the French general-audience news media from 2000 to 2020 around tobacco tax increases, which is one of the most effective tobacco control measures, especially amongst youth. We queried Europresse (a European news media and specialized press database) using the keywords "increase", "price or taxes", and "tobacco or cigarettes", and found 5409 topic-relevant articles, from which we extracted 8015 arguments for or against the measure. In total,64.3% were against the measure (mostly on grounds of "ufueling the black market"), 32.1% were for the measure (mostly claiming it is "effective at reducing smoking prevalence"), and 1.8% proposed alternative measures. Tobacconists, the primary source of media content on the topic, led a discourse that was strongly opposed to tax increases. Public health agencies, which attracted only half as much media attention, were strongly supportive of the measure. Analysis of discourses relayed in the French general-audience press revealed overwhelming opposition to tobacco tax increases, and this discourse was widely advanced by tobacconists. The results were congruent with international literature that had highlighted a similar set of arguments to those found in the French general press that were broadcasted by the tobacco industry and its allies (tobacconists in France) in an effort to block this evidence-based public health measure.

How the alcohol industry fought against pregnancy warning labels in France. A press coverage analysis spanning 20 years.

Background: Drinking alcohol while pregnant is dangerous for health. To inform on this issue, various countries have adopted pregnancy warning labels on alcoholic beverages, including France since 2007, where wine holds deep cultural consonance. The aim of this research was to analyze the arguments put forward by the alcohol industry (producers, distributors, wholesalers, allied industries, trade associations, social aspects and public relations organizations, councilors who publicly defend wine-sector interests) via the press in France: (1) in 2007 when pregnancy warnings were first implemented, and (2) in 2018 when larger pregnancy warnings to increase visibility were proposed but not adopted. Methods: We used documentary method to analyze the arguments advanced by the alcohol industry in mainstream (national, regional and specialized) press in France from 2000 to 2020, using the Europresse documentary database. Quantitative analysis (number and trend curve of articles, mapping alcohol-industry actors who spoke in the press) and inductive thematic content analysis (analytical framework of the arguments identified) using NVivo software were carried out. Results: We found a total of 559 relevant press articles in the database, of which 85 were included in the analysis. Peaks in number of publications were found to coincide with the warning label implementation and with the expansion-project schedule. A large majority of the arguments promoted by the alcohol industry contested the pregnancy warnings measure (very few were in favor). They argued that (1) pregnancy warnings were a questionable measure (e.g., ineffective, or the pictogram clearly links alcohol to mortality), (2) pregnancy warnings would have counterproductive effects (on women and the wider economy), (3) better alternatives exist (e.g., targeted prevention programs, prevention by health professionals). A large majority of the actors who spoke in the press came from the winegrowing sector. Conclusion: This study fills a gap in the Anglosphere research on lobbying against alcohol warnings by analyzing lobbyists' arguments over a 20-year period covering both failed and successful industry lobbying. New findings have emerged that are likely related to the wine-oriented culture of France. In order to counter the alcohol lobbying practices we conclude with a number of public health recommendations.

Cognitive Factors Associated With Public Acceptance of COVID-19 Nonpharmaceutical Prevention Measures: Cross-sectional Study.

Background: During the COVID-19 crisis, protests against restrictions emerged and rule violations increased, provoking peaks in new positive cases, forcing authorities in France to impose fines to slow down the spread of the disease. Due to these challenges, subsequent implementations of preventive measures in response to COVID-19 recurrences or other pandemics could present difficulties for decision makers. A better understanding of the factors underlying the public acceptance of COVID-19 nonpharmaceutical preventive measures may therefore contribute greatly to the design of more effective public communication during future pandemics. Objective: The aim of this study was to evaluate the acceptance of COVID-19 nonpharmaceutical prevention measures in France. The specific objectives were (1) to examine the public's acceptance of COVID-19 nonpharmaceutical prevention measures and (2) to assess the association of the public's acceptance of these prevention measures and their perception of COVID-19. Methods: Data were collected from 2004 individuals through an online survey conducted 6-8 weeks after the first lockdown in France. For objective 1, participants were asked the extent to which they supported 8 COVID-19 nonpharmaceutical preventive measures using a 4-point Likert scale. For objective 2, COVID-19-related perceptions were assessed using a 5-point Likert scale from an adapted version of Witte's Extended Parallel Process Model. Sociodemographic and environmental variables were also collected. The public's acceptance factors were estimated using an unweighted least squares factorial analysis, and their associations with perceptions of COVID-19, expressed as rate ratios (RR) and 95% CIs, were estimated using generalized linear Poisson regression models. Statistical analyses were performed using the SPSS statistical package. Results: The acceptance rate reached 86.1% for individual protective measures, such as making masks mandatory in public open spaces, and 70.0% for collective restrictions, such as isolating the most vulnerable people (1604/2004, 80%) or forbidding public gatherings (n=1590, 79.3%). The least popular restrictions were closing all schools/universities and nonessential commerce such as bars and restaurants (n=1146, 57.2%). Acceptance of collective restrictions was positively associated with their perceived efficacy (RR 1.02, 95% CI 1.01-1.03), fear of COVID-19 (RR 1.04, 95% CI 1.03-1.05), and perceived severity of COVID-19 (RR 1.04, 95% CI 1.03-1.06), and negatively with age >60 years (RR 0.89, 95% CI 0.81-0.98). Acceptance of individual protective measures was associated with their perceived efficacy (RR 1.03, 95% CI 1.03-1.04), fear of COVID-19 (RR 1.02, 1.01-1.03), and perceived severity of COVID-19 (RR 1.03, 1.01-1.05). Conclusions: Acceptance rates of COVID-19 nonpharmaceutical measures were rather high, but varied according to their perceived social cost, and were more related to collective than personal protection. Nonpharmaceutical measures that minimize social costs while controlling the spread of the disease are more likely to be accepted during pandemics.

Plain packaging on tobacco products in France: Effectiveness on smokers' attitudes one year after implementation.

INTRODUCTION: New packaging of tobacco products, with plain packaging and new enlarged health warnings, was made compulsory in France in 2017. This study aims to measure the impact of new packaging on smokers' embarrassment and their motivation to quit smoking. METHODS: Data from Santé publique France 2016, 2017 and 2018 Health Barometer surveys were used. These randomized surveys were conducted by telephone with samples of 15216 (2016), 25319 (2017), and 9074 (2018) people aged 18-75 years. The association between smokers' embarrassment and the influence of new packaging on motivation to quit smoking was studied using multivariate logistic regressions. RESULTS: After the introduction of new plain packaging, the proportion of smokers who felt embarrassed taking out their pack of cigarettes in plain sight because of its appearance doubled in 2017 (11.9%, 95% CI: 10.2-13.9 vs 5.9%, 95% CI: 4.4-7.8 in 2016, p<0.001) and continued to increase in 2018 (15.5%, 95% CI: 13.7-17.5, p<0.01). In 2018, women were more embarrassed than men (OR=2.0; 95% CI: 1.5-2.6, p<0.001). In 2018, 26.8% (95% CI: 24.6-29.1) of smokers said the appearance of a pack of cigarettes motivated them to quit, and 22.5% (95% CI: 18.3-27.2) ex-smokers cited it as having motivated them to quit. Smokers who were embarrassed by displaying their pack were more likely to be motivated to quit because of the pack's appearance. People with higher incomes were less likely to report motivation to quit due to the pack than people with the lowest income (OR=0.5; 95% CI: 0.3-0.7, p<0.001). CONCLUSIONS: In the French context, the new plain packaging of tobacco products probably had an impact on smokers' perception of tobacco by increasing the embarrassment they felt when they took out their pack of cigarettes in plain sight. It also influenced the motivation to quit smoking, and more generally, it could contribute to the denormalization of tobacco.

Does the French Évin Law on Alcohol Advertising Content Reduce the Attractiveness of Alcohol for Young People? An Online Experimental Survey.

OBJECTIVE: France's Évin law limits the content of alcohol advertising to purely factual product information. Little research to date has examined the effectiveness of this measure. To address this gap, we investigated the effect on young people of (a) content restrictions in general, (b) more or less strict content regulations, and (c) whether different youth profiles are more or less susceptible to content regulations. METHOD: An online experimental survey on 18- to 25-year-olds in France was conducted (n = 2,163). Participants were exposed to three advertising conditions for four alcohol brands: (a) neutral ads with only bottles and logos (in line with Évin law restrictions); (b) contextual ads (partying and sport iconography) without characters; and (c) contextual ads featuring characters. Participants self-reported their reactions on attention, appeal, product, alcohol consumption perception, image benefits, and perceived behavioral impact. Demographics and alcohol use measures were also collected. RESULTS: For almost all reactions, ads that featured sport or party contexts (with/without characters) generated more positive reactions and more perceived behavioral impact compared with neutral ads. Ads that featured characters had more positive reactions than ads without characters. Women and the youngest segment (18-21 years old) emerged as the most sensitive to contextual ads. CONCLUSIONS: Regulating alcohol advertising content via strongly prohibitive measures, as per France's Évin law in 1991 or similar measures in other countries, is an effective policy direction for protecting vulnerable young people. This approach should be considered by countries that currently have only partial bans on alcohol advertising placement.

Plain tobacco packaging: progress, challenges, learning and opportunities.

The aim of this paper is to overview progress made with respect to the adoption of plain (or standardised) packaging, key challenges faced, evaluative evidence and opportunities for extending this policy. It has been a decade since Australia became the first country to require tobacco products to be sold in plain packaging; after slow initial uptake, 16 countries have now fully implemented this policy. Since 2020, plain packaging laws have become more comprehensive in some countries, expanding coverage beyond traditional tobacco products to include heated tobacco, tobacco accessories (rolling papers) and other nicotine-containing products (e-cigarettes). Laws have also become more innovative: some now ban non-biodegradable filters, include provision for a periodic change of the pack colour or require both plain packaging and health-promoting pack inserts. The tobacco industry has and will continue to use multi-jurisdictional strategies to oppose this policy. Evaluations suggest that plain packaging has improved health outcomes and has not burdened retailers, although research is limited to early policy adopters and important gaps in the literature remain. While the power of packaging as a sales tool has diminished in markets with plain packaging, tobacco companies have exploited loopholes to continue to promote their products and have increasingly focused on filter innovations. Opportunities exist for governments to strengthen plain packaging laws.

Analysis of How Lobbying by the Alcohol Industry Has Eroded the French Évin Law Since 1991.

OBJECTIVE: The French Évin Law was passed in 1991 to prohibit alcohol advertising in media from targeting young people and to regulate content in authorized media. This research analyzes how lobbying by the alcohol industry has undermined this law over the last 30 years. METHOD: A narrative approach, consisting of the collection and analysis of semistructured interviews with persons who recount their experience and offer interpretation, was used to analyze lobbying by the alcohol industry against the Évin Law from 1991 to 2020. We conducted 18 interviews with key French informants involved in implementing and/ or changing the Évin Law (including founders of the law) to identify strategies and arguments used by the alcohol industry. An established framework of corporate political activity specific to the alcohol industry was used to classify the findings. RESULTS: The industry tactics and arguments were found to be similar to those in other countries; however, some were specific to France, such as highlighting winegrowing as central to French culture and integrating the wine industry into decision-making bodies, alliances with parliamentarians, and circumventions of the law. These specific features may be explained by the age of the Évin Law (30 years) and the economic weight of alcohol and wine at the heart of French culture. CONCLUSIONS: The Évin Law has been continuously weakened since its initial implementation. This research analyzes the long-term lobbying strategies and arguments that have been used to erode it. The results are useful for other countries that have implemented alcohol marketing regulations to help anticipate tactics and arguments deployed by the alcohol industry to weaken marketing regulations.

Social Marketing Intervention to Engage Older Adults in Balance Workshops for Fall Prevention: A Multicenter Quasi-Experimental Protocol Study.

Background: Falls affects one of three people after 65 years old, and it can lead to serious consequences. Scientific evidence point out that physical exercise is the most efficient way to prevent falls among older adults. Objective: The main objective of this study is to determine if a social marketing program can increase the attendance rate of people aged 60 and over at group balance workshops. Methods: This quasi-experimental multicenter study is being conducted in three French Regions (Loire, Haute-Loire and Rhône) over a period of 18 months. The Social Marketing Campaign will be done in three ways. Firstly, a Communication Campaign will take place in the two Test Areas but not in the Control Area. Secondly, flyers have been designed to be distributed by local partners. Finally, conferences for older people will be organized in the areas of intervention in order to reach the target audience for the program. The study will include people aged 60 and older who want to participate in the Balance Program. Results: The Crédit Agricole Loire/Haute-Loire Foundation funded the study and the Jean Monnet University of Saint-Etienne reviewed it. The Ethics Committee of the University Teaching Hospital of Saint-Etienne approved and peer-reviewed it on September 6, 2019, under Reference Number IRBN622019/CHUSTE. Conclusion: The results of this first study will demonstrate whether or not social marketing for promoting group balance workshops in the elderly will increase their attendanceship in adapted physical activity sessions, especially those that prevent falls. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04136938, identifier NCT04136938.

Effectiveness of 'Mois sans tabac 2016': A French social marketing campaign against smoking.

INTRODUCTION: In October 2016, the first edition of Mois sans tabac (Tobacco-Free Month) was launched, a campaign which had invited French smokers to challenge themselves to quit smoking for the whole month of November. We aimed to study the effectiveness of this social marketing intervention on quit attempts (QA) in the general French population, and to study possible differences according to sociodemographic characteristics. METHODS: This study used data from the 2017 Health Barometer survey, a random survey conducted by telephone on 25319 individuals. It included 6341 respondents who reported that they were daily smokers when the Mois sans tabac campaign was launched in 2016. The association between self-declared exposure to the campaign and making a QA has been studied using multivariate logistic regressions. RESULTS: Exposure to the 2016 Mois sans tabac campaign is associated with a QA lasting at least 24 hours in the final quarter of 2016 (AOR=1.32; 95% CI: 1.07- 1.63, p<0.01), with a QA lasting at least 30 days (AOR=1.95; 95% CI: 1.31-2.91, p<0.001), and being abstinent at the time of the interview in 2017 (AOR=2.39; 95% CI: 1.37-4.15, p<0.01). A dose-effect relationship is observed between the frequency of exposure to the campaign and QA, which is mostly explained by the number of sources of exposure (television, radio, posters, the press, the internet and social networks). Although certain priority groups (e.g. manual workers, the unemployed) had poorer recall of the campaign than other groups, the impact of self-reported exposure to the campaign on QA in unemployed people or those with less than high school educational level appears to have been greater. CONCLUSIONS: These analyses suggest the effectiveness of the 2016 Mois sans tabac intervention, in a context of strengthening public tobacco control policies in France, which may have contributed to the drop in smoking observed between 2016 and 2019.