Impact of a targeted direct marketing price promotion intervention (Buywell) on food-purchasing behaviour by low income consumers: a randomised controlled trial.

BACKGROUND: Price promotions are a promising intervention for encouraging healthier food purchasing. We aimed to assess the impact of a targeted direct marketing price promotion combined with healthy eating advice and recipe suggestions on the purchase of selected healthier foods by low income consumers. METHODS: We conducted a randomised controlled trial (n = 53 367) of a direct marketing price promotion (Buywell) combined with healthy eating advice and recipe suggestions for low income consumers identified as 'less healthy' shoppers. Impact was assessed using electronic point of sale data for UK low income shoppers before, during and after the promotion. RESULTS: The proportion of customers buying promoted products in the intervention month increased by between 1.4% and 2.8% for four of the five products. There was significantly higher uptake in the promotion month (P < 0.001) for the intervention group than would have been expected on the basis of average uptake in the other months. When product switching was examined for semi-skimmed/skimmed milk, a modest increase (1%) was found in the intervention month of customers switching from full-fat to low-fat milk. This represented 8% of customers who previously bought only full-fat milk. The effects were generally not sustained after the promotion period. CONCLUSIONS: Short-term direct marketing price promotions combined with healthy eating advice and recipe suggestions targeted at low income consumers are feasible and can have a modest impact on short-term food-purchasing behaviour, although further approaches are needed to help sustain these changes.

Young people's exposure to point-of-sale tobacco products and promotions.

OBJECTIVES: Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for evaluating POS exposure based on young people's use of retail outlets and recall of tobacco displays and observational data on the characteristics of displays. STUDY DESIGN: Observational audit of retail outlets (n = 96) and school-based pupil survey (n = 1482) in four Scottish communities reflecting different levels of social deprivation and urbanisation, conducted in 2013 before legislation to remove POS displays was implemented in supermarkets. METHODS: Measures were taken of: visibility and placement of tobacco displays; internal and external advertising; display unit size, branding and design; visibility of pack warnings; proximity of tobacco products to products of potential interest to children and young people; pupils' self-reported frequency of visiting retail outlets; and pupils' recall of tobacco displays. Variation in POS exposure across social and demographic groups was assessed. RESULTS: Displays were highly visible within outlets and, in over half the stores, from the public footway outside. Tobacco products were displayed in close proximity to products of interest to children (e.g. confectionery, in 70% of stores). Eighty percent of pupils recalled seeing tobacco displays, with those from deprived areas more likely to recall displays in small shops. When confectioners, tobacconists and newsagents (CTNs) and grocery/convenience stores (two of the outlet types most often visited by young people) were examined separately, average tobacco display unit sizes were significantly larger in those outlets in more deprived areas. CONCLUSIONS: POS displays remain a key vector in most countries for advertising tobacco products, and it is important to develop robust measures of exposure. The data reported in this paper provide a baseline measure for evaluating the efficacy of legislation prohibiting such displays.

Does exposure to cigarette brands increase the likelihood of adolescent e-cigarette use? A cross-sectional study.

OBJECTIVE: To examine the relationship between tobacco cigarette brand recognition, and e-cigarette use in adolescents. DESIGN: Cross-sectional observational study. SETTING: High schools in Scotland. PARTICIPANTS: Questionnaires were administered to pupils in Secondary 2 (S2 mean age: 14.0 years) and Secondary 4 (S4 mean age: 15.9 years) across 4 communities in Scotland. An 86% response rate with a total sample of 1404 pupils was achieved. MAIN OUTCOME MEASURES: Self-reported previous use of e-cigarettes and self-reported intention to try e-cigarettes in the next 6 months. RESULTS: 75% (1029/1377) of respondents had heard of e-cigarettes (69.5% S2, 81.1% S4), and of these, 17.3% (10.6% S2, 24.3% S4 n=1020) had ever tried an e-cigarette. 6.8% (3.7% S2, 10.0% S4 n=1019) reported that they intended to try an e-cigarette in the next 6 months. Recognition of more cigarette brands was associated with greater probability of previous e-cigarette use (OR 1.20, 99% CI 1.05 to 1.38) as was having a best friend who smoked (OR 3.17, 99% CI 1.42 to 7.09). Intention to try e-cigarettes was related to higher cigarette brand recognition (OR 1.41, 99% CI 1.07 to 1.87), hanging around in the street or park more than once a week (OR 3.78, 99% CI 1.93 to 7.39) and living in areas of high tobacco retail density (OR 1.20, 99% CI 1.08 to 1.34). Never having smoked was a protective factor for both future intention to try, and past e-cigarette use (OR 0.07, 99% CI 0.02 to 0.25; and OR 0.10, 99% CI 0.07 to 0.16, respectively). CONCLUSIONS: Higher cigarette brand recognition was associated with increased probability of previous use and of intention to use e-cigarettes. The impact of tobacco control measures such as restricting point-of-sale displays on the uptake of e-cigarettes in young people should be evaluated.

E-cigarette marketing in UK stores: an observational audit and retailers' views.

OBJECTIVES: To explore how e-cigarettes are being promoted at point of sale in the UK and how retailers perceive market trends. SETTING: Fixed retail outlets subject to a ban on the display of tobacco products. PARTICIPANTS: Observational audit of all stores selling tobacco products (n=96) in 4 Scottish communities, conducted over 2 waves 12 months apart (2013-2014), and qualitative interviews with small retailers (n=25) in 4 matched communities. PRIMARY AND SECONDARY OUTCOME MEASURES: The audit measured e-cigarette display characteristics, advertising materials and proximity to other products, and differences by area-level disadvantage. Interviews explored retailers' perceptions of e-cigarette market opportunities and risks, and customer responses. RESULTS: The number of e-cigarette point-of-sale display units and number of brands displayed increased between waves. E-cigarettes were displayed close to products of interest to children in 36% of stores. Stores in more affluent areas were less likely to have external e-cigarette advertising than those in deprived areas. Although e-cigarettes delivered high profit margins, retailers were confused by the diversity of brands and products, and uncertain of the sector's viability. Some customers were perceived to purchase e-cigarettes as cessation aids, and others, particularly low-income smokers, as a cheaper adjunct to conventional tobacco. CONCLUSIONS: E-cigarette point-of-sale displays and number of brands displayed increased over 12 months, a potential cause for concern given their lack of regulation. Further scrutiny is needed of the content and effects of such advertising, and the potentially normalising effects of placing e-cigarettes next to products of interest to children.

Development and evaluation of an early detection intervention for mouth cancer using a mass media approach.

BACKGROUND: Scotland has a high incidence of mouth cancer, but public awareness and knowledge are low compared with other cancers. The West of Scotland Cancer Awareness Project sought to increase public awareness and knowledge of mouth cancer and to encourage early detection of symptoms among an at-risk population of people aged over 40 years from lower socio-economic groups using a mass media approach. The media campaign aimed to increase people's feelings of personal risk, while also enhancing feelings of efficacy and control. To achieve this, a testimonial approach (using real people to tell their own stories) was adopted. METHODS: Campaign impact and reach was assessed using in-home interviews with a representative sample of the target population in both the campaign area and controls outside of the target area. Surveys were conducted at three stages: at baseline before the campaign was launched, and at 7 and 12 months thereafter. RESULTS: Awareness of media coverage was higher at both follow-up points in the intervention area than in the control area, the differences largely being accounted for by television advertising. The campaign had a short-term, but not a long-term impact on awareness of the disease and intention to respond to the symptoms targeted by the campaign. Awareness of two of the symptoms featured in the campaign (ulcers and lumps) increased, post-campaign, among the intervention group. CONCLUSIONS: While the study provides evidence for the effectiveness of the self-referral model, further work is needed to assess its ability to build public capacity to respond appropriately to symptoms and to compare the cost-effectiveness of a mass media approach against alternative communication approaches and more conventional mass screening.

"Hello, hello--it's English I speak!": a qualitative exploration of patients' understanding of the science of clinical trials.

Informed consent may be seriously compromised if patients fail to understand the experimental nature of the trial in which they are participating. Using focus groups, the authors explored how prospective trial participants interpret and understand the science of clinical trials by using patient information sheets relative to their medical condition. An opportunity was provided to hear in the patients' own words how they interpret the information and why there is variable understanding. Respondents struggled to comprehend the meaning and purpose of concepts such as randomisation and double blinding, and found them threatening to their ideas of medical care. Suggestions are made about how to improve the national guidelines on written information for trial participants and pretesting of the information sheets is advocated.

Community pharmacists' experience of over-the-counter medicine misuse in Scotland.

Over the last decade Britain has observed a trend towards the re-regulation of 'prescription only medicines' in favour of pharmacy status drugs. This move towards self-treatment to reduce pressures on general practitioner drug budgets and workloads has focused attention on the need for community pharmacists to extend their patient education and screening roles. In response to these changes, this study was conducted to explore: the type of over-the-counter (OTC) medicine being misused in Scotland; pharmacists' professional attitudes and management of OTC misuse; and the training and support needs of pharmacists. A postal questionnaire was designed. This was informed by an earlier stage of qualitative research and the available literature. It was then piloted and administered to all 110 pharmacies in the study area. A 79% response rate was achieved. The research found that OTC misuse, particularly of certain analgesics, sleeping prescriptions, products containing codeine or pseudoephedrine, caffeine, cough mixtures, and laxatives was common. The estimated mean number of patients suspected of misusing medicines in a typical week was 5.63. Pharmacies in urban areas were more likely than those in rural areas to report suspected misuse. The research identified a number of intervention strategies relating to: patient/pharmacist interaction; information provision; removal of products from the point of sale; sharing of information with other local pharmacists; and referral to other members of the primary care team. Pharmacists expressed a need for support in managing OTC misuse and in organising 'early warning systems' to share information locally.

"It's as if you're locked in": qualitative explanations for area effects on smoking in disadvantaged communities.

Evidence suggests that place of residence may be associated with smoking independently of individual poverty and socio-economic status. Qualitative research undertaken in disadvantaged communities in Glasgow explored possible pathways which might explain this 'area effect'. A poorly resourced and stressful environment, strong community norms, isolation from wider social norms, and limited opportunities for respite and recreation appear to combine not only to foster smoking but also to discourage or undermine cessation. Even the more positive aspects of life, such as support networks and identity, seem to encourage rather than challenge smoking. Policy and intervention responses need to tackle not only individual but also environmental disadvantage.

Management of alcohol misuse in Scotland: the role of A&E nurses.

Despite national targets to reduce excessive drinking in Scotland, rates have increased dramatically since the mid-eighties. The role of Accident and Emergency (A&E) departments in the management of alcohol misuse is much debated. This postal survey was conducted with senior medical and nursing staff in A&E departments and minor injury units throughout Scotland to examine the prevalence of alcohol-related attendances and staff's attitudes towards identifying and responding to alcohol-related attendances. A 57% response rate was achieved, representing 87% of all A&E institutions in Scotland (n = 84). The results reveal an estimated 1 in 7 attendances in A&E in Scotland are alcohol-related, and 1 in 5 of these result in admission. However, over two-fifths of departments do not routinely screen for, or keep records of, patients who attend with alcohol problems. Intervention is normally limited to a brief dialogue and referral to the patient's GP. Despite considerable barriers, A&E nursing staff express a willingness to assume a preventive role, but acknowledge lack of appropriate training and sources of support. It is concluded that there is scope for developing identification and brief intervention services within A&E. However, such developments are dependent upon alcohol issues assuming a higher priority among senior A&E staff.

Marketing alcohol to young people: implications for industry regulation and research policy.

This paper focuses on the marketing of alcohol to young people in the United Kingdom, but the lessons that emerge have international significance. Alcohol is a global enterprise and recent consolidation means that it is controlled by a decreasing number of expanding multi-nationals. Alcohol companies are able to allocate significant resources to researching consumer preferences, developing new products and promoting them on an international level. Recent years have seen a growth in the value that youth culture attaches to brand labels and symbols and a move away from the healthy-living ethos. The alcohol industry's response to these trends has been to design alcoholic beverages that appeal to young people, using well-informed and precisely targeted marketing strategies. This has led to growing concerns about the implications for public health and a demand for tighter controls to regulate alcohol marketing practices. In the United Kingdom, controls on alcohol are piecemeal and reactive and the current system of voluntary regulation appears ineffective. This paper argues for more research to establish current industry practice and inform the development of a comprehensive regulatory structure and system of monitoring.

Localization of receptors for luteinizing hormone/chorionic gonadotropin in neural retina.

Although the expression of the luteinizing hormone (LH)/human chorionic gonadotropin (CG) receptor gene has been traditionally thought to be restricted to gonadal tissue, recent studies have shown that LH/CG receptors are present in many regions of the central nervous system (CNS), as well as in peripheral tissues. We now report the characterization of LH/CG receptor gene expression in the neural retina, a component of the CNS. Transcript levels in the retina are approximately equal to levels present in the cerebral cortex, but are at least 100 fold lower than the levels in testis. The density of LH/CG receptor transcripts, receptor protein and 125I-CG binding is the highest in the photoreceptor cells and then decreased throughout the inner retina. Our study is the first to demonstrate the presence of LH/CG receptors in the neural retina. This finding raises the possibility that photoreceptor cells have the potential to mount cellular responses to LH/CG that may impact on visual processing, and poses an intriguing connection to the proposed role of gonadotropins in the progression of proliferative retinopathy.

How to involve hard to reach groups: a consumer-led project with lay carers of people with advanced HIV infection.

The identification and provision of support to lay carers is crucial if Health Authorities are to meet the identified health care needs of their populations. This paper outlines in Part One the process for recruiting a defined but potentially hard to reach group, namely lay carers of people with advanced HIV infection, into a project designed as part of an ongoing development in HIV/AIDS education, the specific difficulties encountered, and how these were overcome. Part Two describes how to make a video, highlighting the involvement of carers in all stages of the research and development of a health education video-based resource package. Crucial to overcoming many of the difficulties and in winning the confidence and trust of the carers was the overview throughout of a committed multi-disciplinary Steering Group, the emphasis on confidentiality, the support of colleagues in the six UK centres, and the sensitivity and skills of the university research and production facilitators. This process ensured that the carers as consumers were involved in a continuing and active dialogue through the project.

Characterization of the human type 2 neuropeptide Y receptor gene (NPY2R) and localization to the chromosome 4q region containing the type 1 neuropeptide Y receptor gene.

Neuropeptide Y (NPY) signals through a family of G-protein-coupled receptors present in the brain and sympathetic neurons. To further our understanding of the genetic elements involved in the regulation of NPY receptor expression, we have cloned and characterized the human gene encoding the type 2 NPY receptor (Y2 receptor, HGMW-approved symbol NPY2R).2 The transcript spans 9 kb of genomic sequence and is encoded on two exons. As in the type 1 NPY receptor (Y1 receptor) gene, the 5'-untranslated region of the Y2 receptor is interrupted by an intervening sequence ( approximately 4.5 kb). However, the Y2 receptor gene does not contain an intron analogous to that present in the coding region of the Y1 receptor. The predicted transcript size ( approximately 4.5 kb) is consistent with the size observed by Northern analysis. The 381-amino-acid sequence deduced from the open reading frame is identical to that encoded by the cDNA. The Y2 receptor gene maps to human chromosome 4q31, the same region containing the Y1 receptor locus, suggesting that these subtypes may have arisen by gene duplication despite their structural differences.

General anaesthesia: who decides, and why?

This study sought to determine the relative influence dentists and parents have on the decision to give a general anaesthetic to a child, and to identify the factors that influence that decision. The research involved group discussions and in-depth interviewing as a method of investigating attitudes and behaviour in greater detail. The results indicated that parents are not able to make informed choices about general anaesthesia being used on their child; the dentist has the greatest influence on the decision to use general anaesthesia; and that this decision is often influenced by non-clinical factors. These non-clinical factors were identified as: the norms of the dentist, overall attitudes to general anaesthesia and how general anaesthesia provision was structured locally. The findings suggest that any attempt to reduce the current levels of general anaesthesia further must address these factors, whilst taking into account the needs of patients and dentists.

Meeting the change challenge: managing growth in the nonprofit and public human services sectors.

The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector leaders, need to concern themselves with the concurrent management of two agendas: Running the Shop and Meeting the Change Challenge. This can be done effectively through the use of strategic issue management, which is a set of techniques that represents a blend of traditional strategic management and change management approaches.

An exploratory study of barriers to promoting oral hygiene through carers of elderly people.

This paper outlines the main findings of an exploratory study into carers' attitudes towards looking after the oral hygiene needs of their elderly patients and relatives. The data were collected using eight group discussions covering a cross-section of carers and carer settings throughout central Scotland. A range of barriers to improving levels of care was identified. The paper concluded that to make positive progress, a comprehensive oral hygiene programme is required to break down these barriers. It is believed that a strong educational policy based upon carers' needs should form the main impetus of such a programme.

Predisposing effects of cigarette advertising on children's intentions to smoke when older.

Six hundred and forty Glasgow children, initially aged between 11 and 14 years, were interviewed twice, with approximately one year between interviews. Children whose intentions to smoke when older became more positive between the two interviews tended to be more aware of cigarette advertising at the time of the first interview (compared with children whose intentions to smoke were negative at both interviews). Children whose intentions to smoke became more negative between the interviews tended to be less appreciative of cigarette advertisements at the time of the first interview (compared with children whose intentions to smoke were positive at both interviews). Since both groups differed from their respective contrast groups before their declared intentions changed, these findings support the view that cigarette advertising has predisposing as well as reinforcing effects on children's attitudes and behaviour with respect to smoking.

Qualitative study of oral health norms and behaviour among elderly people in Scotland.

This study was undertaken to examine oral health norms and behaviour among elderly people in Scotland. Qualitative methodology in the form of informal group discussions was used. The study population comprised 9 groups of 6-8 respondents aged 65 years and over, selected according to the quota criteria of sex, social class, level of dependency and oral health status. All groups were recruited by a professional market research interviewer, using a random route procedure. Discussions were conducted under the guidance of an experienced group moderator and tape recorded. Each group discussion lasted between 1 1/2 and 2 1/2 hours. The results showed that oral and denture hygiene was a sensitive issue and part of individual routine behaviour which most respondents were reluctant to change. Tooth loss was expected and accepted as part of a natural ageing process. Dental visits were regarded as problem-solving behaviour; self-care was preferred to professional care; non-attendance was explained by no perceived need, low interest, fear or expected high cost. Health was seen in an illness context or in a positive lifestyle context and not associated with oral health. The main conclusions were: oral health behaviour was characterised either as personal routine behaviour or as problem-solving behaviour. Tooth loss was expected. Oral health was perceived as unrelated to general health. The elderly saw no incentive or reason to change these norms and behaviours.

Reinforcing effects of cigarette advertising on under-age smoking.

Interviews were conducted with 848 Glasgow children aged between 11 and 14 years. There were consistent differences between smokers and non-smokers. Smokers tended to be more adept at recalling, recognizing and identifying cigarette advertisements. This suggests they tend to pay more attention to cigarette advertising. Smokers also tended to be generally more appreciative of cigarette advertising. Moreover, this greater awareness and appreciation of cigarette advertising was independent of other important predictors of under-age smoking, such as smoking by peers, siblings and parents. These findings, taken in conjunction with previous research, indicate that cigarette advertising is reinforcing under-age smoking. The smokers showed an enhanced or heightened preference for Kensitas Club, the brand favoured by adults. This is consistent with previous research indicating that promotional devices which help determine and reinforce adult cigarette brand preferences have an even greater effect on under-age smokers.