Messages about climate, pollution and social justice harms of tobacco as motivators to quit: an untapped communication opportunity?

BACKGROUND: Campaigns highlighting the health harms of smoking have demonstrated success in motivating people who smoke to quit. Tobacco production and use also exert a toll on the environment, sustainable development and human rights. However, messages highlighting these harms of tobacco have been relatively unexplored as a cessation motivation strategy. In this study, we examined the extent to which a range of messages about climate, pollution and social justice harms of tobacco are perceived as motivating among people who smoke, overall and by sociodemographics. DATA AND METHODS: Australian adults who smoke (n=395) aged 18-59 years reported the 'extent to which each of the following motivated them to quit smoking' and were then presented with messages about climate (four items), pollution (three items) and social justice (three items) harms of tobacco, which they rated on a 5-point scale ranging from 1 'Not at all' to 5 'Very much so' in this online cross-sectional survey. Differences by age, education, gender, socioeconomic status (SES) and geographical region were examined using prevalence ratios from generalised linear models with log-link (Poisson regression). RESULTS: For each of the 10 messages, between one-half and two-thirds of the overall sample perceived them as motivating (49-65%), particularly messages highlighting harms to human or animal life and welfare (all ≥60%). Across all message themes, younger adults (18-35 years) and those who completed tertiary education were more likely to perceive some messages as motivating. Perceived motivation did not vary significantly by gender, SES or geographical region. CONCLUSION: Findings suggest that value-based messaging featuring the environmental and social justice footprint of tobacco is perceived as motivating for smoking cessation, especially among younger people and those with higher education who may be more engaged with these issues. Inclusion of such messages as part of a comprehensive antitobacco communication strategy may provide an untapped opportunity by potentially providing people who smoke with additional compelling reasons to quit.

Impact of product-based e-cigarette marketing on the attitudes and behavioural intentions of young Australians: an experimental study.

BACKGROUND: The tobacco industry has a history of using language to downplay the harms associated with cigarettes and mislead consumers and policymakers. Emerging evidence suggests similar tactics are being used in the context of e-cigarettes; however, exploration of the impact of product name on attitudes towards e-cigarettes and susceptibility to use is lacking. This experimental study explored whether attitudes towards e-cigarettes and susceptibility to use are influenced by the names used by the industry to describe and market these products. METHOD: An accredited web panel provider recruited a sample of 383 Australians aged 12-29 years who had never smoked to participate in an online survey that featured an embedded experiment. Participants were randomly allocated to one of three conditions, each of which used a different name to describe e-cigarettes (condition 1: 'e-cigarettes', condition 2: 'vapes'; condition 3: either 'IGETS', 'Puff Bars', 'HQD Cuvies' or 'Gunnpods'). The survey assessed respondents' overall opinion of the product described; attitudes towards the product; liking of the product; and curiosity, willingness and intentions to use the product. RESULTS: Those in the 'brand name' condition scored higher than those in the 'e-cigarettes' condition on all dependent variables. Those in the 'vapes' condition scored higher than those in the 'e-cigarettes' condition on product attitude. CONCLUSION: Findings indicate that the use of brand names and terms such as 'vapes' instead of 'e-cigarettes' results in more favourable attitudes towards e-cigarettes and susceptibility to use among young Australians. Results highlight the problematic influence of promotional language use favoured by industry.

Optimising tobacco control campaigns within a changing media landscape and among priority populations.

Reviews published over the past decade confirm tobacco control campaigns can be effective for influencing adult and youth tobacco use behaviours, with strengthening evidence for high cost-effectiveness. Evidence is also accumulating for positive campaign effects on interpersonal discussions, social norms and policy support that can help motivate and sustain quitting and reduce uptake. Research needs over the next decade centre on the rapidly changing media environment and the equity of campaign effects among high smoking prevalence communities. The field needs specific evidence on: how to measure total campaign reach and frequency across the diverse range of media platforms and channels; the optimum mix of traditional, digital and social media to achieve behaviour change, especially among high smoking prevalence communities; the relative reach and impact of the wide variety of integrated, digital and social media message delivery methods; the relative effectiveness of messages that aim to build capacity to quit and optimum methods for combining motivational and capacity-building messages, especially for high prevalence groups who face additional barriers to staying quit; the ongoing effectiveness of traditional versus new versions of messages highlighting tobacco industry practices; the influence of e-cigarette use on tobacco control campaign effects; and the effectiveness of different types of campaigns aiming to prevent e-cigarette uptake and motivate e-cigarette cessation. Research is also needed to investigate the potential for campaigns to influence the public's understanding and support for endgame tobacco control policies and for campaign elements that may influence the social and environmental contexts surrounding smokers that support and maintain behaviour change.

Public support for policies to phase out the retail sale of cigarettes in Australia: results from a nationally representative survey.

BACKGROUND: There is growing international interest in a goal once considered unthinkable: phasing out the retail sales of smoked tobacco products. In this study, we examined public support for phasing out sales and specific measures for moving towards a phase-out among a nationally representative sample of Australian adults. METHODS: In December 2019, we used a probability-based online panel, Life in Australia™, to survey n=1939 Australian adults (n=1874 included in analyses due to missing data). RESULTS: Almost two-thirds of respondents thought it would be 'a good thing' if there came a time when it was no longer legal to sell cigarettes in shops in Australia and only 16.7% thought it would be 'a bad thing'. After the concept of a phase-out was defined as removing a product from the Australian market over a set period, such as 5 years, but still allowing purchases online from overseas companies, 50.7% indicated support for such a phase-out and 61.8% thought it should happen within 10 years. Support was greater for specific measures such as licensing tobacco retailers (75.3%) and restricting sales to places children cannot enter (76.3%). Support tended to be consistent across demographic subgroups but was stronger among never and former smokers than among current smokers. CONCLUSIONS: There has been little public discussion in Australia about the goal of 1 day phasing out the retail sale of cigarettes. It is notable that such policies are reasonably well supported by the Australian public, with only minority opposition.

Are anti-smoking social norms associated with tobacco control mass media campaigns, tax and policy changes? Findings from an Australian serial cross-sectional population study of smokers.

BACKGROUND: Anti-smoking social norms are associated with subsequent quitting behaviours. We examined if exposure to tobacco control advertisements and policy changes predict subjective (perceived disapproval of smoking among close family and friends) and internalised injunctive norms (embarrassed about telling others you are a smoker). METHODS: A serial cross-sectional population survey of Australian adult smokers (n=6649; 2012 to 2015). Logistic regression analyses examined associations of social norms with exposure to different types of tobacco control advertisements, tax increases and other tobacco control policies, adjusting for key demographic, smoking and media exposure covariates. Interaction analyses examined differences by age and socioeconomic status (SES). RESULTS: Greater past month exposure to predominantly fear-evoking advertisements was associated with increased odds of perceiving disapproval (per 1000 gross rating points: adjusted OR (AOR) 2.69, 95% CI: 1.34 to 5.39), while exposure to advertisements evoking multiple negative emotions (fear, guilt, sadness) reduced perceived disapproval (AOR 0.61, 95% CI: 0.42 to 0.87). Increased perceived disapproval was also associated with anticipation (AOR 1.38, 95% CI: 1.02 to 1.88), and implementation of a series of annual 12.5% tobacco tax rises (AOR 1.41, 95% CI: 1.03 to 1.94). Associations were consistent across age and SES. There were no associations nor subgroup interactions between advertisement exposure or policy changes and feeling embarrassed about telling others you are a smoker. CONCLUSION: Smokers' perceptions of family and friends' disapproval of their smoking was more common after exposure to fear-evoking tobacco control campaigns and after large tobacco tax increases were announced and implemented.

Impact of three annual tobacco tax rises on tobacco sales in remote Australian Aboriginal community stores.

BACKGROUND: There is strong evidence from many settings that tobacco tax rises which increase prices reduce tobacco consumption, but only limited evidence from Indigenous settings. METHODS: We analysed 3 years (2016-2018) of weekly sales data from 32 stores in remote Aboriginal communities. We used interrupted time series analysis to estimate the immediate impact of the price rice following annual 12.5% tobacco tax rises on sales on (A) stick equivalents of tobacco and (B) fruit and vegetables (kg) per $A1000 of grocery sales, and on the trend in sales between price rises. RESULTS: We detected 5.8% and 8.2% immediate declines in tobacco sales following the price rises associated with annual 12.5% tax rises in 2016 and 2018, and a non-significant decline (1.6%) following the 2017 tax rise. Decreased sales were mainly driven by declines in mainstream and premium factory-made cigarettes. Fruit and vegetable sales did not change at the time of tobacco price rises. CONCLUSION: For the first time, we demonstrated evidence of price-sensitivity and the immediate impact of price rises from tobacco tax rises on tobacco sales in remote Aboriginal communities. We acknowledge that Australia already has very high tobacco taxation and prices, but recommend further increases to the taxation of roll-your-own (RYO) tobacco to prevent smokers and industry using cheaper RYO cigarettes to undermine this impact of high tobacco taxes and prices.

Australian smokers' experiences and perceptions of recessed and firm filter cigarettes.

BACKGROUND: While cigarette filter modifications have long been used to increase product appeal and assuage health concerns, tighter marketing restrictions, including plain packaging, have further spurred the growth of filter variants. We explored and assessed experiences and perceptions of smokers who had tried and/or currently use recessed filter cigarettes (RFCs) and firm filter cigarettes (FFCs). METHOD: In November 2018, we undertook eight exploratory focus groups of Australian adult factory-made cigarette smokers (total n=56). In July 2019, we surveyed 999 smokers aged 18-69 years to quantify ever and current use of these products and associated beliefs and sensory experiences. RESULTS: Focus group and survey findings were consistent. Among 988 smokers who had at least tried factory-made cigarettes, 28.9% had tried FFCs and 11.1% currently smoked these, while 36.4% had tried RFCs and 7.5% currently smoked these. Smokers in both studies believed these filters may reduce harm and that FFCs increase appeal. In the survey, 58.9% of RFC triers agreed these hide the filter's brown stain and 48.9% agreed that RFCs keep harmful substances away from the mouth. Similarly, 58.4% of FFC triers agreed these trap more harmful substances than standard filters. Relative to standard filter cigarettes, more smokers experienced FFCs and RFCs as feeling clean (p=0.03) and more current FFC users experienced these as feeling smooth (p=0.01). CONCLUSION: RFCs and FFCs undermine plain packaging legislation, which aims to reduce appeal and minimise misperceptions about the relative harms of different tobacco products. Like other filter modifications, these filter variants should be disallowed.

Indexation of Tobacco Excise and Customs Duty and Smoking Prevalence Among Australian Adults, 2001-2010: A Serial Cross-sectional Study.

INTRODUCTION: Australia's excise and customs duty on tobacco has been automatically increased biannually since 1984. Increases in duty on par with inflation ensured that tobacco stayed at least as costly as other goods. This would be expected to maintain, rather than drive down, smoking prevalence. We examined the association between smoking prevalence and duty over a 10-year period. METHODS: Using monthly data from five Australian capital cities, collected from March 2001 to March 2010 among Australians aged at least 18 years, multiple linear regression modeled associations between smoking prevalence and the two components (duty and non-duty) of the recommended retail price of an average packet of cigarettes, adjusting for policy covariates. RESULTS: Prevalence declined from 23.6% in March 2001 to 17.0% in March 2010 [absolute difference 6.6%; 95% confidence interval (CI) = 6.5 to 6.8]. Duty increased from $0.2026 to $0.2622 per cigarette over the same period. In the adjusted model, a 1-cent increase in the duty component of price was not associated with changes in prevalence (0.019; 95% CI = -0.035 to 0.028). Increased non-duty component of price was associated with a decline in prevalence (-0.027; 95% CI = -0.052 to -0.002). This effect was stronger when changes in income were controlled for. CONCLUSIONS: In line with expectations, inflation-adjusted duty was not associated with changes in smoking prevalence, but it may have prevented upward pressure on prevalence that increasing affordability could have exerted. Frequent increases in duty greater than the growth in both wages and goods would more effectively reduce smoking than regular indexation. IMPLICATIONS: Few countries inflation-adjusted excise duty to ensure that tobacco products do not become more affordable; however, Australia experienced a decade of inflation adjustment alone, enabling the impact of this policy to be studied. This study shows that inflation-adjusted duty likely did prevent tobacco becoming more affordable and that indexation was associated with declines in smoking when tobacco companies over-shifted the duty rises (ie, increased price over and above duty rises).The study also suggests that frequent increases in taxation that exceed both wage growth and increases in costliness of other goods are needed to prompt increased rates of quitting.

Hardening or softening? An observational study of changes to the prevalence of hardening indicators in Victoria, Australia, 2001-2016.

BACKGROUND: The hardening hypothesis predicts that as smoking prevalence declines, remaining smokers will be more heavily addicted to nicotine and/or less interested in quitting. We tested this hypothesis in a population exposed to a comprehensive tobacco control programme over a 16-year period. METHODS: Annual cross-sectional surveys randomly sampled adults (aged 26+) in the state of Victoria, Australia, between 2001 and 2016. Until 2010, participants were recruited through random digit dialling to landline telephones; from 2011, sampling frames also included mobile phones. Logistic regressions assessed changes over time in the prevalence of smoking and each hardening indicator; additional models examined interactions by sex, age, education and socioeconomic status. RESULTS: Smoking prevalence declined significantly between 2001 and 2016 (20.1%-13.0%), as did the prevalence of seven hardening indicators: daily smoking, heavy consumption, no quit attempt in the past 5 years or past 12 months, no intention to quit in the next 6 months or next 30 days, and happiness to keep smoking. In addition, the proportion of smokers defined as 'hardcore' decreased from 17.2% to 9.1%. On the whole, hardening indicators decreased to a similar extent among demographic subgroups. CONCLUSIONS: These results are inconsistent with the hardening hypothesis. Rather, they suggest that a comprehensive tobacco control programme that combines provision of cessation support to individual smokers with implementation of population-level interventions to drive all smokers towards quitting, can successfully reduce both smoking prevalence and levels of dependence and desire to keep smoking among the remaining population of smokers.

Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience.

BACKGROUND: Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads). METHOD: Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded. RESULTS: In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults. CONCLUSIONS: Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given most alcohol-attributable harm is due to long-term disease, these findings suggest future campaigns may fill a potentially important gap if they were to focus on long-term harms. There is scope for such long-term harm campaigns to place greater emphasis on encouraging reduced personal consumption of alcohol, potentially through more frequent communication of low-risk drinking guidelines.

Why Do Smokers Talk About Antismoking Campaigns? Predictors of the Occurrence and Content of Campaign-Generated Conversations.

Smokers often talk about antismoking campaigns, and these conversations can contribute to campaign effectiveness. However, little is known about the predictors and content of naturally occurring campaign-generated conversations. In two studies (Study 1, N = 480; Study 2, N = 232), we systematically examined whether the occurrence and content of smokers' conversations after exposure to one of eight antismoking television advertisements were predicted by characteristics of (a) the message, (b) intrapersonal responses to the message, (c) the individual, and (d) the social context in which exposure occurred. In multivariable models, we found that conversations were more likely to occur when advertisement exposure occurred in the presence of others, and as the amount of anxiety elicited by the advertisement increased. Conversations were more likely to contain a favorable appraisal of the advertisement when the message elicited higher levels of sadness, and less likely to contain favorable appraisals when the respondent had finished secondary education (vs. lower levels of education). Stronger feelings of guilt reduced the likelihood that conversations contained unfavorable appraisals, and increased the likelihood that they contained quitting talk. These findings suggest several promising avenues for future investigations into why smokers talk and talk in particular ways.

Talking About Antismoking Campaigns: What Do Smokers Talk About, and How Does Talk Influence Campaign Effectiveness?

Campaign-stimulated conversations have been shown to increase the effectiveness of antismoking campaigns. In order to explore why such effects occur, in the current study we coded the content of naturally occurring conversations. We also examined whether the short-term effects of talking, and of different types of talk, on quitting intentions were mediated through intrapersonal message responses. Using the Natural Exposure(SM) methodology, we exposed 411 smokers to 1 of 6 antismoking advertisements while they were watching television at home. Responses to the advertisement-conversation participation and content, emotional responses, personalized perceived effectiveness, and changes in intentions to quit-were measured within 3 days of exposure. Conversations were coded for appraisal of the advertisement (favorable, neutral, or unfavorable) and the presence of quitting talk and emotion talk. Mediation analyses indicated that the positive effects of talking on intention change were mediated through personalized perceived effectiveness and that the positive effects were driven by conversations that contained a favorable appraisal and/or quitting talk. Conversely, conversations that contained an unfavorable appraisal of the advertisement were negatively associated with campaign effectiveness. These findings highlight the importance of measuring interpersonal communication when evaluating campaigns and the need for further research to identify the message characteristics that predict when smokers talk and when they talk only in desirable ways.

What is the role of tobacco control advertising intensity and duration in reducing adolescent smoking prevalence? Findings from 16†years of tobacco control mass media advertising in Australia.

OBJECTIVE: To examine how the intensity and duration of tobacco control advertising relate to adolescent smoking prevalence. METHODS: Australian students (aged 12-17 years) participating in a national survey conducted triennially between 1993 and 2008 (sample size range 12 314-16 611). The outcome measure was students' smoking in the previous 4 weeks collected through anonymous, self-completed surveys. For each student, monthly targeted rating points (TRPs, a measure of television advertising exposure) for tobacco control advertising was calculated for the 3 and 12 months prior to surveying. For each time period, cumulative TRPs exposure and exposure to three intensity levels (≥100 TRPs/month; ≥400 TRPs/month; ≥800 TRPs/month) over increasing durations (eg, 1 month, 2 months, etc) were calculated. Logistic regression examined associations between TRPs and adolescent smoking after controlling for demographic and policy variables. RESULTS: Past 3-month cumulative TRPs were found to have an inverse relationship with smoking prevalence. Low TRPs exposure in the past 12 months was positively associated with adolescent smoking prevalence. However, smoking prevalence reduced with cumulative exposure levels above 5800 cumulative TRPs. Additionally, exposure to ≥400 TRPs/month and ≥800 TRPs/month were associated with reduced likelihood of smoking, although the duration needed for this effect differed for the two intensity levels. When intensity was ≥400 TRPs/month, the odds of smoking only reduced with continuous exposure. When intensity was ≥800 TRPs/month, exposure at levels less than monthly was associated with reductions in smoking prevalence. CONCLUSIONS: Both antismoking advertising intensity and duration are important for ensuring reductions in adolescent smoking prevalence.

Time series analysis of the impact of tobacco control policies on smoking prevalence among Australian adults, 2001-2011.

OBJECTIVE: To determine the impact of tobacco control policies and mass media campaigns on smoking prevalence in Australian adults. METHODS: Data for calculating the average monthly prevalence of smoking between January 2001 and June 2011 were obtained via structured interviews of randomly sampled adults aged 18 years or older from Australia's five largest capital cities (monthly mean number of adults interviewed: 2375). The influence on smoking prevalence was estimated for increased tobacco taxes; strengthened smoke-free laws; increased monthly population exposure to televised tobacco control mass media campaigns and pharmaceutical company advertising for nicotine replacement therapy (NRT), using gross ratings points; monthly sales of NRT, bupropion and varenicline; and introduction of graphic health warnings on cigarette packs. Autoregressive integrated moving average (ARIMA) models were used to examine the influence of these interventions on smoking prevalence. FINDINGS: The mean smoking prevalence for the study period was 19.9% (standard deviation: 2.0%), with a drop from 23.6% (in January 2001) to 17.3% (in June 2011). The best-fitting model showed that stronger smoke-free laws, tobacco price increases and greater exposure to mass media campaigns independently explained 76% of the decrease in smoking prevalence from February 2002 to June 2011. CONCLUSION: Increased tobacco taxation, more comprehensive smoke-free laws and increased investment in mass media campaigns played a substantial role in reducing smoking prevalence among Australian adults between 2001 and 2011.

Assessing the effectiveness of antismoking television advertisements: do audience ratings of perceived effectiveness predict changes in quitting intentions and smoking behaviours?

BACKGROUND: Decisions about which antismoking advertisements should be aired are often guided by audience ratings of perceived effectiveness (PE). Given that the usefulness of PE measures depends on their ability to predict the likelihood that a message will have a positive impact on outcomes such as behaviour change, in the current study we used pre-exposure, postexposure and follow-up measures to test the association between PE and subsequent changes in quitting intentions and smoking behaviours. METHODS: Daily smokers (N=231; 18 years and older) completed baseline measures of quitting intentions before watching an antismoking advertisement. Immediately following exposure, intentions were measured again and PE was measured using six items that factored into two scales: ad-directed PE (ADPE) and personalised PE (PPE). A follow-up telephone survey conducted within 3 weeks of exposure measured behaviour change (reduced cigarette consumption or quit attempts). RESULTS: From pre-exposure to postexposure, 18% of smokers showed a positive change in their intentions. Controlling for baseline intentions, PPE independently predicted intention change (OR=2.57, p=0.004). At follow-up, 26% of smokers reported that they had changed their behaviour. PPE scores also predicted the likelihood of behaviour change (OR=1.93, p=0.009). CONCLUSIONS: Audience ratings of PPE, but not ADPE, were found to predict subsequent intention and behaviour change. These findings increase confidence in the use of PE measures to pretest and evaluate antismoking television advertisements, particularly when these measures tap the extent to which a smoker has been personally affected by the message.

The silent salesman: an observational study of personal tobacco pack display at outdoor café strips in Australia.

OBJECTIVE: We sought to determine the relative frequency and nature of personal display of cigarette packs by smokers in two Australian cities where 30% front-of-pack and 90% back-of-pack health warnings have been used since 2006 and comprehensive tobacco marketing restrictions apply. METHODS: An observational study counted patrons, active smokers and tobacco packs at cafés, restaurants and bars with outdoor seating. Pack orientation and use of cigarette cases were also noted. RESULTS: Overall, 18954 patrons, 1576 active smokers and 2153 packs were observed, meaning that one out of every 12.0 patrons was actively smoking, and one of every 8.8 patrons displayed a pack. Packs were more frequently observed in lower socio-economic neighbourhoods, reflecting the higher prevalence of smoking in those regions. Packs were displayed less often in venues where children were present, suggesting a greater tendency not to smoke around children. Most packs (81.4%) were oriented face-up, permitting prominent brand display. Only 1.5% of observed packs were cigarette cases, and 4.2% of packs were concealed by another item, such as a phone or wallet. CONCLUSIONS: Tobacco packs are frequently seen on table-tops in café strips, providing many opportunities for other patrons and passers-by to be incidentally exposed to cigarette brand names and imagery. Use of cigarette cases is rare, suggesting that smokers eventually habituate to pictorial warnings on branded packs and/or find repeated decanting of each newly purchased branded pack into a case to be inconvenient.

Does tobacco-control mass media campaign exposure prevent relapse among recent quitters?

OBJECTIVE: To determine whether greater mass media campaign exposure may assist recent quitters to avoid relapse. METHOD: Using date of data collection and postcode, media market estimates of televised tobacco-control advertising exposure measured by gross ratings points (GRPs) were merged with a replenished cohort study of 443 Australians who had quit in the past year. Participants' demographic and smoking characteristics prior to quitting, and advertising exposure in the period after quitting, were used to predict relapse 1 year later. RESULTS: In multivariate analysis, each increase in exposure of 100 GRPs (i.e., 1 anti-smoking advertisement) in the three-month period after the baseline quit was associated with a 5% increase in the odds of not smoking at follow-up (OR = 1.05, 95% CI 1.02-1.07, p < 0.001). This relationship was linear and unmodified by length of time quit prior to the baseline interview. At the mean value of 1081 GRPs in the 3 months after the baseline-quit interview, the predicted probability of being quit at follow-up was 52%, whereas it was 41% for the minimum (0) and 74% for the maximum (3,541) GRPs. CONCLUSION: Greater exposure to tobacco-control mass media campaigns may reduce the likelihood of relapse among recent quitters.

Engaging lower screening groups: a field experiment to evaluate the impact of a multiwave national campaign on participation in the National Bowel Cancer Screening Program.

OBJECTIVES: This field study evaluated a multiwave media campaign that aired in 2019 to promote participation in the Australian National Bowel Cancer Screening Program (NBCSP), which provides free biennial mailed-out immunochemical faecal occult blood test (iFOBT) kits to Australians aged 50-74 years. DESIGN: Adjusted negative binomial regression models determined rate ratios of iFOBT kits returned during and following three campaign waves compared with 2018 (baseline). Interaction terms determined whether effects differed by gender×age group, socioeconomic status (SES) and previous participation. SETTING: Australia. PARTICIPANTS: All Australians eligible for the NBCSP (men and women aged 50-74 years) who returned an iFOBT kit between 1 January 2018 and 30 October 2019. INTERVENTIONS: A multiwave national integrated media campaign to promote participation in the NBCSP. MAIN OUTCOME MEASURES: iFOBT kit return rate and number of iFOBT kits returned during and immediately following campaign activity overall and within historically lower screening groups (men, 50-59 years old; lower SES; never participants). RESULTS: The rate of iFOBT kits returned increased significantly during all three campaign waves, with evidence of carry-over effects of the second wave coinciding with a general practitioner mail-out strategy (all p<0.001). At each wave, effects were observed among men and women in the younger (50-59 years old) age group, but were less consistent for the older age group. Each SES group and both never and previous participants had increased return rates at each wave, but increases were stronger among mid-higher SES and those who had never participated. An estimated 93 075 extra iFOBT kits were returned due to the campaign. CONCLUSIONS: The campaign increased participation, especially among those who were younger and never previously screened-key groups to recruit given reparticipation rates of over 80%. Ongoing investment in national integrated media campaigns of sufficient duration and intensity can increase bowel cancer screening and ultimately save lives.