The potential of shame as a message appeal in antismoking television advertisements.

BACKGROUND: As smoking is increasingly de-normalised, different messages may become more appropriate for use in tobacco control advertisements to reflect the changing social environment. To date, more commonly used messages have included fear appeals relating to physical health and guilt appeals focusing on the effects of smoking on loved ones. OBJECTIVE: This study investigated the relative effectiveness of varying advertising appeals to promote smoking cessation. The study was conducted in Australia, where only 12% of the population smokes and legislation restricts smoking in many public places. The aim was to provide insight into ways to motivate the small segment of existing smokers to consider quitting. METHODS: Across a qualitative phase and an ad testing phase, shame was found to be highly salient to current smokers and those who had quit recently. On the basis of these results, a television advertisement featuring a shame appeal was developed and broadcast. The ad featured various scenarios of individuals hiding their smoking from others. The campaign was evaluated using the measures of awareness, believability, perceived relevance and smoking behaviours. RESULTS: The shame appeal television advertisement was found to resonate with smokers and encourage quitting/reducing behaviours. Around 4 in 5 (78%) smokers surveyed recalled seeing the ad, almost all of whom could nominate at least one correct take-out message (94%). Around three-quarters (72%) found the ad to be personally relevant and half (53%) reported that they had successfully quit, attempted to quit or cut down the number of cigarettes they smoked since the start of the campaign. CONCLUSIONS: The use of shame appeals may be an effective method of motivating smokers to quit in an environment where they are members of a small minority and supportive legislation exists to discourage smoking in public places.

A cost-effectiveness analysis of online, radio and print tobacco control advertisements targeting 25-39 year-old males.

OBJECTIVE: To assess the relative cost-effectiveness of various non-television advertising media in encouraging 25-39 year-old male smokers to respond to a cessation-related call to action. Information about how new electronic media compare in effectiveness is important to inform the implementation of future tobacco control media campaigns. METHODS: Two testimonial advertisements featuring members of the target group were developed for radio, press and online media. Multiple waves of media activity were scheduled over a period of seven weeks, including an initial integrated period that included all three media and subsequent single media phases that were interspersed with a week of no media activity. The resulting Quit website hits, Quitline telephone calls, and registrations to online and telephone counselling services were compared to advertising costs to determine the relative cost-effectiveness of each media in isolation and the integrated approach. RESULTS: The online-only campaign phase was substantially more cost-effective than the other phases, including the integrated approach. CONCLUSIONS: This finding is contrary to the current assumption that the use of a consistent message across multiple media simultaneously is the most cost-effective way of reaching and affecting target audiences. IMPLICATIONS: Online advertising may be a highly cost-effective channel for low-budget tobacco control media campaigns.

Selected dietary micronutrients and the risk of right- and left-sided colorectal cancers: a case-control study in Western Australia.

PURPOSE: Contradictory results about the role of dietary factors in the causation of colorectal cancer (CRC) may partly be due to failure to discriminate between left- and right-sided CRC. METHODS: We undertook a population-based case-control study comparing 577 cases of left-sided CRC and 277 cases of right-sided CRC (n = 277) with 958 age- and sex-matched controls. Dietary exposure was measured using a food frequency questionnaire. Odds ratios (OR) were calculated across quintiles of dietary intakes of micronutrients, adjusting for potential confounders. RESULTS: Compared to those in the lowest quartiles of intake, we found a protective role of phosphorus on CRC particularly for right-sided cancers (Q5 OR = 0.66, 95% confidence interval [CI]: 0.52-1.02) and protective associations for iron and zinc were observed with left-sided cancers (Q5 OR = 0.78, 95% CI: 0.56-1.09 and Q5 OR = 0.65, 95% CI: 0.46-0.92, respectively). An increased risk of left-sided cancer, was observed for vitamin E (Q5 OR = 1.37, 95% CI: 0.97-1.96). CONCLUSIONS: An increased risk of CRC was observed for vitamin E and decreased risks were seen for phosphorus, iron, and zinc. Differences in the risk of developing CRC according to subsite were observed for phosphorus and vitamin E.

Beliefs about bowel cancer among the target group for the National Bowel Cancer Screening Program in Australia.

OBJECTIVE: To assess awareness of and intentions and self-reported participation in the National Bowel Cancer Screening Program (NBCSP) in Australia and the program's impact on knowledge of and beliefs about bowel cancer. METHOD: Cross-sectional, computer-assisted telephone surveys of Western Australians aged 55-74 years conducted in April 2007 (n = 505) and June 2008 (n = 500) measured beliefs about the prevalence of bowel cancer, its preventability, impact of early detection on life expectancy, knowledge of the symptoms and tests for bowel cancer, and awareness of and participation in the NBCSP. RESULTS: In 2008, awareness of the Program was 58%. Seventy-seven per cent of those invited to participate in the program agreed to do so. The vast majority believed bowel cancer to be preventable (83%), with early treatment making 'a great deal of difference' to life expectancy (85%). Awareness of blood in faeces as a sign of bowel cancer increased from 64% in 2007 to 75% in 2008 (p<0.01). Awareness of FOBT as a test for bowel cancer increased from 54% in 2007 to 70% in 2008 (p<0.01). CONCLUSIONS: The NBCSP appears to have increased knowledge of bowel cancer. IMPLICATIONS: Education and screening campaigns are required to further increase perceived prevalence of bowel cancer and to increase knowledge of symptoms and risk factors.

The MTHFR C677T and DeltaDNMT3B C-149T polymorphisms confer different risks for right- and left-sided colorectal cancer.

Etiological risk factors for proximal (right-sided) colon cancers may be different to those of distal colon and rectal (left-sided) cancers if these tumors develop along distinct pathways. The CpG Island Methylator Phenotype (CIMP+) occurs in approximately 15% of colorectal cancers (CRC) and predominantly in the proximal colon. CIMP+ tumors have frequent methylation of gene promoter regions and increased tissue folate levels. The aim here was to determine whether polymorphisms in 2 genes involved in cellular methyl group metabolism were associated with different risks for right- and left-sided CRC. This population-based case-control study involved 859 incident cases of CRC and 973 sex and age-matched controls. Information on dietary folate and alcohol intake was obtained from food frequency questionnaires and information on the anatomical site of tumors from pathology reports. DNA was collected using FTA cards and genotyping performed for the MTHFR C677T and DeltaDNMT3B C-149T polymorphisms. The MTHFR 677 T allele was associated with increased risk for proximal colon cancer (adjusted odds ratio, AOR = 1.29) but decreased risk for distal cancers (AOR = 0.87). The increased risk for proximal cancers was especially pronounced in older individuals (AOR = 1.49) and those with a low folate diet (AOR = 1.67) or high alcohol consumption (AOR = 1.90). The DeltaDNMT3B-149 TT genotype was protective against proximal colon cancers (AOR = 0.65), but showed no association with the risk of distal colon and rectal cancers (AOR = 1.02). Epidemiological studies on dietary and genetic risk factors for CRC should take into account these may confer different risks for right- and left-sided tumors.

Assessing the effectiveness of a mammography screening service.

BACKGROUND: Trials have shown that mammography screening reduces mortality and probably decreases morbidity related to breast cancer. METHODS: We assessed whether the major mammography service in Western Australia (BreastScreen WA) is likely to reduce mortality by comparing prognostic variables between screen-detected and other cases of breast cancer diagnosed in 1999. We assessed likely reductions in morbidity by comparing treatments received by these two groups. To confirm mortality and morbidity reduction, we also compared prognostic variables and treatments with targets. Information on demographic variables, tumour characteristics at presentation and treatments were collected from medical records for all incident cases of breast cancer in Western Australia in 1999. We matched cases with the Western Australian Cancer Registry records to determine which cases had been detected by BreastScreen WA. RESULTS: BreastScreen WA achieved the targets for mortality reduction. Tumours detected by BreastScreen WA were smaller in size, less likely to have vascular invasion, of lower histological grade and were more likely to be ductal carcinoma in situ alone without invasive carcinoma. Oestrogen receptor status was more likely to be positive, the difference in progesterone status was not significant, and lymph node involvement tended to be lower. BreastScreen WA patients were treated more often with local therapy and less often with systemic therapy, and the proportion of patients treated with breast-conserving surgery was close to the target for minimizing morbidity in breast cancer. CONCLUSION: Mammographic detection of breast cancer by BreastScreen WA is associated with reduced breast cancer morbidity and a more favourable prognosis.