The Role of Social Media Advertisement and Physical Activity on Eating Behaviors among the General Population in Saudi Arabia.

Over the past few decades, people in Saudi Arabia have become less inclined to adopt active lifestyles and healthy eating habits due to the increasing use of digital technologies such as social media. The objective of this online-based cross-sectional study was to assess the role of social media food advertisements and physical activity on eating behaviors among the general population in Saudi Arabia (n = 471). Data were collected through a structured questionnaire, which consisted of four parts: (i) sociodemographic information, (ii) attitude towards social media, (iii) eating behaviors-related information, and (iv) exposure to and engagement with social media advertisements. The study's outcome variable, eating behaviors (healthy vs. unhealthy), was assessed using the following question: "Are you on a healthy diet (such as a balanced diet, keto, or low carb)?" A multiple binary logistic regression analysis was performed to investigate the factors that influence unhealthy eating behaviors. Approximately 79.6% of the participants had unhealthy eating behaviors. Participants who were not involved in daily physical activity were more likely to have unhealthy eating behaviors compared to their counterparts (adjusted odds ratio, AOR = 4.86). Participants who watched food ads on social media channels 1-3 times a week (AOR = 2.58) or daily (AOR = 3.49) were more likely to have unhealthy eating behaviors than their counterparts. Participants whose appetite to try foods increases always (AOR = 1.42) or usually (AOR = 2.88) after viewing ads on social media were more likely to have unhealthy eating behaviors. These findings suggest that policymakers should take immediate action to regulate food advertising policy to promote a healthy food environment across the country. Saudis should be encouraged to engage in more physical activity, which could support the maintenance of healthy eating patterns and lifestyles.

Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations.

BACKGROUND: Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. METHODS: This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. RESULTS: Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). CONCLUSION: California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.

Environmental influences on E-cigarette use among young people: A systematic review.

E-cigarettes are a popular mode of delivery for nicotine, tobacco and cannabis. The prevalence of vaping among youth is increasing and this review aims to identify features of the neighbourhood environment, e.g., retailers, advertisements, and policies, that are associated with youth vaping. We included 48 studies. Of these, approximately 40% and 60% reported that presence of e-cigarette retailers, and advertisements, was associated with statistically higher odds of e-cigarette use in youth, respectively. Approximately 30% of studies reported that policies affecting e-cigarette availability were associated with statistically lower odds of vaping. Identifying these influential features of the neighbourhood environment will help formulate appropriate policies to reduce e-cigarette use among youth.

Association Between Secondhand Smoke Exposure Among Women and the Implementation of Tobacco Control Measures on Campus: A Cross-Sectional Study in 50 Universities Across China.

INTRODUCTION: Exposure to secondhand smoke (SHS) among women is prevalent in China which increases their risk of developing a wide range of diseases and can affect their susceptibility to adverse reproductive health effects. This study aims to examine the association between SHS exposure among women and the adoption and implementation of tobacco control measures on campus in China. AIMS AND METHODS: 7469 female college students who have never smoked were recruited from 50 universities across China using a multistage sampling technique. All participants reported their exposure to SHS and the tobacco advertising and promotion on campus. Participants from colleges with smoke-free policies reported the implementation of smoke-free policies on campus measured by: (1) no evidence of smoking and (2) the display of smoke-free signs in public places. Multivariate logistic regression models were applied using weighted survey data. RESULTS: SHS exposure among participants was 50.5% (95% CI = 44.2% to 56.9%). The adoption of a smoke-free policy was not associated with SHS exposure (OR: 1.01, 95% CI = .71, 1.42), however, the implementation of the policy was significantly negatively associated with SHS exposure (OR: 0.56, 95% CI = .47 to 0.67). In addition, tobacco advertising and promotion on campus were significantly positively associated with SHS exposure (OR: 2.33, 95% CI = 1.42, 3.82; OR: 1.52; 95% CI = 1.15, 2.02, respectively). CONCLUSIONS: Exposure to SHS is prevalent among female college students in China. Successful implementation of a smoke-free policy and banning tobacco advertising and promotion on campus could be effective measures to protect young women from the harms of SHS in China. IMPLICATIONS: Approximately half of female college students are exposed to SHS on campus in China. Failure to implement smoke-free policies and exposure to tobacco marketing on campus are associated with higher SHS exposure. To protect millions of young Chinese women from the health harms of SHS, universities need to enact and enforce smoke-free policies within campus boundaries and adopt comprehensive bans on tobacco advertising and promotion on campus.

National Trends of Adolescent Exposure to Tobacco Advertisements: 2012-2020.

BACKGROUND AND OBJECTIVES: The objective of the current study is to evaluate the temporal trends in the prevalence of cigarette and electronic cigarette (e-cigarette) advertisement exposure by venue and sociodemographic correlates among US adolescents from 2012 to 2020. METHODS: We conducted a serial cross-sectional analysis of nationally representative samples of middle and high school youth from the 2012-2020 National Youth Tobacco Survey. Advertisement exposure was defined as self-report of seeing advertisements "sometimes," "most of the time," and "always." The prevalence of cigarette (and other tobacco products) and e-cigarette advertisement exposure, including overall and at specific venues (Internet, press, screen, and retail stores), was estimated by survey year. RESULTS: A total of 139 795 adolescents aged 11 to 19 years old were included in the analysis. The prevalence of exposure to combustible cigarette marketing remained high across all years (any venue ranging from 77.0% [2018] to 91.1% [2014]). An increasing trend for cigarette advertisement exposure was observed from 2017 to 2020 after a drop in 2015 (ß2012-2015 = 2.8, P for trend < .001; ß2017-2020 = .7, P for trend = .03), driven by retail store-based and Internet-based exposure. A similar increasing pattern in the estimated prevalence of e-cigarette marketing was observed (ß2014-2016 = 4.6, P for trend < .001; ß2017-2020 = 5.1, P for trend < .001). CONCLUSIONS: Given the high estimated prevalence of cigarette and e-cigarette marketing exposure among US adolescents, further regulation efforts for both off-line and online tobacco marketing are needed to mitigate adolescent exposure to content regarding these products, reducing susceptibility to uptake.

Examining how changes in provincial policy on vape marketing impacted the distribution of vaping advertisements near secondary schools in London, Ontario.

OBJECTIVES: On January 1, 2020, the Government of Ontario passed a regulation banning vaping advertisements by retailers, apart from specialty shops. A motivation for this ban was to limit youth exposure to vaping advertisements. The primary goal of this research was to evaluate the impact of this ban on the number and density of vaping advertisements surrounding secondary schools. Additionally, we examined whether the number of vaping advertisements varied by school socio-demographic characteristics. METHODS: This study used a pre-post design. Audits were conducted December 2019 (pre-ban) and again January to February 2020 (post-ban), to identify vaping advertisements within 800 m surrounding secondary schools (n = 18) in London, Ontario. RESULTS: Prior to the ban, there were 266 vaping advertisements within 800 m of secondary schools. After the ban, this was reduced to 58, a 78.2% reduction. The mean number of vaping advertisements surrounding schools significantly decreased from 18.1 before the ban to 3.6 after the ban (p < 0.001). A significant positive correlation was found, prior to the ban, between the number of vaping advertisements surrounding schools and school-level residential instability (r = 0.42, p = 0.02). After the ban, no significant correlations were found between the number of vaping advertisements and school socio-demographic characteristics. CONCLUSION: The provincial ban of vaping advertisements in select retail settings significantly reduced the number of vaping advertisements in the areas surrounding secondary schools in London, Ontario. The ban also reduced socio-demographic inequities in youths' potential exposure to marketing of vaping products. Continued monitoring of the geographic accessibility and promotion of vaping products is warranted.

RéSUMé: OBJECTIFS: Le 1er janvier 2020, le gouvernement de l'Ontario adoptait un règlement interdisant les annonces publicitaires sur le vapotage dans les magasins de détail, sauf dans les boutiques spécialisées. L'une des raisons de cette interdiction était de limiter l'exposition des jeunes à la publicité sur le vapotage. Notre étude visait principalement à évaluer les incidences de l'interdiction sur le nombre et la densité des annonces publicitaires sur le vapotage autour des écoles secondaires. Nous avons aussi cherché à déterminer si le nombre d'annonces publicitaires sur le vapotage variait selon le profil sociodémographique des écoles. MéTHODE: Un protocole avant-après été utilisé pour cette étude. Des audits ont été menés en décembre 2019 (avant l'interdiction), puis de nouveau en janvier et février 2020 (après l'interdiction) pour dénombrer les annonces publicitaires sur le vapotage dans un rayon de 800 m des écoles secondaires (n = 18) de London, en Ontario. RéSULTATS: Avant l'interdiction, il y avait 266 annonces publicitaires sur le vapotage dans un rayon de 800 m des écoles secondaires. Après l'interdiction, ce nombre n'était plus que de 58, soit une baisse de 78,2 %. Le nombre moyen d'annonces publicitaires sur le vapotage autour des écoles a diminué de façon significative, passant de 18,1 avant l'interdiction à 3,6 après (p < 0,001). Une corrélation positive significative a été observée, avant l'interdiction, entre le nombre d'annonces publicitaires sur le vapotage autour des écoles et l'instabilité résidentielle au niveau des écoles (r = 0,42, p = 0,02). Après l'interdiction, aucune corrélation significative n'a été observée entre le nombre d'annonces publicitaires sur le vapotage et le profil sociodémographique des écoles. CONCLUSIONS: L'interdiction provinciale des annonces publicitaires sur le vapotage dans certains magasins de détail a considérablement réduit le nombre de ces annonces dans les environs des écoles secondaires de London, en Ontario. L'interdiction a aussi réduit les iniquités sociodémographiques de l'exposition potentielle des jeunes au marketing des produits de vapotage. Il est justifié d'assurer une surveillance continue de l'accessibilité géographique et de la promotion des produits de vapotage.

Truth-in-Advertising Laws: Are They Working? A Cross-Sectional Analysis of a "Plastic Surgeon" Patient Search Simulation.

BACKGROUND: Non-board-certified plastic surgeons performing cosmetic procedures and advertising as plastic surgeons may have an adverse effect on a patient's understanding of their practitioner's medical training and patient safety. The authors aim to assess (1) the impact of city size and locations and (2) the impact of health care transparency acts on the ratio of board-certified and non-American Board of Plastic Surgeons physicians. METHODS: The authors performed a systematic Google search for the term "plastic surgeon [city name]" to simulate a patient search of online providers. Comparisons of board certification status between the top hits for each city were made. Data gathered included city population, regional location, practice setting, and states with the passage of truth-in-advertising laws. RESULTS: One thousand six hundred seventy-seven unique practitioners were extracted. Of these, 1289 practitioners (76.9 percent) were American Board of Plastic Surgery-certified plastic surgeons. When comparing states with truth-in-advertising laws and states without such laws, the authors found no significant differences in board-certification rates among "plastic surgery" practitioners (88.9 percent versus 92.0 percent; p = 0.170). There was a significant difference between board-certified "plastic surgeons" versus out-of-scope practitioners on Google search between large, medium, and small cities (100 percent versus 92.9 percent versus 86.5; p < 0.001). CONCLUSIONS: Non-board-certified providers tend to localize to smaller cities. Truth-in-advertising laws have not yet had an impact on the way a number of non-American Board of Plastic Surgery-certified practitioners market themselves. There may be room to expand the scope of truth-in-advertising laws to the online world and to smaller cities.

Trabalho sexual em período de pandemia por COVID-19 no contexto íbero-americano: análise de anúncios em websites / Sex Work during the COVID-19 Pandemic Period in the Ibero-American Context: analysis of advertisements on websites

Resumo Trabalhadores do sexo tornam-se cada vez mais vulneráveis economicamente como resultado das medidas restritivas implementadas para responder à pandemia de coronavírus. Nesse sentido, o objetivo deste estudo é analisar o conteúdo dos websites e anúncios de prostituição sobre medidas relacionadas à pandemia por COVID-19. Trata-se de descrição do fluxo de visitas e análise de conteúdo das comunicações em websites que anunciam transações de sexo comercial. Realizou-se cálculo de variação percentual do número de visitas para três períodos compreendidos entre 02/2019 a 04/2020. Posteriormente, extraíram-se anúncios com os termos "corona", "pandemia" e "quarentena" em websites que oferecem mecanismo de busca. Para análise de conteúdo, utilizou-se o método de Bardin. Houve aumento no número de acessos nos websites de prostituição entre o ano de 2019 e 2020, seguido de queda com a advento da crise pandêmica por coronavírus. Dentre as medidas de proteção durante a pandemia, destacam-se as recomendações de saúde e o incentivo ao sexo virtual. Dentre 1.991.014 anúncios, 0,51% mencionam a crise por COVID-19 quanto ao descumprimento do distanciamento social, medidas de proteção e oferta de sexo on-line.

Abstract Sex workers become increasingly economically vulnerable due to the restrictive measures implemented to combat the coronavirus pandemic. In this respect, the scope of this study is to analyze the content of prostitution websites and advertisements regarding measures related to the COVID-19 pandemic. It involved a description of the visits and analysis of content of communications on websites that advertise commercial sex transactions. The percentage change in the number of visits for three periods from 02/2019 to 04/2020 was calculated. Subsequently, ads with the terms "corona," "pandemic" and "quarantine" on websites that offer search engines were extracted. The Bardin method was then used for content analysis. There was an increase in the number of visits to prostitution websites between 2019 and 2020, followed by a decrease with the advent of the coronavirus pandemic crisis. With regard to the protection measures during the pandemic, health recommendations and the incentive to engage in virtual sex are highlighted. Of the 1,991,014 advertisements, 0.51% mention the COVID-19 crisis regarding noncompliance with social distancing, protection measures and the offer of online sex.

Youth Exposure to Marijuana Advertising in Oregon's Legal Retail Marijuana Market.

INTRODUCTION: Research from tobacco and alcohol markets suggests advertising exposure is associated with perceptions of lower risk and increased use among young people. Limiting marketing may be a regulatory approach to prevent potential negative effects of retail marijuana legalization on youth use. This study assessed marijuana advertising exposure reported by youths in Oregon after the start of retail marijuana sales in October 2015. METHODS: Data from a 2017 school-based survey of Oregon 8th (N = 14,852) and 11th (N = 11,895) graders were used to characterize marijuana advertising exposure. Subgroup differences in reported exposure were assessed by using Pearson χ2 tests and multiple logistic regression. RESULTS: About three-quarters of 8th (72.2%) and 11th graders (78.1%) in Oregon reported seeing marijuana advertising in the past month. Youths most frequently reported seeing advertising on storefronts and online, and odds of exposure were significantly higher for girls; lesbian, gay, or bisexual youths; current marijuana users; 8th graders living with an adult who uses marijuana; and youths in school districts with a closer average proximity to retail marijuana stores. CONCLUSION: Reporting exposure to marijuana advertising is common among youths in Oregon's legal retail market. Oregon and other states working to prevent youth marijuana use may want to examine how well their rules are working to prevent youth exposure. Although some sources of youth advertising exposure may be difficult to regulate and enforce (eg, online), others may be within the purview of state authority (eg, billboards, storefronts) depending on state-specific interpretation of free speech protections.

Tobacco and tobacco branding in films most popular in the UK from 2009 to 2017.

BACKGROUND: Exposure to tobacco content in films is a cause of smoking uptake in young people. In an earlier study, we reported that tobacco content occurred in 70% of UK box office films popular between 1989 and 2008. We now report an analysis of tobacco content in a sample of the top grossing UK box office films between 2009 and 2017, and of population exposure resulting from audience exposure to the 2017 films. METHODS: Occurrence of tobacco intervals (actual tobacco use, implied use, appearance of smoking paraphernalia or branding) was measured by 5 min interval coding in the 15 most commercially successful films in the UK in each year from 2009 to 2017. A nationally representative survey was used to estimate population exposure to the top 15 films from 2017. RESULTS: We coded 3248 intervals from the 135 films. Tobacco content appeared in 245 intervals (8%, 95% CI 7% to 9%) across 56 (41%, 95% CI 33% to 49%) films. Tobacco content occurred in films in all BBFC age ratings, and 36 (64%, 95% CI 51% to 77%) of films containing tobacco imagery were classified as suitable for viewing by people aged under 15 years. Although less prevalent than in our earlier study, there was no evidence of a secular decline in tobacco content during this study period. The top 15 films from 2017 delivered approximately 21.6 (95% CI 21.06-22.14) million tobacco impressions to young people aged 10-18 years in the UK. CONCLUSIONS: Tobacco content continues to appear in UK Box Office films and is widely seen by young people, representing a major driver of smoking uptake.

The role of social norms in the relationship between anti-smoking advertising campaigns and smoking cessation: a scoping review.

A systematic scoping review of anti-smoking mass media campaign literature provided opportunity to explore how social normative theories and constructs are used to influence smoking cessation. Synthesis of findings was constrained by significant heterogeneity. Nevertheless, the results indicate that a broader conceptualization of social norm is worthy of further exploration. Perceptions of what others think and do contributed in multiple ways to the relationship between anti-smoking messaging and quitting outcomes. Furthermore, integrating research on social norms, social identity and communication may improve understanding of why quitting intentions are enhanced in some circumstances but reactance and counter-arguing responses corresponding to lower quitting intentions occur in others. Integrating a broader theoretical understanding of normative influences into campaign development and evaluation may prove useful in demonstrating the effectiveness of this approach in behaviour change campaigns.

Cross-sectional study on tobacco advertising, promotion and sponsorship (TAPS) and violations of tobacco sale regulations in Myanmar: do these factors affect current tobacco use among Myanmar high school students?

OBJECTIVES: To examine the associations of current tobacco use with tobacco advertising, promotion and sponsorship (TAPS), and illicit tobacco sales exposures among Myanmar high school students. DESIGN: A quantitative, cross-sectional study. SETTING: Seven high schools from both urban and rural areas of four states and regions in Myanmar. PARTICIPANTS: In total, 1174 high school students (482 males and 692 females) were interviewed using a self-administered questionnaire. MAIN OUTCOME MEASURE: Current tobacco use of participants, defined as using any kind of smoked or smokeless tobacco product at least one occasion within the past 30 days. RESULTS: The prevalence of TAPS exposure was 90.9% among high school students in Myanmar. Current tobacco use was positively associated with being over 14 years old (adjusted OR (AOR) 9.81; 95% CI 4.54 to 21.19), being male (AOR 28.06; 95% CI 13.29 to 59.25), exposure to any kind of TAPS (AOR 6.59; 95% CI 2.33 to 18.64), having seen any smoked tobacco product for sale inside or within 100 feet of the school premises (AOR 4.17; 95% CI 1.65 to 10.58), having seen the sale or gifting of any smoked tobacco product to minors (AOR 6.46; 95% CI 2.18 to 19.12) and having seen the sale or distribution of any smoked tobacco product by minors (AOR 2.42; 95% CI 1.42 to 4.10). Having ever received health education about tobacco use (AOR 0.45; 95% CI 0.27 to 0.78), or having a higher perception score of tobacco use (AOR 0.17; 95% CI 0.10 to 0.30) were negatively associated with current tobacco use. CONCLUSIONS: There was an alarming prevalence of TAPS exposure among Myanmar high school students. TAPS exposure and violations of tobacco sale regulations were strong risk factors for current tobacco use among Myanmar high school students, while health education about tobacco products was reported as an effective protective factor. Specific smokeless tobacco sale regulations for minors are needed immediately in Myanmar.

Association of Educational Attainment and Race/Ethnicity With Exposure to Tobacco Advertisement Among US Young Adults.

Importance: Associations of educational attainment with improved health outcomes have been found to be weaker among racial/ethnic minority groups compared with those among the racial/ethnic majority group. Recent research has also documented higher than expected prevalence of smoking in highly educated African American and Hispanic adults. Objective: To compare the association of educational attainment with exposure to tobacco advertisements among racial/ethnic groups of US young adults. Design, Setting, and Participants: This cross-sectional study included data from 6700 young adults who participated in wave 1 of the Population Assessment of Tobacco and Health Study, a nationally representative survey of US adults in 2013. Educational attainment was classified as less than high school diploma, high school graduate, or college graduate. Analysis was conducted between September 20 and October 4, 2019. Main Outcomes and Measures: The independent variable was educational attainment (less than high school diploma, high school graduate, and college graduate). The dependent variable was any exposure to tobacco advertisements in the past 12 months. Race/ethnicity, age, sex, poverty status, unemployment, and region were the covariates. Binary logistic and Poisson regression were used to analyze the data. Results: The study included 6700 participants (3366 [50.2%] men) between ages 18 and 24 years. Most participants were non-Hispanic (5257 participants [78.9%]) and white (5394 participants [80.5%]), while 1443 participants (21.5%) were Hispanic. Educational levels included 1167 participants (17.4%) with less than a high school diploma, 4812 participants (71.8%) who were high school graduates, and 4812 participants (10.8%) who were college graduates. A total of 4728 participants (70.6%) reported exposure to tobacco advertisements in the past 12 months. Exposure to tobacco advertising was reported by 383 participants (53.1%) who were college graduates, 3453 participants (71.8%) who were high school graduates, and 892 participants (76.4%) with less than high school educational attainment. In regression analysis, high school graduation (odds ratio, 0.79; 95% CI, 0.68-0.92) and college graduation (odds ratio, 0.46; 95% CI, 0.39-0.54) were associated with lower odds of exposure to tobacco advertisements compared with young adults with lower educational attainment. Compared with non-Hispanic participants, high school education had a weaker protective association for tobacco advertisement exposure among Hispanic participants (odds ratio, 1.44; 95% CI, 1.03-2.01; P = .03), suggesting that the association of high school graduation with lower exposure to tobacco advertisement is weaker among Hispanic young adults than non-Hispanic young adults. Conclusions and Relevance: This study found that high school graduation had a weaker inverse association with tobacco advertisement exposure among Hispanic than non-Hispanic young adults. Future research should explore the role of targeted marketing strategies of the tobacco industry that largely advertise tobacco in areas with high concentrations of racial/ethnic minority groups. Future research should also evaluate the efficacy of more restrictive marketing policies on racial/ethnic disparities in tobacco use.

Alcohol Advertising and Violence.

INTRODUCTION: Numerous studies have found associations between alcohol outlet density and violence, but it is unknown whether alcohol advertisements visible outside outlets are also associated with violent crime. Baltimore City, MD enacted restrictions on retail alcohol establishment advertising practices as of June 5, 2017. This study examines the association between alcohol advertisements visible outside off-premise alcohol outlets and violent crime before this restriction. METHODS: Outlet observations (n=683) were conducted in summer 2015, and violent crime data (n=24,085) were from June 5, 2015, through June 4, 2017. The number of violent crimes per square mile within 1,000 feet of outlets was summed using kernel density estimation. In 2018-2019, authors used mixed models with a Simes-Benjamini-Hochberg correction for multiple testing. RESULTS: Roughly half (47%, n=267) of the outlets with complete data (n=572) had alcohol advertisements visible from the exterior. Outlets with alcohol advertisements had 15% more violent crimes per square mile within 1,000 feet (eß=1.15, 95% CI=1.07, 1.25, q<0.001) after adjusting for neighborhood context. All associations between alcohol advertisements and specific types of violent crime were significant, with the association strongest for homicides (eß=1.28, 95% CI=1.13, 1.46, q<0.001). There was no association between cigarette advertisements and violent crime (eB=1.08, 95% CI=0.92, 1.26, q=0.43). CONCLUSIONS: Alcohol advertisements visible outside off-premise outlets were associated with increased violent crime over and above the association between the outlets themselves and violent crime. Reducing alcohol advertising visible from the street may decrease risk of violent crime that is associated with alcohol outlets.

Tobacco Advertisements: What Messages Are They Sending in African American Communities?

Racial disparities in tobacco-related death and disease persist. Despite evidence of disparities in exposure to tobacco retailers and point-of-sale advertising, little is known about the extent to which tobacco advertisements within African American communities use three prominent messaging strategies: reassure use is safe despite health risks, redirect attention from health risks to other product features, or incite bravery to use despite health risks. Using a multistage design, we examined tobacco advertisements at 24 retail stores listed on Countertools.org StoreMapper within 15 census tracts where roughly 74% of the population was African American. After confirming interrater reliability, trained data collectors assessed messaging strategy (reassurance, misdirection of attention, or inducement to bravery) usage in ads (n = 165) for various brands (e.g., Newport, Swisher Sweets, Blu) and whether strategies varied by product type (e.g., cigarettes, nonlarge cigar, e-cigarettes). Chi-square analysis of 165 advertisements revealed that the misdirection of attention strategy was used more often than reassurance or inducement to bravery. Tobacco advertisement messaging strategies also varied by product type, with misdirection of attention used more frequently in cigarette and nonlarge cigar advertisements and reassurance used more frequently in e-cigarette advertisements. Cigarette and nonlarge cigar advertisement messages prey on African American communities by redirecting their focus from consequences toward favorable product attributes. Additionally, reassurance messaging may misconstrue risks associated with e-cigarettes; therefore, we should vigilantly monitor e-cigarette trends among this population. Countering misleading messages and advocating policies regarding advertisement content and density within African American communities could help reduce health disparities.

Retail Tobacco Marketing in Rural Versus Nonrural Counties: Product Availability, Discounts, and Prices.

Objectives. To assess tobacco product availability, advertised discounts, and prices in rural and nonrural stores, comparing results for two definitions of rural. Method. This geospatial study linked data from marketing surveillance in a representative sample of licensed tobacco retailers in California (n = 1,276) and categorized rural/nonrural stores at the county and tract levels. Data were collected from January to March, 2017, and mixed-models analyses tested for differences by location (rural vs. nonrural). Results. Compared to nonrural stores, rural-county stores were 2.1 (95% confidence interval [CI; 1.2, 3.6]) times more likely to sell chewing tobacco and 2.5 (95% CI [1.4, 4.2]) times more likely to sell roll-your-own. Rural-county stores sold larger packs of cigarillos for less than $1 (coefficient = 0.22, 95% CI [0.05, 0.39]) and charged less for the cheapest cigarette pack regardless of brand (estimated mean difference = $-0.21, 95% CI [-0.39, -0.03]). Contrary to expectation, a popular brand of chewing tobacco cost more in rural-county stores. A tract-level definition of rural reclassified only 1 in 10 stores, and did not substantially alter the results. Overall, 32.9% of stores advertised discounts on chewing tobacco, but this was more common in rural than nonrural census tracts (adjusted odds ratio = 1.81, 95% CI [1.14, 2.88]). Discussion. Evidence that $1 buys more cigarillos in rural-county stores than elsewhere adds to health equity concerns that the prevalence of cheap, flavored tobacco is not limited to neighborhoods characterized by socioeconomic disadvantage, higher proportions of African Americans, and higher proportions of school-age youth. Policies that focus on the retail environment for tobacco are needed to make tobacco less attractive and more costly everywhere, including rural areas.

Food and beverage supply and advertising in schools and their surroundings in Metropolitan Lima. An exploratory study. / Oferta y publicidad de alimentos y bebidas en instituciones educativas y entornos escolares de Lima Metropolitana. Un estudio exploratorio.

This study aimed to describe the supply and advertising of foods and beverages both inside educational institutions and in their respective local areas in 15 public and private schools in Lima during 2019. Unbiased observations were recorded regarding the types of food available, the presence of octagons, and advertisements used in kiosks and cafeterias. Mobile food vendors were observed at the end of the school day. All schools offered processed products, 73.3% sold food with octagons, and 60% displayed advertising for processed and ultraprocessed foods. Mobile food vendors were observed in 86.7% of schools, several of which were found to sell ultraprocessed products. The results suggest an unhealthy food environment both inside and outside schools, and a noncompliance with current regulations. It is therefore necessary to improve the dissemination and supervision of the food policy, and develop strategies with schools to promote healthy eating.

El objetivo del estudio fue describir la oferta y la publicidad de alimentos y bebidas en instituciones educativas y entornos escolares de 15 colegios públicos y privados de Lima en 2019. Se realizaron observaciones inopinadas y se registraron los alimentos ofrecidos, la presencia de advertencias publicitarias, octógonos y la publicidad en quioscos y cafeterías. A la hora de salida se observó la venta ambulatoria de alimentos. Todas las escuelas ofrecían productos ultraprocesados, el 73,3% vendía alimentos con octógonos y el 60% tenía publicidad de alimentos procesados y ultraprocesados. En el 86,7% de los colegios había vendedores ambulantes de alimentos, varios de los alimentos eran productos ultraprocesados. Los resultados sugieren un ambiente alimentario no saludable dentro y alrededor de las escuelas, y el incumplimiento de la regulación actual. Resulta necesario mejorar la difusión y supervisión de la política alimentaria, y construir con las escuelas estrategias para promover una alimentación saludable.

Point-of-sale marketing of little cigars and cigarillos on and near California Tribal lands.

INTRODUCTION: American Indians have the highest cigarette smoking prevalence of any racial/ethnic group in the USA. Tobacco marketing at point-of-sale is associated with smoking, possibly due to easy access to cheap tobacco products. The sale of novel tobacco products like little cigars/cigarillos (LCCs) has increased in recent years which may further increase combustible tobacco use among American Indians. METHODS: Between October 2015 and February 2017, trained community health workers collected LCC product and price information by conducting audits of tobacco retailers on Tribal lands (n=53) and retailers within a 1-mile radius of Tribal lands (n=43) in California. Χ2 analyses were performed to examine associations among the availability and advertising of LCCs, including indoor price promotions and store location. RESULTS: Overall, 85.4% of stores sold LCCs, 76.0% sold flavoured LCCs and 51.0% sold LCCs for less than $1. Indoor price promotions were displayed at 45 (46.9%) stores. Stores within a 1-mile radius of Tribal lands sold significantly more LCC (p<0.01) and flavoured LCCs (p=0.01) than stores on Tribal lands. Stores within a 1-mile radius of Tribal lands also displayed significantly more LCCs priced at less than $1 (p<0.01) than stores on Tribal lands. CONCLUSIONS: LCCs are widely available in stores on and near California Tribal lands. Stores located a short distance away from Tribal lands were more likely to sell LCCs, including flavoured versions, more likely to sell LCCs priced below $1, and more likely to advertise little LCC price promotions than stores on Tribal lands. Policy-makers and Tribal leaders should consider regulations that would limit access to LCCs at point of sale to help prevent youth initiation and reduce smoking-related morbidity and mortality among American Indians.