Young athletes' awareness and monitoring of anti-doping in daily life: Does motivation matter?

This study was a preliminarily investigation into the prevention of unintentional doping on the basis of self-determination theory (SDT). Specifically, we examined the relationship between athletes' motives for doping avoidance and their behavior when offered an unfamiliar food product. Participants were young Australian athletes (n = 410) that were offered a free lollipop prior to completing a questionnaire. It was noted whether participants refused to take or eat the lollipop and whether they read the ingredients of the lollipop. The questionnaire assessed autonomous and controlled forms of motivation, amotivation, doping intentions, and adherence regarding doping avoidance behaviors. The results showed that young athletes who adopted controlled reasons to avoid doping in sport (e.g., not getting caught) tended to report higher adherence to behaviors related to avoiding and monitoring banned substances, whereas those who adopted autonomous reasons (e.g., anti-doping being consistent with life goals) appeared to be more willing to read the ingredients of the provided food. The significant interaction effect between autonomous and controlled motivation indicated that autonomous motivation was more predictive to doping intention for athletes with low controlled motivation. It is concluded that SDT may help understand the motivational processes of the prevention of unintentional doping in sport.

The effect of retail cigarette pack displays on unplanned purchases: results from immediate postpurchase interviews.

OBJECTIVE: To assess the influence of point-of-sale (POS) cigarette displays on unplanned purchases. METHODS: Intercept interviews were conducted with customers observed purchasing cigarettes from retail outlets featuring POS cigarette displays. Measures included intention to purchase cigarettes prior to entering the store, unprompted and prompted salience of POS tobacco displays, urge to buy cigarettes as a result of seeing the POS display, brand switching and support for a ban on POS cigarette displays. RESULTS: In total, 206 daily smokers aged 18-76 years (90 male, 116 female) were interviewed. Unplanned cigarette purchases were made by 22% of participants. POS displays influenced nearly four times as many unplanned purchases as planned purchases (47% vs 12%, p<0.01). Brand switching was reported among 5% of participants, half of whom were influenced by POS displays. Four times as many smokers were supportive of a ban on POS tobacco displays than unsupportive (49% vs 12%), and 28% agreed that such a ban would make it easier to quit. CONCLUSIONS: POS tobacco displays act as a form of advertising even in the absence of advertising materials. They stimulate unplanned cigarette purchases, play an important role in brand selection and tempt smokers trying to quit. This justifies removing POS tobacco displays from line of sight-something that very few smokers in our sample would object to.

Self-determined motivation in sport predicts anti-doping motivation and intention: a perspective from the trans-contextual model.

OBJECTIVES: Motivation in sport has been frequently identified as a key factor of young athletes' intention of doping in sport, but there has not been any attempt in scrutinizing the motivational mechanism involved. The present study applied the trans-contextual model of motivation to explain the relationship between motivation in a sport context and motivation and the social-cognitive factors (attitude, subjective norm, perceived behavioral control, and intention) from the theory of planned behavior (TPB) in an anti-doping context. DESIGN: A cross-sectional survey was conducted. METHODS: Questionnaire data was collected from 410 elite and sub-elite young athletes in Australia (Mean age [17.7±3.9 yr], 55.4% male, Years in sport [9.1±3.2]). We measured the key model variables of study in relation to sport motivation (Behavioral Regulation in Sport Questionnaire), and the motivation (adapted version of the Treatment Self-Regulation Questionnaire) and social cognitive patterns (the theory of planned behavior questionnaire) of doping avoidance. The data was analyzed by variance-based structural equation modeling with bootstrapping of 999 replications. RESULTS: The goodness-of-fit of the hypothesized model was acceptable. The bootstrapped parameter estimates revealed that autonomous motivation and amotivation in sport were positively associated with the corresponding types of motivation for the avoidance of doping. Autonomous motivation, subjective norm, and perceived behavioral control in doping avoidance fully mediated the relationship between autonomous motivation in sport and intention for doping avoidance. CONCLUSIONS: The findings support the tenets of the trans-contextual model, and explain how motivation in sport is related to athletes' motivation and intention with respect to anti-doping behaviors.

Epidemiological measures of participation in community health promotion projects.

BACKGROUND: The paper is concerned with the use of epidemiological methods to measure the rates at which different strata of a defined population participate in community health promotion projects. The specific aim was to estimate the incidence rates of participation in projects sponsored by the Western Australian Health Promotion Foundation (Healthway), separately for sociodemographic and health-related behavioural subgroups. METHODS: Data were drawn from Healthway sponsorship projects in 1992. Each sport, arts and racing project was associated with promotion of a health message and creation of a health promoting environment. The study used a two-stage sampling design. Thirteen of 57 large sponsorship projects and 30 of 129 small projects were selected. In the second stage, respondents were randomly surveyed from among project participants. A total of 4060 respondents aged > or = 10 years was sampled from the 43 selected projects. Population-based incident participants were estimated and were related to person-years at risk. RESULTS: The total participation rate was 4.01 per person-year. The rate was very high at ages 10-14 years and thereafter declined with increasing age. Compared with the least socially disadvantaged 25% of population, the participation rate fell by around one-third in the medium and high disadvantage groups, but exceeded the baseline by a ratio of 1.85 (95% confidence interval: 1.57-2.18) in the most disadvantaged 10% of population. The effect was most pronounced at ages 10-19 years. Participation was higher in those who smoked, drank alcohol unsafely, reported sunburn and reported low consumption of fruit and vegetables. However, participation was reduced in people who were sedentary. CONCLUSIONS: Epidemiological methods can be used to evaluate the distribution of participation of a population in community health promotion projects. The Western Australian Health Promotion Foundation has been successful in reaching disadvantaged youth.

PIP: The paper is concerned with the use of epidemiological methods to measure the rates at which different strata of a defined population participate in community health promotion projects. The specific aim was to estimate the incidence rates of participation in projects sponsored by the Western Australian Health Promotion Foundation (Healthway), separately for sociodemographic and health-related behavioral subgroups. Data were drawn from Healthway sponsorship projects in 1992. Each sport, arts, and racing project was associated with promotion of a health message and creation of a health promoting environment. The study used a 2-stage sampling design. 13 of 57 large sponsorship projects and 30 of 129 small projects were selected. In the second stage, respondents were randomly surveyed from among project participants. A total of 4060 respondents at least 10 years old was sampled from the 43 selected projects. Population-based incident participation were estimated and were related to person-years at risk. The total participation rate was 4.01 per person-year in people or= 10 years old. The rate was very high at ages 10-14 years and thereafter declined with increasing age. Compared with the least socially disadvantaged 25% of the population, the participation rate fell by around 1/3 in the medium and high disadvantaged groups, but exceeded the baseline by a ratio of 1.85 (95% confidence interval: 1.57-2.18) in the most disadvantaged 10% of the population. The comparatively high rate of participation in the most disadvantaged group occurred only at ages 50 years and the effect was most pronounced at ages 10-19 years. Compared with the least disadvantaged 25%, the rate ratio in the most disadvantaged 10% of the population was 2.50 in the metropolitan area and 1.25 in the country regions of western Australia. Participation was higher in those who smoked, drank alcohol unsafely, reported sunburn, and reported low consumption of fruit and vegetables. Epidemiological methods can be used to evaluate the distribution of participation of a population in community health promotion projects.

Misclassification of social disadvantage based on geographical areas: comparison of postcode and collector's district analyses.

BACKGROUND: Analysis of socioeconomic status (SES), defined on the basis of geographical area, will always be subject to misclassification of individuals. We studied the relationship between SES and selected health-related measures when SES was defined firstly on the basis of postcode and secondly on the basis of the smaller spatial area of collector's district (CD). METHOD: A Census population of 1.4 million was used to investigate the misclassification of individuals to SES group using postcode as opposed to CD. A field survey of 1000 respondents and a mortality register of 1756 deaths were used to compare the relationship between SES and certain outcome variables, when SES group was assigned using postcode and CD. Misclassification probability matrices were used to try to adjust the postcode-based results to approximate CD-based results. RESULTS: The Census data showed that nearly 50% of residents were misclassified into SES groups by the postcode-based system compared with a CD-based system. In comparing the most socially disadvantaged group with the least disadvantaged group, the postcode analysis underestimated the absolute effects of SES by 58% for the increased prevalence of smoking, by 19% for the reduced prevalence of participation in junior sporting clubs and by 13% for the increased mortality rate at ages 0-64 years. Adjustment of postcode-based results using misclassification matrices proved fruitless due to differential misclassification and technical difficulties. CONCLUSIONS: Misclassification of individuals to SES groups on the basis of postcode has caused an underestimation of the true relationship between SES and health-related measures. A reduction of this misclassification by using smaller spatial areas, such as CD or census enumeration districts, will provide improved validity in estimating the true relationship.

Continuous tracking of the Australian National Tobacco Campaign: advertising effects on recall, recognition, cognitions, and behaviour.

OBJECTIVES: To relate Australian National Tobacco Campaign advertising to outcome measures such as smokers' awareness of and reaction to the campaign, and indicators of interest in smoking cessation. DESIGN: Continuous tracking was used to survey random cross sectional samples of the target audience via telephone interviews. Baseline measures were collected preceding each advertising phase, whereafter subjects were interviewed on a weekly basis for the entire period of each phase. Changes in outcomes could thus be inferred on a weekly basis allowing variations in advertising intensity to be monitored for effect. Three phases were evaluated variously in Melbourne, Sydney, and Adelaide. SUBJECTS: A total of 9033 subjects aged 18-40 years were interviewed. Age and sex of the sample were evenly distributed. RESULTS: In general, it was found that the greater the media weight, the greater the recall and recognition mediated by the message of the advertisement and the creative execution-advertisements with a clear figure ground executional format appeared more memorable than those without, and health effects advertisements were more memorable than those encouraging calls to a quitline. The relationship between various communication effects and media weight was limited by the confounding of prior activities in two of the phases. CONCLUSIONS: Advertisements with clear figure ground executional formats and those illustrating health effects of smoking have high memorability. Future campaigns that are continuously tracked are recommended to systematically vary media weight, flighting schedules, and advertisement type, so as to maximise information about these variables and their interactions.

The myth of "healthism" in organized sports: implications for health promotion sponsorship of sports and the arts.

PURPOSE: The study examines the association of involvement in sports and arts with five health risk factors. The aims were to evaluate the argument that promotion of sports alone will achieve health objectives and to assess the suitability of sports and arts populations as targets for health promotion sponsorship. DESIGN: Personal and telephone cross-sectional surveys were performed in Western Australia in 1992 (N = 2629) and 1994 (N = 2031). SETTING: Sports and arts venues in Western Australia. SUBJECTS: Random samples of household respondents aged 16 to 69 years. MEASURES: Measures of association between risk factors and involvement in sports and the arts were adjusted for sex, age, residence, income, and other types of sports/arts involvement. RESULTS: Spectators attending sports events, who were not members of organized sports clubs, were more likely to possess three or more risk factors than nonparticipants (OR = 1.43; 95% CI 1.20-1.70). They were more likely to report cigarette smoking, unsafe alcohol drinking, and poor sun protection practices. Sports club members had a similar profile of risk factors, except that their prevalence of smoking was reduced and they were much less likely to report inadequate physical exercise. The most elevated risk factor in sports populations was unsafe alcohol drinking (OR = 1.81 in club members, 1.88 in spectators, and 2.25 in spectators who were also members). Arts populations were less likely than average to report elevated risk factors, especially in the case of members of arts organizations who also attended arts events (for three or more risk factors, OR = 0.59; 95% CI .45-.75). However, the majority of arts respondents had at least two risk factors. Levels of inadequate exercise in arts populations were the same as those in sports populations. CONCLUSIONS: The promotion of sports alone is unlikely to achieve health objectives. Highest priority in the use of health promotion sponsorship funds should be given to the populations attending sports events and involved as members of sports clubs. Investment in arts sponsorship is warranted, but at a lower level than health sponsorship of sports.

Association of the health-promoting workplace with trade unionism and other industrial factors.

PURPOSE: The study examines associations of five healthy workplace attributes with trade unionism and nine other industrial and sociodemographic factors. The aims were to illustrate the measurement of workplace health promotion indicators in Western Australia and to identify associations leading to a better understanding of determinants of the healthy workplace. DESIGN: Personal and telephone cross-sectional surveys were performed using population-based sampling frames. The overall response rate was 72%. SETTING: Workplaces in Western Australia. SUBJECTS: Random samples of household respondents aged 16 to 69 years in 1992 (n = 1310) and 1994 (n = 1113). MEASURES: Measures of association between healthy workplace attributes and trade unionism were adjusted for workplace location, size, sector, and industrial classification. RESULTS: Trade unionism was strongly associated with healthy catering practices (adjusted OR 2.05; 95% CI 1.30 to 3.23), sun protection practices (2.66; 1.69 to 4.17), disability access (1.47; 1.10 to 1.95), and worksite health promotion programs (2.56; 2.07 to 3.17). A weak and nonsignificant association was observed with restrictive smoking policies (1.21; .95 to 1.55). Generally, healthy workplace attributes were reported less often by respondents working in rural locations, in the private sector, and at small worksites. There was no consistent relationship with sociodemographic factors, including an index of social disadvantage, but members of blue-collar occupations experienced a low prevalence of restrictive smoking policies. CONCLUSIONS: The study raises the hypothesis, but cannot confirm, that trade unions could provide a means for employees to pursue the creation of a health-promoting workplace. Small business represents an excellent target for health promotion activities.

Increasing the reach of health sponsorship: using a "sponsorship kit" to promote health.

In Australia, a tobacco tax provides funding for Healthway, the Western Australian Health Promotion Foundation. Healthway provides sponsorships for the arts and racing and sporting events to replace funds previously provided by tobacco companies. These sponsorships provide visibility for Healthway and positive health messages. Normally, Healthway staff attends these events to help promote health messages. To reduce Healthway staff time spent helping event organizers promote health messages, Healthway developed a sponsor kit of promotional materials which communicate health messages without requiring Healthway staff to attend events. Recognition, awareness, comprehension, and acceptance of health messages was comparable at events that featured Healthway staff versus the sponsor kits, but the average cost of the sponsorship kits was only 40% of the cost when Healthway staff was featured.

Steps in planning and developing health communication campaigns: a comment on CDC's framework for health communication.

This reviews the efforts of the Centers for Disease Control and Prevention to integrate effective health communication into its programs that are designed to change behaviors. Although the 10-step framework for developing and implementing the Centers' health communication programs is both practical and comprehensive, it is suggested that a reversal of steps 2 and 3 is a more logical sequence, is more consistent with the literature and, more importantly, could avoid misapplications of the framework by less experienced practitioners. Comment is also made on the dynamic nature of health communication planning and development, a point not made explicit in the Centers' framework.

Paid advertising for AIDS prevention--would the ends justify the means?

An examination by the Centers for Disease Control and the Research Triangle Institute concluded that "hard-to-reach" populations could be reached with AIDS prevention messages through the broadcast and print media and that a study should be undertaken to assess whether paid placement of these messages could have an effect on HIV-related behaviors. The recommended target population for a study of paid advertising would be sexually active 18-24-year-old black urban dwellers. Its behavioral objectives would include abstinence and safer sex practices. For any evaluation of a paid advertising campaign to be valid, there would have to be extensive audience profiling, research into the development of the message, pretesting of the message, and involvement of the community. The proposed study would include measurement of various "dosage" levels of paid advertising, use of a no-intervention comparison group, and a novel data collection technique. Although a specific target group and specific messages would be involved, the evaluation would make a substantial contribution to resolving the broader issue of whether and how mass media should be used directly or indirectly to change or reinforce health-related behaviors.

Positive versus negative framing of a hypothetical infant immunization: the influence of involvement.

Framing studies dealing with health messages show mixed results, although a tendency in favor of negative framing. Involvement has been hypothesized to account for these conflicting results. The authors selected a realistic issue (immunization of infants) deemed high or low involving depending on the respondent's circumstances: women with an infant or who were pregnant or intending to get pregnant in the next 12 months were deemed to be high involved; women in none of these categories were deemed to be low involved. A convenience sample of adult women was presented with a hypothetical "new" immunization that protected infants against respiratory complaints such as bronchitis and pneumonia Side effects (the common flu) were framed positively (90% chance of no side effects) or negatively (10% chance of side effects). The authors found positive framing to be superior for low-involved respondents, but there was no framing effect for high-involved respondents.

Using sponsorship to promote health messages to children.

A survey of children aged 8 to 14 years attending a three-day football clinic was undertaken to examine the relative impact of different sponsorship strategies used to promote health messages. It was found that promotional clothing worn by role models was an effective method for promoting a specific health message (i.e., "Smoking? No Way!"). Personal endorsement of the health message by an external role model and, to a lesser extent, personal endorsement by clinic leaders and promotional clothing worn by clinic leaders and external role models were also effective in promoting a general health message (i.e., "Don't smoke"). The implications for health sponsorship and the promotion of commercial products to children are discussed.

Creating smoke-free environments in recreational settings.

To facilitate the banning of tobacco industry sponsorship, Australian health promotion foundations were established to provide health sponsorship to sport, arts, and racing organizations. Health sponsorship dollars procure health sponsorship benefits such as naming rights, signage, personal endorsement of a (health) product by a performer or player, and structural controls such as smoke-free policies. Data are presented from surveys and observations of spectators attending events sponsored by the West Australian Health Promotion Foundation (Healthway) and surveys of Healthway-sponsored organizations and the community. The results demonstrate that by using health sponsorship, Healthway increased the prevalence of smoke-free policies in recreational settings, and there was growing support for these policies. There was evidence of good compliance with smoke-free policies, thus reducing exposure to environmental tobacco smoke. The introduction of smoke-free policies in recreational settings has involved working collaboratively with sectors outside of health, taking an incremental approach to change, and gaining the support of stakeholders by communicating evaluation results.

Towards guidelines for survey research in remote Aboriginal communities.

Based on our experience in developing and evaluating community-based health promotion programs in Aboriginal and Torres Strait Islander communities, we offer guidelines to assist nonindigenous health and public policy professionals whose information gathering in these communities includes the use of unstructured interviewing or survey questionnaires. The guidelines primarily apply to research among mainland remote Aboriginal communities, but are placed in a cultural context such that those dealing with Torres Strait Islanders and rural or urban community Aborigines also may benefit from the guidelines. The major aims of these guidelines are to facilitate communication between interviewers and indigenous interviewees and to ensure that interviewing is done with maximum sensitivity to cultural differences and with minimum discomfort to the respondents.

Messages in alcohol advertising targeted to youth.

OBJECTIVE: To assess young people's perceived messages in three ads for a vodka-based, pre-mixed alcohol beverage, and to assess the extent to which the ads appeared to be consistent with the industry's voluntary code. METHOD: Members of two convenience samples of young people (15-16 and 19-21 years) were each exposed to one of three advertisements. Respondents completed a post exposure questionnaire based on standard advertising copy testing procedures. RESULTS: The most frequently nominated open-ended responses to 'the main message(s) of the ad' related to the product delivering mood effects: both removal of negative emotions (e.g. 'stress reduction'), as well as inducing positive states such as feeling 'carefree' and gaining 'increased enjoyment'. Consumption of the product was perceived to offer 'self-confidence', 'sexual/relationship success' and 'social success'. Fewer respondents nominated tangible product characteristics, the main one being 'easy to drink'. One in four of the 15-16 year olds saw the ads as aimed at 'people my age', while almost half of the 19-21 year olds saw the ads as aimed at 'people younger or much younger than me'. DISCUSSION: These results appear to contravene the Alcoholic Beverages Advertising Code (ABAC) by suggesting that the consumption of alcohol beverages: (i) contributes to social and sexual success; and (ii) contributes to a significant change in mood (stress reduction/relaxation). IMPLICATIONS: Incidental observation of alcohol ads suggests that contravention of the code is more widespread than the number of alcohol advertising complaints would indicate. All 11 such complaints lodged with the Advertising Standards Board between May 1998 and April 1999 were dismissed. Evidence such as that gathered in this study might improve the chances of complaints being upheld.

Nurses screening for skin cancer: an observation study.

Skin cancer rates in Australia are the highest in the world and it is an important cause of mortality and morbidity. Screening is a method of control for skin cancer/melanoma through early diagnosis and prompt referral and treatment. To date, there have been no controlled trials evaluating the impact of screening on morbidity and mortality, and hence insufficient evidence to recommend for or against routine screening for skin cancer/melanoma by primary care providers. Australian health authorities have called for studies that investigate the viability of using trained observers apart from medical practitioners--such as nurses, pharmacists and physiotherapists--in opportunistic screening for skin cancer in populations that have a high prevalence of these skin cancers, largely on the basis of cost arguments. We conducted a double blind observation screening study comparing the performance of nurses to those plastic surgeons participating in a skin cancer screening program. The role of the nurse in this program was not to diagnose skin cancer, but to not miss lesions that required further specialist examination. Measurements were recorded for 256 screenees. Plastic surgeons issued 77 (30%) individual referrals for lesions suspicious of being skin cancer. Nurse observations noted 73 (95%) of these 77 cases. The case for the pre-screening of large populations for skin/cancer by trained nurses warrants further attention.

TARPARE: a method for selecting target audiences for public health interventions.

OBJECTIVE: This paper presents a model to assist the health promotion practitioner systematically compare and select what might be appropriate target groups when there are a number of segments competing for attention and resources. METHOD: TARPARE assesses previously identified segments on the following criteria: T: The Total number of persons in the segment; AR: The proportion of At Risk persons in the segment; P: The Persuability of the target audience; A: The Accessibility of the target audience; R: Resources required to meet the needs of the target audience; and E: Equity, social justice considerations. The assessment can be applied qualitatively or can be applied such that scores can be assigned to each segment. Two examples are presented. CONCLUSIONS: TARPARE is a useful and flexible model for understanding the various segments in a population of interest and for assessing the potential viability of interventions directed at each segment. The model is particularly useful when there is a need to prioritise segments in terms of available budgets. IMPLICATIONS: The model provides a disciplined approach to target selection and forces consideration of what weights should be applied to the different criteria, and how these might vary for different issues or for different objectives. TARPARE also assesses segments in terms of an overall likelihood of optimal impact for each segment. Targeting high scoring segments is likely to lead to greater program success than targeting low scoring segments.

Face-to-face household interviews versus telephone interviews for health surveys.

The purpose of this study was to compare response distributions in health surveys for two interview modes: face-to-face household interviews and telephone interviews. There were two samples of the Perth metropolitan general population aged 16 to 69 years: a face-to-face household sample (n = 1000) and a telephone sample (n = 222). The samples were generated by probability-based methods commonly used by commercial market research organisations. The surveys occurred in August-September 1992 as part of a larger statewide survey component of a three-year evaluation of the Western Australian Health Promotion Foundation. Respondents were drawn from a two-stage cluster sample based on private dwellings for personal interviews, and from randomly selected listed and unlisted private numbers for telephone interviews. Although the samples did not differ significantly on a number of variables, the telephone sample was significantly higher in residential social status; there was significantly lower reporting of smoking and lower unsafe alcohol consumption in the telephone sample: significantly higher proportions of the telephone sample were in Prochaska's 'action' stage of change for several health behaviours; and there was significantly greater recall of health messages in the telephone sample. Health researchers should treat comparisons between different survey modes with caution, and should be aware that campaign evaluations using telephone surveys and household surveys may yield substantially different results.

Warning: attending a sport, racing or arts venue may be beneficial to your health.

Concerted efforts to create health-promoting sport, racing and arts venues have become possible since the advent of health promotion foundations in four of Australia's eight states and territories. Large numbers of Australians attend sport, racing and arts venues in pursuit of leisure activities. There is evidence that sport and racing participants and spectators, and certain subgroups of the arts community, have adverse risk-factor profiles that make them an ideal target for health promotion interventions. Through the use of sponsorship, health promotion foundations 'purchase' health-promoting policies in sport, racing and arts settings-policies that have the potential to become institutionalised once sponsorship dollars are depleted. This paper discusses the policies 'purchased' by the foundations and outlines a comprehensive surveillance and evaluation system developed for the Western Australian Health Promotion Foundation. The system monitors the implementation of health-promoting environments at the micro level (sponsorship project); intermediate level (sponsored group); and macro level (community). The article concludes by outlining some of the lessons learned in Western Australia. These provide the basis for development of best practice in working with sport, racing and arts groups, and other sectors outside health, to create health-promoting environments.