Assessing the impact of a national social marketing campaign for antimicrobial resistance on public awareness, attitudes, and behaviour, and as a supportive tool for healthcare professionals, England, 2017 to 2019.

BackgroundPrevious United Kingdom campaigns targeting antimicrobial resistance (AMR) recommended running multimedia campaigns over an increased timeframe. The 3-year-long Keep Antibiotics Working (KAW) campaign was a mass media campaign in England targeting the public and general practitioners (GPs).MethodsEvery year, pre- and post-campaign questionnaire data were collected from the public, whereas post-campaign interview data were obtained from GPs. Data were weighted to allow pre- and post-campaign comparisons between independent samples. Significant changes in nominal and ordinal data were determined using Pearson's chi-squared (X2) and Mann-Whitney U tests, respectively.ResultsPrompted campaign recognition was high, increasing by 6% from 2018 to 2019 (2017: data unavailable; 2018: 68% (680/1,000); 2019: 74% (740/1,000); X2 = 8.742, p = 0.003). Knowledge regarding declining antibiotic effectiveness when taken inappropriately improved following the campaign (net true: pre-2017 = 69.1% (691/1,000); post-2019 = 77.6%; (776/1,000); X2 = 5.753, p = 0.016). The proportion of individuals reporting concern for themselves or for children (≤ 16 years) about AMR increased by 11.2% (Z = -5.091, p < 0.001) and 6.0% (Z = -3.616, p < 0.001) respectively, pre- to post-campaign. Finally, in 2017, reported confidence to say no to patients requesting antibiotics differed significantly between GPs who were and were not aware of the campaign (net agree: 98.9% (182/184) vs 92.4% (97/105) respectively; X2 = 4.000, p = 0.045).ConclusionA high level of prompted campaign recognition was achieved. The KAW campaign improved aspects of AMR knowledge and certain attitudes towards appropriate antimicrobial use. It increased awareness of and concern about AMR, supporting GP confidence to appropriately prescribe antibiotics. Future determination of measurable behaviour changes resulting from AMR campaigns is important.

Comparison of Trends in Self-reported Cigarette Consumption and Sales in England, 2011 to 2018.

Importance: Population cigarette consumption is declining in many countries. Accurate estimates of long- and short-term changes are vital for policy evaluation and planning. Survey data and sales data that are used to make these estimates each have important potential biases, so triangulation using different methods is required for robust estimation. Objectives: To compare monthly estimates of cigarette consumption in England from a nationally representative survey and recorded cigarette sales and to triangulate an accurate estimate of changes in cigarette consumption since 2011. Design, Setting, and Participants: This study used time series analyses based on survey data and recorded cigarette sales to estimate and compare trends in population cigarette consumption in England from 2011 to 2018. Survey participants were representative samples of 1700 people aged 16 years or older each month in England. Main Outcomes and Measures: Monthly cigarette retail sales data from August 2011 through February 2018 were obtained from a data agency. Monthly self-reports of cigarette consumption were collected over the same period using the Smoking Toolkit Study. Results: A total of 136 677 individuals (51.1% female; mean [SD] age, 46.7 [18.8] years) were surveyed. Over the study period, mean monthly cigarette consumption in England was 2.85 billion (95% CI, 2.78 billion to 2.93 billion) cigarettes based on survey data compared with 3.08 billion (95% CI, 3.03 billion to 3.13 billion) estimated from sales data. Over the whole period, cigarette consumption declined by 24.4% based on survey data and 24.1% based on sales data. This equated to 118.4 million and 117.4 million fewer cigarettes consumed per month (or approximately 1.4 billion per year) based on survey data and sales data, respectively. After adjusting for underlying trends, month-by-month changes in cigarette consumption were closely aligned: a 1% change in survey-estimated cigarette consumption was associated with a 0.98% (95% CI, 0.53%-1.44%) change in sales estimates. Conclusions and Relevance: Survey data and sales data were closely aligned in showing that overall cigarette sales in England have declined by almost a quarter since 2011, amounting to more than 1 billion fewer cigarettes smoked each year. The alignment between the 2 methods provides increased confidence in the accuracy of parameters provided by the Smoking Toolkit Study and sales data. It indicates that estimated changes in cigarette consumption are robust and provide a meaningful basis for policy evaluation and planning.

Active 10 - A new approach to increase physical activity in inactive people in England.

Public health physical activity (PA) guidelines are failing to increase levels of population PA, requiring a new approach. A national integrated marketing campaign was developed based on published literature and ethnographic research to get inactive lower socioeconomic 40-60 year olds to walk briskly for bouts of 10 or more minutes per day and move towards recommended levels of PA. National and local communications campaigns and partnerships promoted key messages and directed people to a free mobile phone app that provided the user with time, intensity and periodicity of walking, and included goal setting and encouragement to support behaviour change. Campaigns in the summers of 2017 and 2018 achieved around 500,000 downloads of the mobile phone app, with evaluation suggesting increases in brand and app awareness, and those taking action. Active 10 is a promising example of a physical activity promotion campaign based on evidence-based messages tailored for a target audience to change social norms rather than guidelines, an approach recognised as an effective population intervention for increasing walking.