Colorectal cancer screening: Associations between information provision, attitudes and intended participation.

OBJECTIVE: Properly informing target audiences is crucial in population-based screening programs. We aimed to evaluate the impact of information about CRC screening on attitudes and intended participation in a screening-naive population. METHODS: 614 persons (aged 55-75 years) received a survey. Information on CRC and screening was provided piece by piece, and per piece its impact on attitudes and intended participation was assessed. All persons received the same information content, but the sequence of information differed per condition: information on the high mortality rate of colorectal cancer was presented in the first or the second piece. Educational levels, the extent people considered future consequences, and value concordance between attitudes and intentions were assessed. RESULTS: 436 persons (response 71%) completed the survey. Overall most respondents reported positive attitudes towards CRC screening (78%) and intentions to participate in CRC screening (83%), independent of sequence of information provision. Intentions about participation were value concordant in the majority (88%). Results were similar in low educated groups. CONCLUSION: Providing balanced information about CRC screening (also addressing negative effects) did not impede value concordance and high rates of intended participation. PRACTICE IMPLICATIONS: High rates of screening intentions are possible without omitting threatening health information in communication materials.

Impact of laws restricting the sale of tobacco to minors on adolescent smoking and perceived obtainability of cigarettes: an intervention-control pre-post study of 19 European Union countries.

AIMS: To estimate the impact of introducing sales restriction laws in Europe by measuring changes in adolescent smoking prevalence and perceived obtainability of cigarettes over time in countries that have recently introduced sales restriction laws (intervention countries). These countries were compared with countries where such laws were already in force (control countries). The secondary aim was to test whether these trends differed between adolescents of higher and lower socio-economic position (SEP). DESIGN: Repeated cross-sectional data were used in a quasi-experimental pre-post design. Intervention countries raised tobacco sales restrictions to 18 years in 2007, 2008 or 2009. Control countries have had sales restrictions of 18 years since at least 2004. SETTING: Nineteen European Union (EU) countries in 2007 and 2011. PARTICIPANTS: Data of 97 245 15- and 16-year-old adolescents from the 2007 and 2011 European Survey Project on Alcohol and other Drugs (ESPAD) surveys. MEASUREMENTS: Dependent variables were smoking status (weekly smoking versus non-smoking or less than weekly smoking) and perceived obtainability of tobacco (easy versus difficult). Key independent variables were time (2007 or 2011), intervention exposure (intervention or control country) and their interaction (time × intervention). Covariates included sex, SEP, the tobacco control scale (TCS), gross domestic product (GDP) and adult smoking prevalence. FINDINGS: We did not find a difference in the change in smoking prevalence between intervention and control countries [odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.93-1.07]. However, sales restrictions were associated with a significantly greater decrease in perceived ease of cigarette obtainability in intervention countries (OR = 0.75, 95% CI = 0.70-0.80). No significant differential effects between high and low SEP adolescents were found (OR = 1.01, 95% CI = 0.81-1.25). CONCLUSION: Laws prohibiting the sales of tobacco to minors in Europe do not appear to be associated with a reduction in adolescent smoking rates, but lower the perceived obtainability of cigarettes irrespective of their socio-economic position.