Perceptions of the relative harmfulness of marijuana and alcohol among adults in Oregon.

This study documents perceptions of the relative harmfulness of marijuana and alcohol to a person's health among adults in Oregon just before the first legal sales of marijuana for recreational use. We surveyed 1941 adults in Oregon in September 2015. Respondents were recruited using an address-based sampling (ABS) frame (n = 1314) and social media advertising (n = 627). Respondents completed paper surveys (ABS-mail, n = 388) or online surveys (ABS-online, n = 926; social media, n = 627). We used descriptive statistics and logistic regression models to examine perceptions of the relative harmfulness of marijuana and alcohol by sample characteristics, including substance use. About half of adults in Oregon (52.5%) considered alcohol to be more harmful to a person's health than marijuana. A substantial proportion considered the substances equally harmful (40.0%). Few considered marijuana to be more harmful than alcohol (7.5%). In general, respondents who were younger, male, and not Republican were more likely than others to consider alcohol more harmful than marijuana. Respondents who were older, female, and Republican were more likely to consider marijuana and alcohol equally harmful. Most individuals who reported using both marijuana and alcohol (67.7%) and approximately half of those who used neither substance (48.2%) considered alcohol to be more harmful than marijuana. Perceptions about the relative harmfulness of marijuana and alcohol may have implications for public health. As state lawmakers develop policies to regulate marijuana, it may be helpful to consider the ways in which those policies may also affect use of alcohol and co-use of alcohol and marijuana.

Public support for graphic health warning labels in the U.S.

BACKGROUND: In 2009, the U.S. Food and Drug Administration was required to mandate that graphic health warning labels be placed on cigarette packages and advertisements. PURPOSE: To assess public support in the U.S. for graphic health warning labels from 2007 to 2012. METHODS: Data from 17,498 respondents from 13 waves of the National Adult Tobacco Survey, a list-assisted random-digit-dial survey, were used. Overall support for graphic health warning labels, as well as support by smoking status, and by sociodemographics and smoker characteristics are estimated. Analyses were conducted in 2014. RESULTS: Since 2007, a majority of the public overall has been in favor of labels. Support increased significantly among the public overall and among non-smokers from 2007 through 2009 (p<0.001), after which it remained flat. Among smokers, support levels increased from 2007 through 2011 (p<0.001), but decreased significantly from 2011 through 2012 (p<0.001). Support was high regardless of smoking status, although among smokers, support varied by level of smoking, interest in quitting, and whether labels were seen as an important reason to quit. Support varied by sociodemographic characteristics, particularly among smokers. Younger, less-affluent, and less-educated smokers supported labels at higher levels than their counterparts. CONCLUSIONS: A majority of U.S. residents support graphic health warning labels for cigarette packs, though support among smokers declined after 2011.

Reactions to graphic health warnings in the United States.

This study reports consumer reactions to the graphic health warnings selected by the Food and Drug Administration to be placed on cigarette packs in the United States. We recruited three sets of respondents for an experimental study from a national opt-in e-mail list sample: (i) current smokers aged 25 or older, (ii) young adult smokers aged 18-24 and (iii) youth aged 13-17 who are current smokers or who may be susceptible to initiation of smoking. Participants were randomly assigned to be exposed to a pack of cigarettes with one of nine graphic health warnings or with a text-only warning statement. All three age groups had overall strong negative emotional (ß = 4.7, P < 0.001 for adults; ß = 4.6, P < 0.001 for young adults and ß = 4.0, P < 0.001 for youth) and cognitive (ß = 2.4, P < 0.001 for adults; ß = 3.0, P < 0.001 for young adults and ß = 4.6, P < 0.001 for youth) reactions to the proposed labels. The strong negative emotional and cognitive reactions following a single exposure to the graphic health warnings suggest that, with repeated exposures over time, graphic health warnings may influence smokers' beliefs, intentions and behaviors.

The influence of antismoking television advertisements on cessation by race/ethnicity, socioeconomic status, and mental health status.

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State's antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.

Effectiveness of a national media campaign to promote parent-child communication about sex.

BACKGROUND: Although there is debate on the effectiveness of youth-focused abstinence education programs, research confirms that parents can influence their children's decisions about sexual behavior. To leverage parent-based approaches to adolescent sexual health, the U.S. Department of Health and Human Services launched the Parents Speak Up National Campaign (PSUNC) to encourage parent-child communication about sex. Previous experimental studies have found the campaign to be efficacious in increasing parent-child communication. But to date, the actual reach of the campaign and its real-world effectiveness in promoting parent-child communication has not been established. The present study addresses this gap. METHOD: The authors surveyed 1,804 parents of 10- to14-year-old children from the nationally representative Knowledge Networks online panel. The survey included questions about parents' awareness of PSUNC ads and parent-child communication behaviors. The authors also analyzed market-level data on campaign gross rating points, a measure of market-level intensity of PSUNC advertising in the United States. Multivariate regressions were used to examine the association between PSUNC exposure and a three-item scale for parent-child communication. RESULTS: Overall, 59.4% of parents in the sample reported awareness of PSUNC. The authors found that higher market-level PSUNC gross rating points were associated with increased parent-child communication. Similar relationships were observed between self-reported awareness of PSUNC and increased frequency of communication and recommendations to wait. These associations were particularly strong among mothers. CONCLUSIONS: This study provides the first field-based data on the real-world reach and effectiveness of PSUNC among parents. The data support earlier experimental trials of PSUNC, showing that the campaign is associated with greater parent-child communication, primarily among mothers. Further research may be needed to develop additional messages for fathers.

Do different styles of antismoking ads influence the types of smokers who call quitlines?

This study examined the relationship between television antismoking advertisements and the proportion of smokers who call a smokers' quitline who are ready to quit or have high confidence in quitting. The primary data of interest came from completed intake interviews of smokers. Using a generalized linear model, we modeled the proportion of Quitline callers who are ready to quit and/or have high confidence in quitting. The primary explanatory variable was monthly target audience rating points (TARPs) for antismoking advertisements, a measure of broadcast media exposure, obtained from the state's media buyer. The proportions of callers ready to quit and with high confidence in quitting were negatively associated with total TARPs. This result, over all ad types, was driven by why to quit-graphic ads. These results suggest that why to quit-graphic ads influence smokers who are less ready to quit or have lower confidence they can quit, likely new quitters, to call the Quitline.

Movie smoking and youth initiation: parsing smoking imagery and other adult content.

OBJECTIVES: To isolate the independent influence of exposure to smoking and other adult content in the movies on youth smoking uptake. METHODS: We used discrete time survival analysis to quantify the influence of exposure to smoking and other adult content in the movies on transitioning from (1) closed to open to smoking; (2) never to ever trying smoking; and (3) never to ever hitting, slapping, or shoving someone on two or more occasions in the past 30 days. The latter is a comparative outcome, hypothesized to have no correlation with exposure to smoking in the movies. RESULTS: Assessed separately, both exposure to smoking imagery and exposure to adult content were associated with increased likelihood of youth becoming open to smoking (OR = 1.09, 95% CI: 1.04-1.15 and OR = 1.10, 95% CI: 1.04-1.17) and having tried smoking (OR = 1.06, 95% CI: 1.00-1.12 and OR = 1.06, 95% CI: 1.00-1.13). Both measures were also separately associated with aggressive behavior (OR = 1.09, 95% CI: 1.04-1.14 and OR = 1.09, 95% CI: 1.04-1.15). A very high correlation between the two measures (0.995, p<0.000) prevented an assessment of their independent effects on smoking initiation. CONCLUSION: Although exposure to smoking in the movies is correlated with smoking susceptibility and initiation, the high correlation between exposure to smoking in the movies and other adult content suggests that more research is needed to disentangle their independent influence on smoking.

Promotion of smoking cessation with emotional and/or graphic antismoking advertising.

BACKGROUND: Antismoking campaigns can be effective in promoting cessation, but less is known about the dose of advertising related to behavioral change among adult smokers, which types of messages are most effective, and effects on populations disproportionately affected by tobacco use. PURPOSE: To assess the impact of emotional and/or graphic antismoking TV advertisements on quit attempts in the past 12 months among adult smokers in New York State. METHODS: Individual-level data come from the 2003 through 2010 New York Adult Tobacco Surveys. The influence of exposure to antismoking advertisements overall, emotional and/or graphic advertisements, and other types of advertisements on reported attempts to stop smoking was examined. Exposure was measured by self-reported confirmed recall and market-level gross rating points. Analyses conducted in Spring 2012 included 8780 smokers and were stratified by desire to quit, income, and education. RESULTS: Both measures of exposure to antismoking advertisements are positively associated with an increased odds of making a quit attempt among all smokers, among smokers who want to quit, and among smokers in different household income brackets (<$30,000 and ≥$30,000) and education levels (high-school degree or less education and at least some college education). Exposure to emotional and/or graphic advertisements is positively associated with making quit attempts among smokers overall and by desire to quit, income, and education. Exposure to advertisements without strong negative emotions or graphic images had no effect. CONCLUSIONS: Strongly emotional and graphic antismoking advertisements are effective in increasing population-level quit attempts among adult smokers.

Repeated exposure to media messages encouraging parent-child communication about sex: differential trajectories for mothers and fathers.

PURPOSE: To examine changes in parent-child communication related to sexual behavior after exposure to public health messages. DESIGN: Randomized, controlled trial that was part of precampaign message testing. SETTING: Exposure occurred online or through DVDs mailed to participants and viewed on their personal computers. Data collection occurred via a secure Web site. PATIENTS: Participants included parents (n  =  1969) living with a child age 10 to 14 years drawn from a nationally representative sample of U.S. households. INTERVENTION: Treatment participants were exposed to video, audio, and print advertisements that promoted the benefits of speaking to their children early and often about delaying initiation of sexual activity; messages also directed parents to an informational Web site. MEASURES: The dependent variable assessed frequency of parent-child communication related to sexual behavior. The primary independent variable was treatment assignment. ANALYSIS: Longitudinal growth modeling that included five waves of data. RESULTS: The trajectory of growth over time differed between fathers in the treatment group and fathers in the control group (F[1, 2357]  =  4.15; p < .042), indicating more frequent communication among treatment fathers than among control fathers. Trajectories did not differ between mothers in treatment and control groups. CONCLUSION: This study demonstrates that father-child and mother-child communication patterns differ over time in response to public health messages. Findings have implication for researchers developing health marketing campaigns.

Promoting calls to a quitline: quantifying the influence of message theme, strong negative emotions and graphic images in television advertisements.

OBJECTIVE: To understand the relative effectiveness of television advertisements that differ in their thematic focus and portrayals of negative emotions and/or graphic images in promoting calls to a smokers' quitline. METHODS: Regression analysis is used to explain variation in quarterly media market-level per smoker calls to the New York State Smokers' Quitline from 2001 to 2009. The primary independent variable is quarterly market-level delivery of television advertisements measured by target audience rating points (TARPs). Advertisements were characterised by their overall objective--promoting cessation, highlighting the dangers of secondhand smoke (SHS) or other--and by their portrayals of strong negative emotions and graphic images. RESULTS: Per smoker call volume is positively correlated with total TARPs (p<0.001), and cessation advertisements are more effective than SHS advertisements in promoting quitline call volume. Advertisements with graphic images only or neither strong negative emotions nor graphic images are associated with higher call volume with similar effect sizes. Call volume was not significantly associated with the number of TARPs for advertisements with strong negative emotions only (p=0.71) or with both graphic images and strong emotions (p=0.09). CONCLUSIONS: Exposure to television advertisements is strongly associated with quitline call volume, and both cessation and SHS advertisements can be effective. The use of strong negative emotions in advertisements may be effective in promoting smoking cessation in the population but does not appear to influence quitline call volume. Further research is needed to understand the role of negative emotions in promoting calls to quitlines and cessation more broadly among the majority of smokers who do not call quitlines.

Why are financial incentives not effective at influencing some smokers to quit? Results of a process evaluation of a worksite trial assessing the efficacy of financial incentives for smoking cessation.

OBJECTIVE: Process evaluation of a worksite intervention in which employees were offered $750 to complete a cessation program and to quit smoking. METHODS: Awareness and attitudes about financial incentives were assessed following a randomized controlled trial of 878 smokers at a US-based company. RESULTS: Cessation program attendance was higher in incentive group versus control (20.2% vs 7.1%, P < 0.01). Most quitters (69.8%) in the incentive group who were already motivated to quit and reported that they would have quit for less money, said incentives were "not at all" or only "somewhat" important. Most nonquitters in the incentive group reported that even $1500 would not have motivated them to quit. CONCLUSIONS: Financial incentives are ineffective at motivating some smokers to quit. Internal motivation and readiness to quit need to be sufficiently high for relatively modest incentives to be effective.

Impact of a parent-child sexual communication campaign: results from a controlled efficacy trial of parents.

BACKGROUND: Prior research supports the notion that parents have the ability to influence their children's decisions regarding sexual behavior. Yet parent-based approaches to curbing teen pregnancy and STDs have been relatively unexplored. The Parents Speak Up National Campaign (PSUNC) is a multimedia campaign that attempts to fill this void by targeting parents of teens to encourage parent-child communication about waiting to have sex. The campaign follows a theoretical framework that identifies cognitions that are targeted in campaign messages and theorized to influence parent-child communication. While a previous experimental study showed PSUNC messages to be effective in increasing parent-child communication, it did not address how these effects manifest through the PSUNC theoretical framework. The current study examines the PSUNC theoretical framework by 1) estimating the impact of PSUNC on specific cognitions identified in the theoretical framework and 2) examining whether those cognitions are indeed associated with parent-child communication METHODS: Our study consists of a randomized efficacy trial of PSUNC messages under controlled conditions. A sample of 1,969 parents was randomly assigned to treatment (PSUNC exposure) and control (no exposure) conditions. Parents were surveyed at baseline, 4 weeks, 6 months, 12 months, and 18 months post-baseline. Linear regression procedures were used in our analyses. Outcome variables included self-efficacy to communicate with child, long-term outcome expectations that communication would be successful, and norms on appropriate age for sexual initiation. We first estimated multivariable models to test whether these cognitive variables predict parent-child communication longitudinally. Longitudinal change in each cognitive variable was then estimated as a function of treatment condition, controlling for baseline individual characteristics. RESULTS: Norms related to appropriate age for sexual initiation and outcome expectations that communication would be successful were predictive of parent-child communication among both mothers and fathers. Treatment condition mothers exhibited larger changes than control mothers in both of these cognitive variables. Fathers exhibited no exposure effects. CONCLUSIONS: Results suggest that within a controlled setting, the "wait until older norm" and long-term outcome expectations were appropriate cognitions to target and the PSUNC media materials were successful in impacting them, particularly among mothers. This study highlights the importance of theoretical frameworks for parent-focused campaigns that identify appropriate behavioral precursors that are both predictive of a campaign's distal behavioral outcome and sensitive to campaign messages.