COVID-19 Causes Ciliary Dysfunction as Demonstrated by Human Intranasal Micro-Optical Coherence Tomography Imaging.

Severe acute respiratory syndrome coronavirus (SARS-CoV-2), causative agent of coronavirus disease 2019 (COVID-19), binds via ACE2 receptors, highly expressed in ciliated cells of the nasal epithelium. Micro-optical coherence tomography (µOCT) is a minimally invasive intranasal imaging technique that can determine cellular and functional dynamics of respiratory epithelia at 1-µm resolution, enabling real time visualization and quantification of epithelial anatomy, ciliary motion, and mucus transport. We hypothesized that respiratory epithelial cell dysfunction in COVID-19 will manifest as reduced ciliated cell function and mucociliary abnormalities, features readily visualized by µOCT. Symptomatic outpatients with SARS-CoV-2 aged ≥ 18 years were recruited within 14 days of symptom onset. Data was interpreted for subjects with COVID-19 (n=13) in comparison to healthy controls (n=8). Significant reduction in functional cilia, diminished ciliary beat frequency, and abnormal ciliary activity were evident. Other abnormalities included denuded epithelium, presence of mucus rafts, and increased inflammatory cells. Our results indicate that subjects with mild but symptomatic COVID-19 exhibit functional abnormalities of the respiratory mucosa underscoring the importance of mucociliary health in viral illness and disease transmission. Ciliary imaging enables investigation of early pathogenic mechanisms of COVID-19 and may be useful for evaluating disease progression and therapeutic response.

Alcohol brands' use of age-restriction controls on Facebook and Instagram in Australia.

OBJECTIVES: Since 2017, the self-regulatory alcohol advertising system in Australia has required alcohol marketers to activate age-restriction controls on social networking sites to prevent access to children. With no monitoring mechanisms, the level of compliance with this requirement is unknown. We aimed to identify the extent to which the dominant alcohol companies in Australia have activated age-restriction controls on their official brand accounts on Facebook and Instagram. STUDY TYPE: Nonexperimental descriptive study. METHODS: We identified the brands owned by the top three beer, wine and spirit companies by market share in Australia, and located their official Facebook and Instagram accounts. International accounts were used when Australia-specific accounts did not exist. Two researchers independently attempted to access all accounts on a computer by entering the URL into a web browser that was not logged into either platform. We recorded the accessibility and audience size of each account. RESULTS: For the 195 alcohol brands that were available for sale in Australia through the nine top companies, we identified 153 Facebook accounts (84 Australian, 69 international) and 151 Instagram accounts (77 Australian, 74 international). We found 28% of Instagram and 5% of Facebook accounts did not have age-restriction controls activated. Similar proportions of Australian and international accounts on both platforms were not using controls. Only two companies were compliant across all of their accounts. CONCLUSIONS: Compliance with the industry marketing code requirement for age-restriction controls is inconsistent among the largest alcohol companies operating in Australia. The industry-managed regulatory system is not preventing children's access to alcohol content on social networking sites.

An evaluation of the evidence submitted to Australian alcohol advertising policy consultations.

BACKGROUND: Industry self-regulation is the dominant approach to managing alcohol advertising in Australia and many other countries. There is a need to explore the barriers to government adoption of more effective regulatory approaches. This study examined relevance and quality features of evidence cited by industry and non-industry actors in their submissions to Australian alcohol advertising policy consultations. METHODS: Submissions to two public consultations with a primary focus on alcohol advertising policy were analysed. Submissions (n = 71) were classified into their actor type (industry or non-industry) and according to their expressed support for, or opposition to, increased regulation of alcohol advertising. Details of cited evidence were extracted and coded against a framework adapted from previous research (primary codes: subject matter relevance, type of publication, time since publication, and independence from industry). Evidence was also classified as featuring indicators of higher quality if it was either published in a peer-reviewed journal or academic source, published within 10 years of the consultation, and/or had no apparent industry connection. RESULTS: Almost two-thirds of submissions were from industry actors (n = 45 submissions from alcohol, advertising, or sporting industries). With few exceptions, industry actor submissions opposed increased regulation of alcohol advertising and non-industry actor submissions supported increased regulation. Industry actors cited substantially less evidence than non-industry actors, both per submission and in total. Only 27% of evidence cited by industry actors was highly relevant and featured at least two indicators of higher quality compared to 58% of evidence cited by non-industry actors. CONCLUSIONS: Evaluation of the value of the evidentiary contribution of industry actors to consultations on alcohol advertising policy appears to be limited. Modifications to consultation processes, such as exclusion of industry actors, quality requirements for submitted evidence, minimum standards for referencing evidence, and requirements to declare potential conflicts, may improve the public health outcomes of policy consultations.

Public Perceptions of Harm for Nine Popular Gambling Products.

Gambling causes significant levels of harm globally and is recognised as a serious public health issue. To reduce gambling-related harm, various strategies and policies have been recommended, including decreasing the availability of gambling products, restricting gambling advertising, and implementing public education campaigns. Government willingness to implement such strategies will be influenced by levels of public support, which in turn will be dependent on public perceptions of the harm caused by gambling products. The aim of the present study was to assess public perceptions of the harm associated with individual gambling products to inform future gambling reform. A sample of 2112 Australian adults provided perceived harm ratings for nine popular gambling products that are known to be associated with gambling-related harm: electronic gambling machines, casino table games, sports betting, bingo, scratch tickets, private betting, horse/dog races, keno, and the lottery. Binary logistic regressions were used to identify factors associated with harm perceptions. Only electronic gambling machines (70%), casino table games (64%), betting on horse/dog races (59%), and sports betting (53%) were perceived by a majority of respondents as being harmful. Less frequent gambling and experiencing greater levels of gambling-related harm were associated with higher harm perceptions. Many potentially harmful gambling products may not be recognised as such by the public, which is likely to reduce support for recommended harm-reduction strategies and policies. Efforts are needed to ensure Australians in general and gamblers in particular understand the levels of harm associated with popular gambling products.

Are Australian regulatory codes adequate in scope to protect youth from alcohol advertising?

ISSUE ADDRESSED: Exposure to alcohol advertising has been found to be associated with more positive attitudes toward alcohol and heavier drinking among youth. Appropriate regulation of alcohol advertising is thus crucial for reducing use among members of this population group. To assist policy makers in their alcohol control efforts, this study explored the scope of Australian alcohol advertising codes and the extent to which they address issues relating to youth exposure. METHODS: Two researchers assessed 628 unique alcohol advertisements against youth-related provisions of the Alcohol Advertising Review Board (AARB) Code and Alcohol Beverages Advertising Code (ABAC). A third researcher resolved discrepancies. The ads sampled were those that had been the subject of formal complaints to the AARB. RESULTS: Most (94%) ads were assessed as violating at least one of the AARB Code provisions relating to youth, while 36% were found to violate at least one of the ABAC youth provisions. The most frequently violated AARB Code provision related to placement, with 88% of ads located in places or broadcast at times where young people were likely to be exposed. The most frequently violated ABAC provision related to appeal to minors (33%). CONCLUSIONS: Results indicate that self-regulation is an ineffective means of protecting youth from alcohol advertising, with the ABAC failing to capture many ads featuring content that appeals to youth. SO WHAT?: Greater efforts are required to protect youth from alcohol advertising. Findings from the present study reinforce calls for mandatory, evidence-based regulation that is administered independently of the alcohol industry. SUMMARY: An analysis of 628 unique alcohol advertisements found that the vast majority were in violation of the AARB Code's youth-related provisions whereas substantially fewer were in violation of the ABAC, supporting arguments that self-regulation is an ineffective means of protecting youth from alcohol advertising.

Get Them Laughing to Get Them Drinking: An Analysis of Alcohol Advertising Themes Across Multiple Media in Australia.

OBJECTIVE: Efforts to develop and implement effective advertising regulations require a comprehensive understanding of alcohol promotion techniques used across a rapidly growing range of media platforms. The aim of this study was to analyze themes commonly used in alcohol ads in order to identify commonalities and differences by media type and the implications for existing regulatory frameworks. METHOD: In total, 628 Australian alcohol advertisements were coded according to media used for dissemination and themes known to be attractive to children and young people or problematic in other ways (humor, sport, mateship/friendship, manliness, value for money, buying in bulk, partying, sexual attraction, and adrenaline activities). RESULTS: The largest proportion of analyzed ads belonged to the out-of-home category (41%), followed by the online category (27%), indicating the importance of ensuring that these media are appropriately covered by regulations. Overall, humor was the most common theme (present in 18% of ads), followed by value for money (14%), sports (14%), and bulk purchases (10%). Humor often co-occurred with other themes: 59% of ads with a sexual attraction theme, 40% of ads depicting mateship/friendship, 31% of ads depicting manliness, and 27% of ads with a partying theme also featured humor. Trends were evident in the types of themes most commonly used in ads disseminated via specific media, indicating that alcohol marketers are strategically selecting media platforms for particular themes. CONCLUSIONS: The results of this study demonstrate that alcohol advertising controls need to cover all media, be clear in delineating inappropriate themes, and be adequately authorized to ensure compliance.

Gambling-related harms attributable to lotteries products.

Lotteries products (lottery tickets and scratch tickets) are the most popular forms of gambling worldwide, however little research has investigated whether these products are associated with gambling-related harm. The limited available research suggests these products are linked to problematic gambling behaviors and a range of resulting negative outcomes, with certain sub-groups appearing to be more vulnerable to experiencing harms. The present study examined risk of gambling-related harm (measured by the Problem Gambling Severity Index) from lotteries products use in an Australian sample of lotteries-only gamblers (n = 540). Additionally, the study investigated whether risk varied according to a range of sociodemographic and behavioral characteristics (age, gender, household income, location (rural vs. metropolitan), employment status, alcohol consumption, smoking status, frequency of e-cigarette use, frequency of scratch ticket use, frequency of lottery ticket use, expenditure on scratch tickets, and expenditure on lottery tickets). Almost one-third of the sample was found to be at some level of gambling-related risk due to their use of lotteries products. Younger respondents, males, current smokers, e-cigarette users, and those who purchase scratch tickets more frequently were more likely to report problematic use of lotteries products. Policy makers should enact strategies to prevent and reduce harms resulting from lotteries products, especially among the identified at-risk groups.

Alcohol advertisement characteristics that increase the likelihood of code breaches.

BACKGROUND: Exposure to alcohol advertising is associated with adverse outcomes among youth. Alcohol advertising codes attempt to ensure that alcohol promotion meets community standards, especially in relation to minimising the exposure of children and young people. The aim of the present study was to assess the characteristics of Australian alcohol advertisements that breach the Alcohol Advertising Review Board's (AARB) Code, with a particular focus on provisions relating to youth exposure. METHODS: The sample comprised 628 unique ads that were the subject of complaints to the AARB in its first five years of operation. The assessed characteristics were product type, company type, media type, and ad themes used. All ads were coded by two coders, with a third coder resolving any disagreements. RESULTS: On average, each of the assessed ads breached four AARB provisions, of which three breaches pertained to youth-related provisions. Across all categories, the proportion of youth-related provisions violated was significantly larger than the proportion of total provisions violated. CONCLUSION: Results suggest beer and spirits producers that use partying ad themes, engage in sponsorship arrangements, and use online advertising platforms should be a particular focus of alcohol advertising regulations.

The volume and type of unhealthy bus shelter advertising around schools in Perth, Western Australia: Results from an explorative study.

ISSUE ADDRESSED: Exposure to advertising for unhealthy food, alcohol and gambling has been shown to influence children and adolescents' behaviours and attitudes. This exploratory study aimed to assess the volume and type of unhealthy bus shelter advertisements near schools in five local government areas in Perth, Western Australia and to monitor whether the volume of unhealthy advertisements varied seasonally. METHODS: The 29 local governments in the Perth metropolitan region were contacted seeking information regarding the locations of bus shelters featuring advertisements in their local government area. Five local governments provided sufficient information for an audit of the bus shelter advertisements in their area to be conducted. Every bus shelter within 500 m of a school was photographed and the type of advertisement recorded. The advertisements in the food, non-alcoholic beverage, alcohol, or gambling categories were then classified as being healthy, moderate, or unhealthy. This process was carried out in June, September, December 2016, and March 2017 to ascertain whether the type of advertisements displayed changed depending on the season. RESULTS: Of the 293 advertisements recorded over the four audits, 31% featured unhealthy products, 3% moderate, and <1% healthy. Only two of the 293 advertisements were classified as being healthy. Seasonal variation in the volume of unhealthy advertisements was not identified. SO WHAT?: Western Australian school students are regularly exposed to unhealthy bus shelter advertisements. Stricter regulation of outdoor advertising is needed to ensure that young people are protected from the influence of unhealthy industries.

Regulation of alcohol marketing in Australia: A critical review of the Alcohol Beverages Advertising Code Scheme's new Placement Rules.

INTRODUCTION AND AIMS: Rules concerning the placement of alcohol advertisements (Placement Rules) were added to the industry-managed Alcohol Beverages Advertising Code Scheme in November 2017. This study aimed to critically review the Placement Rules and evaluate their ability to effectively regulate the placement of alcohol marketing and provide safeguards for young people in Australia. DESIGN AND METHODS: An established framework for evaluating the design of an effective self-regulatory system was applied to the substantive content of the Placement Rules and associated regulatory processes. Publicly available documents, including recent Alcohol Beverages Advertising Code Scheme determinations, informed the review. RESULTS: The objectives and key terms of the Placement Rules are inadequately defined and narrow in scope, resulting in the dismissal of almost all relevant complaints. Weaknesses identified in the regulatory processes include limited representation from external stakeholders in the development of the Placement Rules, a lack of transparency and independence in the Scheme's administration, and limited monitoring and enforcement options. DISCUSSION AND CONCLUSIONS: The Placement Rules are unlikely to reduce young people's exposure to alcohol marketing and hence fail to meet public health objectives. This review adds to the body of literature that demonstrates that industry-managed systems fail to effectively regulate alcohol marketing. Government intervention is needed if young people's wellbeing is to be prioritised.

Behind Closed Doors: The Priorities of the Alcohol Industry as Communicated in a Trade Magazine.

Background: Efforts to reduce alcohol-related harm face strong resistance from the alcohol industry. It is important to monitor industry actions over time to assist in developing appropriate responses to this resistance. Monitoring can enable public health to identify industry positions on alcohol policy issues, stay abreast of current and emerging marketing tactics, and inform the development of possible counter-actions. One form of monitoring is the examination of industry trade publications where the industry converses with itself. The aim of this study was to assess industry strategic approaches as communicated in articles published in a leading Australian alcohol trade magazine to provide insights for policy makers and advocacy groups. Methods: Thematic analysis of 362 articles published in a trade magazine over a one-year period. Results: Three primary themes were evident in the articles: (1) the legitimization of alcohol as an important social and economic product, (2) the portrayal of the industry as trustworthy and benign, and (3) the strategic embedding of alcohol in various facets of everyday life. Conclusions: There was a general failure to acknowledge the substantial burden of disease caused by alcohol products, and instead much effort was expended on legitimizing the product and the companies responsible for its production, distribution, and promotion. The level of denial exhibited shows that additional regulation of the industry and its tactics will need to proceed without industry acceptance. Clear resistance to increasing consumer protections also points to the futility of inviting industry members to the policy table.

Developing an alternative alcohol advertising complaint review system: lessons from a world-first public health advocacy initiative.

Young people in Australia are frequently exposed to alcohol marketing. Leading health organisations recommend legislative controls on alcohol advertising as part of a comprehensive approach to reduce alcohol-related harm. However, Australia relies largely on industry self-regulation. This paper describes the development and implementation of the Alcohol Advertising Review Board (AARB), a world-first public health advocacy initiative that encourages independent regulation of alcohol advertising. The AARB reviews complaints about alcohol advertising, and uses strategies such as media advocacy, community engagement and communicating with policy makers to highlight the need for effective regulation. In 4 years of operation, the AARB has received more complaints than the self-regulatory system across a similar period. There has been encouraging movement towards stronger regulation of alcohol advertising. Key lessons include the importance of a strong code, credible review processes, gathering support from reputable organisations, and consideration of legal risks and sustainability. The AARB provides a unique model that could be replicated elsewhere.

Alcohol promotions in Australian supermarket catalogues.

INTRODUCTION AND AIMS: In Australia, most alcohol is sold as packaged liquor from off-premises retailers, a market increasingly dominated by supermarket chains. Competition between retailers may encourage marketing approaches, for example, discounting, that evidence indicates contribute to alcohol-related harms. This research documented the nature and variety of promotional methods used by two major supermarket retailers to promote alcohol products in their supermarket catalogues. DESIGN AND METHODS: Weekly catalogues from the two largest Australian supermarket chains were reviewed for alcohol-related content over 12 months. Alcohol promotions were assessed for promotion type, product type, number of standard drinks, purchase price and price/standard drink. RESULTS: Each store catalogue included, on average, 13 alcohol promotions/week, with price-based promotions most common. Forty-five percent of promotions required the purchase of multiple alcohol items. Wine was the most frequently promoted product (44%), followed by beer (24%) and spirits (18%). Most (99%) wine cask (2-5 L container) promotions required multiple (two to three) casks to be purchased. The average number of standard drinks required to be purchased to participate in catalogue promotions was 31.7 (SD = 24.9; median = 23.1). The median price per standard drink was $1.49 (range $0.19-$9.81). Cask wines had the lowest cost per standard drink across all product types. DISCUSSION AND CONCLUSIONS: Supermarket catalogues' emphasis on low prices/high volumes of alcohol reflects that retailers are taking advantage of limited restrictions on off-premise sales and promotion, which allow them to approach market competition in ways that may increase alcohol-related harms in consumers. Regulation of alcohol marketing should address retailer catalogue promotions. [Johnston R, Stafford J, Pierce H, Daube M. Alcohol promotions in Australian supermarket catalogues. Drug Alcohol Rev 2017;36:456-463].