Messages about climate, pollution and social justice harms of tobacco as motivators to quit: an untapped communication opportunity?

BACKGROUND: Campaigns highlighting the health harms of smoking have demonstrated success in motivating people who smoke to quit. Tobacco production and use also exert a toll on the environment, sustainable development and human rights. However, messages highlighting these harms of tobacco have been relatively unexplored as a cessation motivation strategy. In this study, we examined the extent to which a range of messages about climate, pollution and social justice harms of tobacco are perceived as motivating among people who smoke, overall and by sociodemographics. DATA AND METHODS: Australian adults who smoke (n=395) aged 18-59 years reported the 'extent to which each of the following motivated them to quit smoking' and were then presented with messages about climate (four items), pollution (three items) and social justice (three items) harms of tobacco, which they rated on a 5-point scale ranging from 1 'Not at all' to 5 'Very much so' in this online cross-sectional survey. Differences by age, education, gender, socioeconomic status (SES) and geographical region were examined using prevalence ratios from generalised linear models with log-link (Poisson regression). RESULTS: For each of the 10 messages, between one-half and two-thirds of the overall sample perceived them as motivating (49-65%), particularly messages highlighting harms to human or animal life and welfare (all ≥60%). Across all message themes, younger adults (18-35 years) and those who completed tertiary education were more likely to perceive some messages as motivating. Perceived motivation did not vary significantly by gender, SES or geographical region. CONCLUSION: Findings suggest that value-based messaging featuring the environmental and social justice footprint of tobacco is perceived as motivating for smoking cessation, especially among younger people and those with higher education who may be more engaged with these issues. Inclusion of such messages as part of a comprehensive antitobacco communication strategy may provide an untapped opportunity by potentially providing people who smoke with additional compelling reasons to quit.

E-cigarette use and other risk factors associated with tobacco smoking susceptibility among Australian adolescents.

OBJECTIVE: To explore risk factors for smoking susceptibility among Australian adolescents to inform prevention policies and programs. METHODS: Cross-sectional survey of students aged 12-17 years who reported having never smoked (n=4,171). Bivariate associations between smoking susceptibility and a range of factors previously linked to youth smoking and smoking susceptibility were initially examined, with significant factors (p<0.05) included in a final multivariable logistic regression model. RESULTS: Eleven percent of adolescents who had never smoked were susceptible to smoking. Smoking susceptibility was independently associated with ever use of e-cigarettes (adjusted odds ratio [AOR]=3.26, 95% confidence interval [CI]: 1.83-5.81), perceiving those who smoke to be more popular (AOR=2.87, 95% CI: 1.62-5.10), having a close friend/s who smokes (AOR=2.66, 95% CI: 1.61-4.40), not perceiving smoking one or two cigarettes occasionally as personally dangerous (AOR=2.56, 95% CI: 1.61-4.09), and having symptoms of depression (AOR=1.59, 95% CI: 1.06-2.38). CONCLUSIONS: The strongest smoking-initiation risk factor identified was ever use of e-cigarettes, with social norms, harm misperceptions around low-rate tobacco use and mental health also linked to smoking susceptibility. IMPLICATIONS FOR PUBLIC HEALTH: Stronger e-cigarette regulations that reduce promotion to and access by youth, as well as interventions addressing the other identified risk factors, may help prevent future smoking uptake among Australian adolescents.

Engaging lower screening groups: a field experiment to evaluate the impact of a multiwave national campaign on participation in the National Bowel Cancer Screening Program.

OBJECTIVES: This field study evaluated a multiwave media campaign that aired in 2019 to promote participation in the Australian National Bowel Cancer Screening Program (NBCSP), which provides free biennial mailed-out immunochemical faecal occult blood test (iFOBT) kits to Australians aged 50-74 years. DESIGN: Adjusted negative binomial regression models determined rate ratios of iFOBT kits returned during and following three campaign waves compared with 2018 (baseline). Interaction terms determined whether effects differed by gender×age group, socioeconomic status (SES) and previous participation. SETTING: Australia. PARTICIPANTS: All Australians eligible for the NBCSP (men and women aged 50-74 years) who returned an iFOBT kit between 1 January 2018 and 30 October 2019. INTERVENTIONS: A multiwave national integrated media campaign to promote participation in the NBCSP. MAIN OUTCOME MEASURES: iFOBT kit return rate and number of iFOBT kits returned during and immediately following campaign activity overall and within historically lower screening groups (men, 50-59 years old; lower SES; never participants). RESULTS: The rate of iFOBT kits returned increased significantly during all three campaign waves, with evidence of carry-over effects of the second wave coinciding with a general practitioner mail-out strategy (all p<0.001). At each wave, effects were observed among men and women in the younger (50-59 years old) age group, but were less consistent for the older age group. Each SES group and both never and previous participants had increased return rates at each wave, but increases were stronger among mid-higher SES and those who had never participated. An estimated 93 075 extra iFOBT kits were returned due to the campaign. CONCLUSIONS: The campaign increased participation, especially among those who were younger and never previously screened-key groups to recruit given reparticipation rates of over 80%. Ongoing investment in national integrated media campaigns of sufficient duration and intensity can increase bowel cancer screening and ultimately save lives.

Association between single-channel and cumulative exposure to alcohol advertising and drinking behaviours among Australian adolescents.

INTRODUCTION: Widespread commercial promotion of alcohol products in Australia undermines the abstinence message for young people. This study aims to document the frequency of adolescents' exposure to alcohol advertising and examine associations with drinking behaviours. METHODS: Students aged 12-17 years (n = 3618) participating in a cross-sectional survey self-reported their exposure to alcohol advertising via eight sources. Students also indicated whether they had never consumed alcohol, consumed at least a few sips of alcohol in their lifetime but none in the past month ('irregular drinkers') or consumed more than 10 drinks in their lifetime including at least one drink in the past month ('drinkers'). Multinomial logistic regression analyses examined associations between both single-channel and cumulative exposure to alcohol advertising and drinking status, controlling for sex, age and education sector. RESULTS: Television (61%), the internet (56%) and at sporting events (50%) were the most common channels through which students reported seeing alcohol advertising. Weekly exposure via each of the eight assessed channels was associated with being a drinker (vs. a non-drinker or an irregular drinker, respectively), whereas only weekly exposure via television and sporting events was associated with being an irregular drinker (vs. a non-drinker). As students' level of cumulative exposure to alcohol advertising increased, so too did their likelihood of being a drinker. DISCUSSION AND CONCLUSIONS: Alcohol advertising exposure is positively associated with drinking among Australian adolescents. Tighter restrictions on alcohol advertising across all media in Australia may reduce adolescent exposure and help de-normalise alcohol use.

Testing the effectiveness of alcohol health warning label formats: An online experimental study with Australian adult drinkers.

Health warning labels (HWLs) on alcohol containers may help reduce population-level alcohol consumption. However, few studies have examined the most effective formats for alcohol HWLs. This study tested the effects of three different types of alcohol HWLs. In an online experiment, N = 1,755 Australian adult drinkers were randomly assigned to one of five conditions: (a) No HWL control; (b) DrinkWise control (industry-developed labels currently on some containers); (c) Text-Only HWLs; (d) Text + Pictogram HWLs; or (e) Text + Photograph HWLs. In the three intervention conditions, participants were exposed to eight HWLs, each depicting a different long-term harm. Exposure occurred during an initial session, and repeatedly over the subsequent eight days. Differences between conditions were assessed immediately following initial exposure and at nine-day follow-up. Compared to participants in the No HWL control, participants exposed to Text + Pictogram HWLs were more likely to have intentions to avoid drinking alcohol completely in the next month (post-exposure) and intentions to drink less alcohol in the next week (follow-up), and participants in all three intervention conditions reported stronger negative emotional arousal (follow-up) and weaker positive emotional arousal (follow-up). Compared to participants in the DrinkWise control, those exposed to Text + Pictogram HWLs had stronger intentions to drink less alcohol in the next week and intentions to avoid drinking alcohol completely in the next month (follow-up), participants in the Text + Photograph condition reported significantly weaker positive emotional arousal, and all three intervention conditions resulted in stronger negative emotional arousal. There would likely be benefits to public health if any of the three types of intervention HWLs were implemented. However, there is some evidence that Text + Pictogram HWLs should be recommended over Text-Only or Text + Photograph HWLs, given they were the only HWLs to increase intentions to drink less.

"No Child or Adult Would Ever Probably Choose to Have 16 Teaspoons of Sugar": A Preliminary Study of Parents' Responses to Sugary Drink Warning Label Options.

Front-of-pack (FoP) warning labels are a viable policy option with the potential to inform consumer choice and assist in reducing sugar-sweetened beverage (SSB) consumption as part of a multi-faceted approach. This study explored parents' perceptions and understanding of a range of SSB warning labels. Focus groups (n = 12) with 82 parents of school-aged children were conducted, stratified according to education level, sex and location. Health effects, exercise equivalents, sugar content (teaspoons in text and pictograms, "high in") and energy content labels were shown. Through thematic analysis we identified three themes. Theme 1 related to perceptions of effectiveness of labels, underpinned by four subthemes: perceptions of labels as credible, informative and useful, personally relevant and having the potential to change be haviour. Theme 2 related to participants finding opportunities for self-exemption (e.g., physically active) and message rejection (e.g., misinterpretation). Theme 3 encompassed the potential negative consequences of some labels (e.g., body image concerns). The text teaspoons label was perceived most favourably across all themes, with minimal negative issues raised. These results provide in-depth insight into potential responses to labelling as a policy intervention, providing important guidance for the development of labels to ensure optimal message content and framing for future testing and subsequent implementation.

Public support for policies to phase out the retail sale of cigarettes in Australia: results from a nationally representative survey.

BACKGROUND: There is growing international interest in a goal once considered unthinkable: phasing out the retail sales of smoked tobacco products. In this study, we examined public support for phasing out sales and specific measures for moving towards a phase-out among a nationally representative sample of Australian adults. METHODS: In December 2019, we used a probability-based online panel, Life in Australia™, to survey n=1939 Australian adults (n=1874 included in analyses due to missing data). RESULTS: Almost two-thirds of respondents thought it would be 'a good thing' if there came a time when it was no longer legal to sell cigarettes in shops in Australia and only 16.7% thought it would be 'a bad thing'. After the concept of a phase-out was defined as removing a product from the Australian market over a set period, such as 5 years, but still allowing purchases online from overseas companies, 50.7% indicated support for such a phase-out and 61.8% thought it should happen within 10 years. Support was greater for specific measures such as licensing tobacco retailers (75.3%) and restricting sales to places children cannot enter (76.3%). Support tended to be consistent across demographic subgroups but was stronger among never and former smokers than among current smokers. CONCLUSIONS: There has been little public discussion in Australia about the goal of 1 day phasing out the retail sale of cigarettes. It is notable that such policies are reasonably well supported by the Australian public, with only minority opposition.

Optimising tobacco control campaigns within a changing media landscape and among priority populations.

Reviews published over the past decade confirm tobacco control campaigns can be effective for influencing adult and youth tobacco use behaviours, with strengthening evidence for high cost-effectiveness. Evidence is also accumulating for positive campaign effects on interpersonal discussions, social norms and policy support that can help motivate and sustain quitting and reduce uptake. Research needs over the next decade centre on the rapidly changing media environment and the equity of campaign effects among high smoking prevalence communities. The field needs specific evidence on: how to measure total campaign reach and frequency across the diverse range of media platforms and channels; the optimum mix of traditional, digital and social media to achieve behaviour change, especially among high smoking prevalence communities; the relative reach and impact of the wide variety of integrated, digital and social media message delivery methods; the relative effectiveness of messages that aim to build capacity to quit and optimum methods for combining motivational and capacity-building messages, especially for high prevalence groups who face additional barriers to staying quit; the ongoing effectiveness of traditional versus new versions of messages highlighting tobacco industry practices; the influence of e-cigarette use on tobacco control campaign effects; and the effectiveness of different types of campaigns aiming to prevent e-cigarette uptake and motivate e-cigarette cessation. Research is also needed to investigate the potential for campaigns to influence the public's understanding and support for endgame tobacco control policies and for campaign elements that may influence the social and environmental contexts surrounding smokers that support and maintain behaviour change.

Prevalence and correlates of flavour capsule cigarette use among Australian adolescents.

ISSUE ADDRESSED: Introduced relatively recently in the Australian market, flavour capsule cigarettes pose a risk to adolescents by providing a palatable pathway to smoking initiation. The present study aimed to establish the prevalence of the use of flavour capsule cigarettes in Australian adolescents and to examine the association between frequency of use and smoking behaviour and intentions and perceptions of cigarette brand differences. METHODS: Data were from a 2017 cross-sectional school-based survey of secondary students aged 12-17 years (N = 4266) in Victoria who self-reported their smoking behaviours, smoking intentions and cigarette brand perceptions. Regression analyses were conducted controlling for sex, age group, education sector and other covariates. RESULTS: Overall, 5% (n = 195) of all students reported ever using flavour capsule cigarettes. Of the 675 students who had ever smoked, 29% (n = 194) had tried a flavour capsule cigarette. The likelihood of past-month and past-week smoking was significantly higher, and future smoking intentions were significantly stronger, for ever-smokers who had used flavour capsule cigarettes multiple times compared to those who had never used this type of cigarette. Ever-smokers were more likely to agree that 'some brands of cigarettes are easier to smoke than others' if they had tried a flavour capsule cigarette. CONCLUSIONS: There are high levels of use of flavour capsule cigarettes among Australian adolescent smokers, with more frequent use associated with greater involvement in smoking. SO WHAT?: These findings add to those of other studies suggesting that flavour capsule cigarettes may have negative impacts on youth smoking, strengthening the case for their prohibition in Australia.

Australian Smokers' Sensory Experiences and Beliefs Associated with Menthol and Non-Menthol Cigarettes.

Many current smokers incorrectly believe that menthol cigarettes are less harmful, likely due to the biological and sensory effects of menthol, which can lead smokers to have favourable sensory experiences. In this study, we measured the extent to which Australian smokers associate certain sensory experiences with smoking menthol and non-menthol cigarettes, and their beliefs about how damaging and enjoyable they find cigarettes with each of these sensory experiences. A sample of 999 Australian 18-69-year-old weekly smokers was recruited from a non-probability online panel; this study focuses on the 245 respondents who currently smoked menthol cigarettes at least once per week. Current menthol smokers were four to nine times more likely to experience menthol rather than non-menthol cigarettes as having favourable sensory experiences, including feeling smooth, being soothing on the throat, fresh-tasting and clean-feeling. Menthol smokers perceived cigarettes with these favourable sensations as less damaging and more enjoyable than cigarettes with the opposite more aversive sensory experience. Efforts to correct these misperceptions about risk will likely require messages that provide new information to help smokers understand that these sensations do not indicate a lower level of risk. Banning menthol in tobacco products-as has recently been done in some nations-would also be a timely and justified strategy for protecting consumers.

Understanding the effectiveness of advertisements about the long-term harms of alcohol and low-risk drinking guidelines: A mediation analysis.

RATIONALE: Many people overestimate the amount of alcohol that increases their risk of harm and so may not perceive any need to change their drinking behaviour. Several countries have developed low-risk drinking guidelines, yet awareness of these guidelines remains low. Furthermore, mass media campaigns about alcohol-related harms may have limited impact if people do not perceive their current consumption as potentially harmful. Integrating drinking guidelines into media campaigns about alcohol's harms can concurrently provide drinkers with information about low-risk drinking levels and compelling reasons to comply. OBJECTIVE: Our aim was to build understanding of the effectiveness of messages about the long-term harms of drinking and low-risk drinking guidelines, by testing the mediating effects of estimates of harmful drinking levels and attitudes towards drinking alcohol on subsequent intentions and behaviours. METHOD: In an online experiment conducted in 2016, n = 1156 Australian adult monthly drinkers were randomly assigned to view advertisements for non-alcohol products (NON-ALC; control), advertisements featuring long-term harms of alcohol (LTH), or LTH advertisements plus a guideline message (LTH + G). Immediately following exposure, we measured estimates of harmful drinking levels and attitudes towards drinking alcohol. One week later, we measured intentions to drink less and behavioural compliance with the guideline. RESULTS: Compared to NON-ALC advertisements, exposure to LTH + G advertisements increased (i) the proportion of respondents who correctly estimated harmful drinking levels, which in turn, strengthened intentions to drink less (42% of the total effect was mediated), and (ii) negative attitudes, which in turn, also increased intentions to drink less (35% mediated) and behavioural compliance (24% mediated). Compared to NON-ALC, LTH advertisements increased negative attitudes, which in turn strengthened intentions to drink less (53% mediated). CONCLUSIONS: When paired with effective alcohol harm reduction television advertisements, messages promoting low-risk drinking guidelines can increase drinkers' intentions to reduce their alcohol consumption and compliance with low-risk drinking guidelines.

Intentions to reduce sugar-sweetened beverage consumption: the importance of perceived susceptibility to health risks.

OBJECTIVE: There are numerous health effects associated with excess sugar-sweetened beverage (SSB) consumption. Interventions aimed at reducing population-level consumption require understanding of the relevant barriers and facilitators. This study aimed to identify the variables with the strongest relationship with intentions to reduce SSB consumption from a suite of variables derived from the literature. DESIGN: Random-digit dialling of landline and mobile phones was used to survey adults using computer-assisted telephone interviews. The outcome variable was 'likelihood of reducing SSB consumption in next 6 months', and the predictor variables were demographics, SSB attitudes and behaviour, health risk perceptions and social/environmental exposure. SETTING: Australia. PARTICIPANTS: A subsample of 1630 regular SSB consumers from a nationally representative sample of 3430 Australian adults (38 % female, 51 % aged 18-45 years, 56 % overweight or obese). RESULTS: Respondents indicated that they were 'not at all' (30·1 %), 'somewhat' (43·9 %) and 'very likely' (25·3 %) to reduce SSB consumption. Multivariate nominal logistic regressions showed that perceiving future health to be 'very much' at risk was the strongest predictor of intention to reduce SSB consumption (OR = 8·1, 95 % CI 1·8, 37·0, P < 0·01). Other significant predictors (P < 0·01) included self-perceptions about too much consumption, habitual consumption, difficulty reducing consumption and likelihood of benefitting from reduced consumption. CONCLUSIONS: Health risk perceptions had the strongest relationship with intentions to reduce consumption. Age and consumption perceptions were also predictors in the multivariate models, whereas social/environmental exposure variables were not. Interventions may seek to incorporate strategies to denormalise consumption practices and increase knowledge about perceived susceptibility to health risks.

Impact of three annual tobacco tax rises on tobacco sales in remote Australian Aboriginal community stores.

BACKGROUND: There is strong evidence from many settings that tobacco tax rises which increase prices reduce tobacco consumption, but only limited evidence from Indigenous settings. METHODS: We analysed 3 years (2016-2018) of weekly sales data from 32 stores in remote Aboriginal communities. We used interrupted time series analysis to estimate the immediate impact of the price rice following annual 12.5% tobacco tax rises on sales on (A) stick equivalents of tobacco and (B) fruit and vegetables (kg) per $A1000 of grocery sales, and on the trend in sales between price rises. RESULTS: We detected 5.8% and 8.2% immediate declines in tobacco sales following the price rises associated with annual 12.5% tax rises in 2016 and 2018, and a non-significant decline (1.6%) following the 2017 tax rise. Decreased sales were mainly driven by declines in mainstream and premium factory-made cigarettes. Fruit and vegetable sales did not change at the time of tobacco price rises. CONCLUSION: For the first time, we demonstrated evidence of price-sensitivity and the immediate impact of price rises from tobacco tax rises on tobacco sales in remote Aboriginal communities. We acknowledge that Australia already has very high tobacco taxation and prices, but recommend further increases to the taxation of roll-your-own (RYO) tobacco to prevent smokers and industry using cheaper RYO cigarettes to undermine this impact of high tobacco taxes and prices.

Australian smokers' experiences and perceptions of recessed and firm filter cigarettes.

BACKGROUND: While cigarette filter modifications have long been used to increase product appeal and assuage health concerns, tighter marketing restrictions, including plain packaging, have further spurred the growth of filter variants. We explored and assessed experiences and perceptions of smokers who had tried and/or currently use recessed filter cigarettes (RFCs) and firm filter cigarettes (FFCs). METHOD: In November 2018, we undertook eight exploratory focus groups of Australian adult factory-made cigarette smokers (total n=56). In July 2019, we surveyed 999 smokers aged 18-69 years to quantify ever and current use of these products and associated beliefs and sensory experiences. RESULTS: Focus group and survey findings were consistent. Among 988 smokers who had at least tried factory-made cigarettes, 28.9% had tried FFCs and 11.1% currently smoked these, while 36.4% had tried RFCs and 7.5% currently smoked these. Smokers in both studies believed these filters may reduce harm and that FFCs increase appeal. In the survey, 58.9% of RFC triers agreed these hide the filter's brown stain and 48.9% agreed that RFCs keep harmful substances away from the mouth. Similarly, 58.4% of FFC triers agreed these trap more harmful substances than standard filters. Relative to standard filter cigarettes, more smokers experienced FFCs and RFCs as feeling clean (p=0.03) and more current FFC users experienced these as feeling smooth (p=0.01). CONCLUSION: RFCs and FFCs undermine plain packaging legislation, which aims to reduce appeal and minimise misperceptions about the relative harms of different tobacco products. Like other filter modifications, these filter variants should be disallowed.

Are anti-smoking social norms associated with tobacco control mass media campaigns, tax and policy changes? Findings from an Australian serial cross-sectional population study of smokers.

BACKGROUND: Anti-smoking social norms are associated with subsequent quitting behaviours. We examined if exposure to tobacco control advertisements and policy changes predict subjective (perceived disapproval of smoking among close family and friends) and internalised injunctive norms (embarrassed about telling others you are a smoker). METHODS: A serial cross-sectional population survey of Australian adult smokers (n=6649; 2012 to 2015). Logistic regression analyses examined associations of social norms with exposure to different types of tobacco control advertisements, tax increases and other tobacco control policies, adjusting for key demographic, smoking and media exposure covariates. Interaction analyses examined differences by age and socioeconomic status (SES). RESULTS: Greater past month exposure to predominantly fear-evoking advertisements was associated with increased odds of perceiving disapproval (per 1000 gross rating points: adjusted OR (AOR) 2.69, 95% CI: 1.34 to 5.39), while exposure to advertisements evoking multiple negative emotions (fear, guilt, sadness) reduced perceived disapproval (AOR 0.61, 95% CI: 0.42 to 0.87). Increased perceived disapproval was also associated with anticipation (AOR 1.38, 95% CI: 1.02 to 1.88), and implementation of a series of annual 12.5% tobacco tax rises (AOR 1.41, 95% CI: 1.03 to 1.94). Associations were consistent across age and SES. There were no associations nor subgroup interactions between advertisement exposure or policy changes and feeling embarrassed about telling others you are a smoker. CONCLUSION: Smokers' perceptions of family and friends' disapproval of their smoking was more common after exposure to fear-evoking tobacco control campaigns and after large tobacco tax increases were announced and implemented.

Comparing responses to public health and industry-funded alcohol harm reduction advertisements: an experimental study.

OBJECTIVES: Conduct a head-to-head experimental test of responses to alcohol harm reduction advertisements developed by alcohol industry Social Aspects/Public Relations Organisations (SAPROs) versus those developed by public health (PH) agencies. We hypothesised that, on average, SAPRO advertisements would be less effective at generating motivation (H1) and intentions to reduce alcohol consumption (H2) but more effective at generating positive perceptions of people who drink (H3). DESIGN: Online experiment with random assignment to condition. PARTICIPANTS: 2923 Australian adult weekly drinkers (49% high-risk drinkers) recruited from an opt-in online panel. INTERVENTIONS: Participants viewed 3 of 83 advertisements developed by PH agencies (n=2174) or 3 of 28 advertisements developed by SAPROs (n=749). PRIMARY OUTCOME MEASURES: Participants reported their motivation to reduce the amount of alcohol consumed; behave responsibly and/or not get drunk; and limit their drinking around/never supply to minors, as well as intentions to avoid drinking alcohol completely; reduce the number of drinking occasions; and reduce the amount of alcohol consumed per occasion. Participants also reported their perceptions of people who drink alcohol on six success-related items and four fun-related items. RESULTS: Compared with drinkers exposed to PH advertisements, those exposed to SAPRO advertisements reported lower motivation to reduce the amount of alcohol consumed (ß=-0.091, 95% CI -0.171 to -0.010), and lower odds of intending to avoid alcohol completely (OR=0.77, 0.63 to 0.94) and to reduce the amount of alcohol consumed per occasion (OR=0.82, 0.69 to 0.97). SAPRO advertisements generated more favourable fun-related perceptions of drinkers (ß=0.095, 0.013 to 0.177). CONCLUSIONS: The alcohol harm reduction advertisements produced by alcohol industry SAPROs that were tested in this study were not as effective at generating motivation and intentions to reduce alcohol consumption as those developed by PH organisations. These findings raise questions as to whether SAPROs should play a role in alcohol harm reduction efforts.

An In-Depth Exploration of Knowledge and Beliefs Associated with Soda and Diet Soda Consumption.

The need to reduce sugar-sweetened beverage (SSB) consumption is widely accepted, but whether artificially sweetened beverages (ASBs) are a recommended alternative is a growing policy issue because of emerging evidence of potential health effects associated with excess consumption. This study aimed to establish the extent of the Australian population's knowledge of the risks associated with consuming SSBs (e.g., soda) and ASBs (e.g., diet soda), which is essential for identifying which facets of knowledge to target with public health interventions. A national computer-assisted telephone survey of 3430 Australian adults was conducted in 2017. The survey included a range of measures to test associations between SSB and ASB knowledge and beliefs, demographic characteristics, and soda and diet soda consumption. Participants had an overall awareness that there were health risks associated with SSB and ASB consumption, but they lacked more detailed knowledge of health effects and nutritional composition of these drinks. These knowledge gaps are concerning given that SSBs and ASBs are consumed in large quantities in Australia. Public health interventions targeting consumers' limited knowledge and perceptions of health risks associated with excess sugar, calorie intake and artificial sweeteners are essential in reducing the health burden of obesity.