Comparison of Tobacco Product Prices at Fort Liberty Army Installation and Surrounding Community Areas, 2021.

INTRODUCTION: High rates of tobacco use persist in the U.S. military, with 18.4% of service members smoking cigarettes in 2018. The Department of Defense's (DoD) 2017 policy required that tobacco retailers on military installations set tobacco product prices equal to the most common community price, including tax, but there is limited evidence confirming whether local retailers are adhering to this policy. We examined tobacco product pricing in tobacco retailers on- and off-post at the largest U.S. Army installation, Fort Liberty, and Cumberland County, North Carolina. METHODS: Between June-August 2021, we collected data on tobacco product availability, price, and promotions from retailers on Fort Liberty (n=14) and a random sample of off-post retailers within 10-miles of installation gates (n=52). We calculated the mode, mean, and median price of each product, plus the difference in these prices at on- and off-post retailers. We used Welch's t-test to test differences in mean prices between on- vs. off-post retailers. RESULTS: The mode, mean, and median prices of cigarette packs and cartons were lower on-post than off-post (e.g., $0.51-$0.55 cheaper for Marlboro cigarette packs on-post). However, the mode, mean, and median prices of smokeless tobacco products and little cigars were higher on-post than off-post (e.g., $0.82-$0.89 more costly for Swisher Sweets 2-packs on-post). CONCLUSION: Results highlight the need for continued enforcement to ensure compliance with the 2017 DoD policy. Comprehensive policy action to reduce tobacco price disparities on- and off-post is critical to reducing high rates of tobacco use among service members. IMPLICATIONS: Despite the implementation of the 2017 DoD pricing policy, some tobacco products remain cheaper at tobacco retailers on-post compared to off-post retailers. Our results highlight the need for greater routine surveillance to increase implementation of the policy-particularly for cigarettes-to reduce high rates of tobacco use among service members.

A Review of Web-Based Tobacco Control Media Archives for Researchers and Practitioners.

Web-based resources for tobacco use prevention and control provide valuable tools for cancer education. This study sought to (a) identify existing websites that archive prevention and cessation media content and (b) characterize the content and features of those websites. We used a comprehensive search strategy to identify web-based resources. Websites were included if (1) the content was focused on tobacco; (2) a primary purpose of the website was to house a national or international historical archive of anti- or pro-tobacco media or communication content; and (3) the website was designed for researchers or practitioners. Of the 55 websites initially identified, N = 9 met criteria. All websites contained anti-tobacco media content (100%), although 56% also contained pro-tobacco content. Most websites focused on multiple tobacco products (89%), while 11% focused solely on cigarettes. The most common media content in the archives were print ads (67%), warning labels (56%), and video ads (33%). Most archives contained a search function or content filters (67%). While most websites provided free media content with no restrictions (78%), 22% contained paid or restricted content. Other website material included research reports (89%), newsfeeds (89%), fact sheets (67%), advocacy information (56%), and tools for practitioners (44%). This study provides a systematic summary of web-based tobacco prevention and control resources that archive communication and media content. The identified websites can assist researchers and practitioners in their tobacco control efforts, although additional archives focused specifically on vaping media and communication content are needed as the vaping epidemic among youth continues to intensify.

Comparison of Message and Effects Perceptions for The Real Cost E-Cigarette Prevention Ads.

Perceived message effectiveness (PME) is commonly used in health communication research and practice, yet there has been a dearth of studies comparing different operationalizations of the PME construct. In the present study, we compared the two major types of PME - message perceptions and effects perceptions - among N = 557 young adults. Participants were randomized to one of two conditions: 1) The Real Cost e-cigarette prevention ads developed by the Food and Drug Administration (FDA condition) or 2) information-only e-cigarette control ads developed by the Mayo Clinic (control ad condition). Study predictors were message and effects perceptions measures and actual message effectiveness (AME) outcomes were risk beliefs about vaping and intentions to vape. Results showed that both message perceptions (M = 3.82 vs M = 3.29; p < .001) and effects perceptions (M = 4.13 vs M = 3.82; p < .001) were higher in the FDA ad condition compared to control. Risk beliefs about vaping were also higher in the FDA ad condition than control (M = 3.95 vs M = 3.79; p =.022), but we found no differences in participants' intentions to vape, which were low overall (M = 1.59 in FDA vs M = 1.58 in control). In multivariate analyses adjusting for covariates and including both types of PME, only effects perceptions (not message perceptions) were associated with risk beliefs about vaping (b =.37, p < .001) and intentions to vape (b = -.26, p < .001). Our findings advance PME research by demonstrating the differing nature of message and effects perceptions, and suggest that effects perceptions should be utilized during message pretesting.

Physical activity, sedentary behavior, and childhood obesity: a review of cross-sectional studies.

This systematic review examined the associations of physical activity (PA) and sedentary behavior to childhood overweight and obesity in cross-sectional studies from the last 10 years. Cross-sectional approaches are cost-effective methods for identifying relationships that can then be followed by longitudinal studies to establish temporality and create targeted interventions. The 17 selected studies contained a variety of measures of PA and sedentary behavior. PA was related negatively to child weight status in some studies; however, it was not associated in others. In general, sedentary behaviors were positively associated with weight status. However, gender differences appeared in some studies for each variable. Limitations of cross-sectional approaches were discussed, as was the need for more accurate measures of PA, sedentary behavior, and body composition.

What's in the message? An analysis of themes and features used in vaping prevention messages.

Introduction: Federal, state, local, and non-government officials have developed and implemented a variety of vaping prevention messages to curtail the vaping epidemic among youth in the US. This study sought to collect a comprehensive set of vaping prevention messages and characterize the themes and features of those messages. Methods: We used a two-fold search strategy to identify messages, utilizing the existing content database from Vaping Prevention Resource (vapingprevention.org) and supplementing those messages with web searches. Potential messages were included if they were vaping prevention-oriented, appropriate or relevant for youth, and in a static web or print format. Results: A total of 220 messages met criteria. Messages were coded on the presence or absence of 37 objective features within five categories: message themes, imagery, text features, message perspective, and other (e.g., source). The most common themes were nicotine addiction (32%), chemicals (30%), health effects (24%), and industry targeting (19%). Eighty-five percent of messages included imagery, with 27% showing a vaping device, 22% showing smoke or vapor, and 21% showing a person's face. Just over half (56%) included a message source. Conclusions: Vaping prevention messages for youth have commonly focused on addiction and health risks of vaping, and they vary on a series of text and image features. Further research is needed to understand the efficacy of messaging approaches in preventing vaping among youth.

EatWellNow: Formative Development of a Place-Based Behavioral "Nudge" Technology Intervention to Promote Healthier Food Purchases among Army Soldiers.

Approximately 17% of military service members are obese. Research involving army soldiers suggests a lack of awareness of healthy foods on post. Innovative approaches are needed to change interactions with the military food environment. Two complementary technological methods to raise awareness are geofencing (deliver banner ads with website links) and Bluetooth beacons (real-time geotargeted messages to mobile phones that enter a designated space). There is little published literature regarding the feasibility of this approach to promote healthy behaviors in retail food environments. Thus, we conducted a formative feasibility study of a military post to understand the development, interest in, and implementation of EatWellNow, a multi-layered interactive food environment approach using contextual messaging to improve food purchasing decisions within the military food environment. We measured success based on outcomes of a formative evaluation, including process, resources, management, and scientific assessment. We also report data on interest in the approach from a Fort Bragg community health assessment survey (n = 3281). Most respondents agreed that they were interested in receiving push notifications on their phone about healthy options on post (64.5%) and that receiving these messages would help them eat healthier (68.3%). EatWellNow was successfully developed through cross-sector collaboration and was well received in this military environment, suggesting feasibility in this setting. Future work should examine the impact of EatWellNow on military service food purchases and dietary behaviors.

Feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing for active-duty Soldiers.

To increase Soldiers' access to HPV vaccination, we evaluated the feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing procedures for Soldiers. We partnered with nursing staff to introduce HPV vaccine into existing vaccination services at a nurse-led clinic that serves Soldiers at Fort Bragg, North Carolina. In addition to stocking the vaccine, the intervention included training nursing staff (n = 11) strategies for recommending HPV vaccination for Soldiers ages 18-26. We conducted surveys of nursing staff to assess their perspectives on feasibility. Nursing staff tracked HPV vaccine uptake among Soldiers for 4 weeks post-training to assess adoption and again for 2 weeks at 4-month follow-up to assess sustainability. We assessed delivery cost as the cost of personnel time, vaccine doses, and other materials during the initial 4-week intervention period. Nursing staff agreed that recommending HPV vaccination fit in with medical processing procedures (mean = 4.6 of 5.0). Of the 516 Soldiers offered HPV vaccine in the 4 weeks following the training, 198 (38%) accepted and received the vaccine. Soldier ages 18-20 more often accepted HPV vaccination than older Soldier ages 21-26 (46% versus 32%, p < .01). Vaccine uptake was similar at follow-up, with 98 of 230 eligible Soldiers (43%) receiving HPV vaccine. The total delivery cost was $12,737, with an average cost per vaccine dose delivered of $64. Our findings suggest that training nursing staff to recommend and administer HPV vaccinations to Soldiers is feasible and warrants wider-scale testing as a strategy to protect soldiers from HPV-attributable cancers.

HPV vaccination is not required for US military service, and Soldiers' uptake is low. We trained nursing staff at a large military clinic to recommend HPV vaccine to Soldiers using a nursing education intervention to integrate HPV vaccination into routine care for active duty Soldiers. Our findings suggest that training nursing staff to recommend and administer HPV vaccines to Soldiers is feasible and low cost, and may warrant wider-scale testing as a strategy for increasing military readiness and protecting Soldiers from HPV-attributable cancers. Until guideline and policy changes are implemented and HPV vaccine is required for military service, use of education strategies is one path to increasing HPV vaccine coverage among Soldiers to ensure protection from HPV-related diseases.

Evaluating the actual and perceived effectiveness of E-cigarette prevention advertisements among adolescents.

BACKGROUND: The efficacy of e-cigarette prevention ads among adolescents has seldom been studied. We examined the impact of ads from the The Real Cost vaping prevention media campaign on what adolescents think and believe about vaping. We also sought to test whether perceived message effectiveness (PME) served as a proxy for ad impact. METHODS: Participants were 543 U.S. adolescents ages 13-17. In an online experiment, we randomized participants to either: 1) persuasive e-cigarette prevention video ads from the Food and Drug Administration's The Real Cost campaign that was targeted to adolescents or 2) information-only e-cigarette harms control videos (control condition). Participants in each condition viewed 2 videos in a random order. After ad exposure, the survey assessed PME (message and effects perceptions), risk beliefs about vaping, attitudes toward vaping, and intentions to vape. RESULTS: The FDA's The Real Cost ads led to higher beliefs about the harms of vaping (p < .001), more negative attitudes toward vaping (p < .001), and lower intentions to vape (p < .05) compared to the control videos. The Real Cost ads also scored higher on both message perceptions (p < .001) and effects perceptions (p < .001) compared to control videos. Effects perceptions were associated with all three outcomes (all ps < 0.001, adjusting for both types of PME and covariates), but message perceptions did not offer additional predictive value. CONCLUSIONS: Exposure to The Real Cost vaping prevention ads gave adolescents a more negative view of vaping and lowered their intentions to vape compared to control videos. Effects perceptions may be superior to message perceptions as a proxy for e-cigarette prevention ad impact.