A content analysis of the tweets of e-cigarette proponents in Australia.

ISSUE ADDRESSED: Social media sites have become platforms for public discourse on e-cigarettes, providing proponents with an opportunity to disseminate favourable information about the devices. Research examining the information being presented by Australian proponents of e-cigarettes is limited. Accordingly, this study explored the Twitter feeds of Australian proponents of e-cigarettes to determine the nature of the e-cigarette-related content being disseminated. METHODS: All publicly available e-cigarette-related tweets and retweets (n = 1397) disseminated over a 15-week period by five Australian e-cigarette proponents were captured and analysed. RESULTS: The main topics covered in the 1397 tweets analysed related to (a) criticism of the arguments made by public health agencies/advocates who oppose e-cigarettes (29%), (b) Australian e-cigarette policy (19%), (c) the health risks of e-cigarettes (16%) and (d) the efficacy of e-cigarettes as smoking cessation aids (13%). Proponents argued that the precautionary principle adopted by public health agencies/advocates lacks an appropriate evidence base and that legalising e-cigarettes would reduce smoking rates and smoking-related harm. Proponents minimised the risks associated with e-cigarette use and only presented evidence indicating that use facilitates smoking cessation. CONCLUSIONS: The assessed tweets have the potential to reduce the public's trust in the information being presented by authoritative public health agencies/advocates. The dissemination of information downplaying the health risks associated with e-cigarettes may distort perceptions of the devices. SO WHAT?: To assist tobacco control efforts, results highlight the need for (a) ongoing surveillance of the tweets of e-cigarette proponents and (b) provision of evidence-based counterarguments on social media.

Who sells tobacco, who stops? A comparison across different tobacco retailing schemes.

BACKGROUND: Licensing of tobacco retailers has been proposed as a mechanism to encourage retailers to stop selling tobacco. However, previous studies of tobacco licensing and/or of retailers who have stopped selling have been restricted to one legislative environment. This study examines patterns of tobacco retailing across three legislative environments with three different licensing schemes (an annual fee-based licence, a zero-cost, one-off notification scheme and no notification/licensing scheme). METHOD: A telephone survey was conducted of 2928 potential tobacco retailers who could personally choose whether or not to sell tobacco (rather than the decision being made at a head office). RESULTS: Unexpectedly, the annual licence fee to sell tobacco was not significantly associated with a lower rate of selling tobacco or a higher rate of stopping. After allowing for other factors, probability of selling, stopping selling and reported importance of tobacco sales varied across outlet types (p<0.001 for all three outcomes), and according to the remoteness of the retailer (p<0.001, p trend=0.041 and p=0.025 respectively). CONCLUSION: A fee of $A286 was not associated with a lower rate of selling, or a higher rate of stopping. The effect of licensing on retailer numbers will presumably be greater for higher licence fees, but will also depend on the perceived importance of tobacco sales to the retailer. In turn, importance of tobacco sales appears to depend on market factors, including proximity to major urban centres and low-cost competitors. A higher licence fee is likely to have a larger effect on discouraging retailers from selling.

'Friends with benefits': how tobacco companies influence sales through the provision of incentives and benefits to retailers.

BACKGROUND: In countries banning advertising and display of tobacco at point-of-sale, little is known about tobacco companies' continuing promotion of products through incentives and benefits to retailers. METHOD: A telephone survey of 4527 randomly selected Australian retailers was conducted in August 2018, and identified 800 current tobacco retailers (response rate: 72.4%) who were asked a series of questions about benefits offered to them by tobacco companies and what retailers agreed to in return. RESULTS: 41.1% of retailers reported being provided with a tobacco cabinet and 38.3% reported having a price list supplied by a tobacco company. One-third (33.3%) reported being offered at least one benefit from a tobacco company for doing something in return. Price discounts were the most frequently reported benefit (19.0%), followed by rebates (8.4%) and gifts (3.0%). Retailers also reported offers of prizes and incentives for increasing sales or demonstrating product knowledge. In return, retailers reported giving companies benefits such as prominence on the price list and/or in the tobacco cabinet and/or influence over the product range and stock levels. CONCLUSION: Tobacco companies are continuing to market tobacco and influence sales through provision of incentives and benefits to retailers. Laws that ban the supply of benefits to consumers should be extended to also prohibit the provision of benefits to tobacco retailers.

Understanding why some Australian retailers have stopped selling tobacco, some might and some are unlikely.

BACKGROUND: Widespread availability of tobacco has been shown to contribute to ongoing smoking and make quitting harder. This study investigates why some retailers in three Australian states decided to stop selling tobacco, others might stop selling and why others continue to sell in a declining market. METHODS: A telephone survey of 4527 randomly selected retailers was conducted in August 2018 (response rate=72.4%). This study examines responses to open-ended questions in the survey probing retailers' attitudes and beliefs regarding selling (or not selling) tobacco. RESULTS: 27.3% of the sample sold tobacco, and 13.3% had formerly sold. Outlets that had stopped selling most frequently mentioned minimal profit and/or sales as the reason for stopping selling (27.7% across all states). This was also the most frequent reason why retailers said they might stop selling. Uniquely in Western Australia (the only state in the study with a fee-based licensing scheme), 12.5% of former tobacco retailers named tobacco licensing as the reason for stopping sales-the second most frequent reason in Western Australia. Of current sellers who were unlikely to stop, the potential to lose sales was the most frequently named reason (31.0% across all states). CONCLUSION: Retailers report being driven by the profitability of tobacco when deciding whether or not to stop selling, although only a small percentage discussed losing incremental sales if they stopped selling. An annual licence fee contributed to some retailers stopping selling, showing that a fee-based tobacco license can contribute to a decline in retail availability of tobacco.

Assessing Audience Members' Ability to Identify the Media Source of a Health Campaign Disseminated via Different Media.

Background: An important criterion for health campaign media selection is the ability to achieve campaign awareness among target audiences. However, existing campaign exposure metrics cannot be applied across both traditional and digital media, which complicates decision making. The present study assessed the validity of using self-report as a measure of the extent to which different types of media achieve campaign awareness to assist in determining appropriate media budget allocations. Methods: A quasi-experiment involving varying combinations of television, online video, and online display smoking cessation advertisements was conducted to determine whether audience members were able to accurately report the source of their exposure to the campaign. Results: Of the 719 Western Australian adults sampled (50% males, 50 females, 50% smokers, 50% non-smokers), 64% reported seeing the campaign in the previous 2 weeks. Of these, 91% reported seeing the advertisement on television, 8% on online video, and 21% on online display (respondents could select multiple media). Despite proportional scheduling of the three media over the discrete campaign periods, in most cases respondents assumed their exposure had occurred via television, regardless of the actual source of exposure. Conclusions: Among both smokers and non-smokers, television had primacy in memory regardless of the actual media used. As such, relying on self-reported recall is unlikely to constitute a reliable method of assessing target audience exposure to campaigns on different media where those media are all screen-based. The results highlight the need for alternative media effectiveness metrics that permit direct comparisons between traditional and digital media.

Comparing the Cost-Effectiveness of Campaigns Delivered via Various Combinations of Television and Online Media.

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

Are visiting oncologists enough? A qualitative study of the needs of Australian rural and regional cancer patients, carers and health professionals.

AIM: Survival rates for patients with cancer who live in rural and regional areas are worse than in metropolitan areas. This may be due to geographical isolation, delayed diagnosis, inadequate transport, lower socioeconomic status and workforce shortages. We conducted a qualitative study of rural patients, carers and health professionals. It aimed to identify concerns about, and strategies to optimize cancer care from those with direct experience. METHODS: Focus groups and structured interviews were conducted in New South Wales, Australia at four rural and regional hospitals (Bega, Dubbo, Tamworth and Albury) and three metropolitan locations (in Sydney and the Jean Colvin Hostel) caring for rural patients. Sessions were audiotaped, transcribed and analyzed using thematic analysis. RESULTS: In total, 36 patients, 14 carers and 32 health professionals were interviewed in seven focus groups and 42 individual interviews. Concerns related to access to oncologists and other health professionals, and for services for investigation and treatment, the financial and social consequences of travel, unmet carer support needs and the hardships for health professionals. Strategies for improvement included comprehensive staffing and services coordinated in a hub and spoke model from adjacent larger centers, adequate reimbursement for travel and better carer support. CONCLUSION: We identified broad concerns about regional and rural cancer care in Australia. The Australian Federal Government commitment of $560 million to establish regional cancer centers is welcome; however, improvements must extend beyond infrastructure funding in large regional centers to comprehensive staffing in centers currently lacking resident oncologists, travel support and assistance for carers.

Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review.

PURPOSE: The aim of this study was to describe what is known about levels of morbidity and the experience and needs of people with cancer, and their informal caregivers, living in rural areas. METHODS: A search of online databases for English language papers describing or assessing the prevalence of psychosocial morbidity or needs in a population of rural or regional cancer patients was employed. The following were excluded: intervention studies, discussion of service delivery, effectiveness of support groups or support via videoconferencing, concentrated on medical outcomes or survival rates, reported differences in the uptake of cancer screening or concentrated on health attitudes or treatment decision making. RESULTS: There were 37 studies in the review, including 25 quantitative studies (all surveys), 11 of which included a control group of urban patients and 12 qualitative studies. Until recently, most studies had methodological shortcomings. Only two prospective studies were identified, most studies focused on breast cancer and few addressed psychological morbidity. The majority of controlled studies reported worse outcomes for rural patients, who appear to have higher needs in the domains of physical/daily living. This may reflect more limited access to resources, a more self-sufficient lifestyle and personal characteristics, for example, being more stoical and less likely to ask for help. The need to travel for treatment caused many practical, emotional and financial problems for patients and burdened them with additional worry concerning family and work commitments. Some patients reported benefits in sharing experiences with others also forced to stay away from home, but most agreed that staying at home was preferable. CONCLUSION: This review highlights that whilst we are beginning to get some insight into the needs of people with cancer in rural areas, much is still unknown. Population-based, prospective studies including people with heterogeneous cancers from rural and urban settings are needed.

Try and try again--qualitative insights into adolescent smoking experimentation and notions of addiction.

ISSUE ADDRESSED: addiction is a relatively unexplored issue in youth tobacco control. Increasingly, there is recognition of addiction experiences in regular and irregular teenage smokers. Research was undertaken on behalf of the Smarter than Smoking (STS) project to probe young people's reasons for smoking uptake, their attitudes towards the social acceptability of smoking, predictors of continued smoking after trial and understandings and perceptions of addiction. METHODS: twenty focus groups were conducted to collect qualitative data from young people (n=92) aged 13 to 15 years from metropolitan and regional areas of Western Australia (WA), from a variety of socioeconomic backgrounds, including young Aboriginal and Torres Strait Islander people. RESULTS: of the young people spoken to, 20% smoked regularly, 40% had tried smoking and 40% had never tried. Acceptability and normalcy of trialling smoking was a recurring theme, with little perceived risk of trial leading to regular smoking or becoming addicted. Even non-smokers accepted 'just having a try' in the context of curiosity, life experiences and 'informed choice'. CONCLUSIONS: preventing continuation after trial of smoking among young people needs to increase in importance, given the prevailing norms around 'trying it' and individual choice.

Encouraging young Western Australians to be smarter than smoking.

PURPOSE: Smarter than Smoking is a multistrategy statewide youth smoking intervention. This article describes key strategies and results from its inception in 1995 to 2005. DESIGN: Comprehensive evaluation included formative research and baseline and follow-up surveys. Triennial national surveys provided independent monitoring of adolescent smoking prevalence. SETTING: Western Australia. SUBJECTS: 10- to 15-year-olds. INTERVENTION: A multipronged strategy mix, including mass media, the Internet, sponsorship, school initiatives, publications, and advocacy. MEASURES: Smoking prevalence, media awareness, and attitudes toward smoking and campaign messages. ANALYSIS: Trend comparisons across the first decade of the project, along with descriptive statistics. RESULTS: Significant attitudinal and behavioral shifts were observed following media waves and over time. There was a steady increase in the proportion who had never smoked (from 40% in 1996 to 61% in 2005). Results also showed a significant decrease in smoking prevalence from 1996 to 2005, down from 28% to 7% among 14-year-olds and from 43% to 14% among 15-year-olds. CONCLUSIONS: Smarter than Smoking was effective in achieving positive shifts in awareness, attitudes, intentions, and behavior. Effectiveness appeared to have been enhanced by sustained long-term funding, youth involvement in strategy development, and a strong research and evaluation base.

Severe autosomal dominant nocturnal frontal lobe epilepsy associated with psychiatric disorders and intellectual disability.

Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is a relatively benign epilepsy syndrome with few comorbidities. Here we describe two families with unusually severe ADNFLE, with associated psychiatric, behavioral, and cognitive features. Detailed clinical data on 17 affected individuals were obtained, and genotyping of microsatellite markers, linkage analysis, and sequencing of candidate genes was performed. The severe ADNFLE phenotype in these families was often refractory to treatment, with status epilepticus occurring in 24% of subjects. Psychiatric or behavioral disorders occurred in 53%, with intellectual disability in 24%, and developmental regression in two individuals. No mutations were identified in alpha4, alpha2, or beta2 nAChR subunits. In one family there was evidence of linkage to a region of 15q24 without nAChR subunit genes. In conclusion, severe ADNFLE has significant medical, psychiatric, and intellectual morbidity. The molecular basis of severe ADNFLE is unknown but may involve non-nAChR-related mechanisms.

Preventing or accelerating emergency care for children with complex healthcare needs.

OBJECTIVE: A subgroup of children with special health care needs (CSHCN) have chronic and complex medical conditions and frequently attend the emergency department (ED). Some of these ED visits could be prevented through appropriate clinician advice or, if an ED visit is unavoidable, the management time could be decreased. We set out to determine whether an ED-based advice and coordination programme was feasible and could prevent or accelerate ED care for these patients. METHODS, SETTING AND PATIENTS: We identified CSHCN who frequently attended the ED at a large tertiary children's hospital. These patients were enrolled in an ED-based coordination programme, the Accelerated Care through Emergency (ACE) programme providing 24-hour mobile-phone access to experienced ED nurses. We prospectively tracked usage patterns and determined the rate of ED visits after receiving phone advice and the waiting time for patients to be seen in ED. Parental satisfaction and cost of the programme were also assessed. RESULTS: After a pilot phase in 2002, enrollment in the programme increased from 125 in 2003 to 220 patients in 2006. Patients had a broad range of medical conditions. All had two or more and up to 22 medical services involved in their care. 80% of patients used a technical device or implant. Phone calls increased from an initial average of 31 per month in 2003 (0.24 calls per participant) to 66 per month in 2006 (0.3 calls per participant), 60% of which were after hours. The percentage of ED reviews per phone call dropped from an initial 74.2% (95% CI 55.2%-88.1%) in 2003 to 50.0% (95% CI 37.4%-62.5%) in 2006 (p = 0.02). However, decreases in ED visits and admissions as a percentage of enrolled patients and as a percentage of phone calls to ACE staff were not statistically significant. Mean waiting time for enrolled patients remained below 30 minutes. Parent satisfaction with the programme was rated 8.3 on a 0-10 scale (0 meaning poor, 10 meaning excellent). The approximate cost of the programme per child was AU$750 (292 pounds sterling) per year. CONCLUSION: We have developed a coordinated approach towards the provision of healthcare for a group of families with diverse severe chronic medical conditions who frequently present to the ED. Through a comprehensive programme including the development of patient-care plans, care coordination and 24-hour mobile-phone access we were able to enhance families' capacities to manage their children's conditions in the community.

Genetic architecture of idiopathic generalized epilepsy: clinical genetic analysis of 55 multiplex families.

PURPOSE: In families with idiopathic generalized epilepsy (IGE), multiple IGE subsyndromes may occur. We performed a genetic study of IGE families to clarify the genetic relation of the IGE subsyndromes and to improve understanding of the mode(s) of inheritance. METHODS: Clinical and genealogic data were obtained on probands with IGE and family members with a history of seizures. Families were grouped according to the probands' IGE subsyndrome: childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and IGE with tonic-clonic seizures only (IGE-TCS). The subsyndromes in the relatives were analyzed. Mutations in genes encoding alpha1 and gamma 2 gamma-aminobutyric acid (GABA)-receptor subunits, alpha1 and beta1 sodium channel subunits, and the chloride channel CLC-2 were sought. RESULTS: Fifty-five families were studied. 122 (13%) of 937 first- and second-degree relatives had seizures. Phenotypic concordance within families of CAE and JME probands was 28 and 27%, respectively. JAE and IGE-TCS families had a much lower concordance (10 and 13%), and in the JAE group, 31% of relatives had CAE. JME was rare among affected relatives of CAE and JAE probands and vice versa. Mothers were more frequently affected than fathers. No GABA-receptor or sodium or chloride channel gene mutations were identified. CONCLUSIONS: The clinical genetic analysis of this set of families suggests that CAE and JAE share a close genetic relation, whereas JME is a more distinct entity. Febrile seizures and epilepsy with unclassified tonic-clonic seizures were frequent in affected relatives of all IGE individuals, perhaps representing a nonspecific susceptibility to seizures. A maternal effect also was seen. Our findings are consistent with an oligogenic model of inheritance.

Truncation of the GABA(A)-receptor gamma2 subunit in a family with generalized epilepsy with febrile seizures plus.

Recent findings from studies of two families have shown that mutations in the GABA(A)-receptor gamma2 subunit are associated with generalized epilepsies and febrile seizures. Here we describe a family that has generalized epilepsy with febrile seizures plus (GEFS(+)), including an individual with severe myoclonic epilepsy of infancy, in whom a third GABA(A)-receptor gamma2-subunit mutation was found. This mutation lies in the intracellular loop between the third and fourth transmembrane domains of the GABA(A)-receptor gamma2 subunit and introduces a premature stop codon at Q351 in the mature protein. GABA sensitivity in Xenopus laevis oocytes expressing the mutant gamma2(Q351X) subunit is completely abolished, and fluorescent-microscopy studies have shown that receptors containing GFP-labeled gamma2(Q351X) protein are retained in the lumen of the endoplasmic reticulum. This finding reinforces the involvement of GABA(A) receptors in epilepsy.