Methods of the International Tobacco Control (ITC) Four Country Survey.

This paper outlines the design features, data collection methods and analytic strategies of the International Tobacco Control (ITC) Four Country Survey, a prospective study of more than 2000 longitudinal respondents per country with yearly replenishments. This survey possesses unique features that sets it apart among surveys on tobacco use and cessation. One of these features is the use of theory-driven conceptual models. In this paper, however, the focus is on the two key statistical features of the survey: longitudinal and "quasi-experimental" designs. Although it is often possible to address the same scientific questions with a cross-sectional or a longitudinal study, the latter has the major advantage of being able to distinguish changes over time within individuals from differences among people at baseline (that is, differences between age and cohort effects). Furthermore, quasi-experiments, where countries not implementing a given new tobacco control policy act as the control group to which the country implementing such a policy will be compared, provide much stronger evidence than observational studies on the effects of national-level tobacco control policies. In summary, application of rigorous research methods enables this survey to be a rich data resource, not only to evaluate policies, but also to gain new insights into the natural history of smoking cessation, through longitudinal analyses of smoker behaviour.

The role of the public in water fluoridation: public health champions or anti-fluoridation freedom fighters?

OBJECTIVE: Using the opportunity of pretesting a leaflet for the general public on water fluoridation, their views were also sought on the issue as a whole. DESIGN: Qualitative research using focus group discussions led by an experienced moderator. SETTING: Among the general public living in north east England. SUBJECTS: Members of the public living in both fluoridated and non-fluoridated areas in three age bands (20-35, 36-50 and 50+) and by social class. RESULTS: The study found: the low priority given to dental health; how emotive the subject of water is; the variable knowledge of fluoride in relation to dental and general health; and the desire for information if new water fluoridation schemes are planned. CONCLUSIONS: The research confirmed public support for water fluoridation but highlighted the place of public health professionals in championing water fluoridation because of public apathy.

General anaesthesia: who decides, and why?

This study sought to determine the relative influence dentists and parents have on the decision to give a general anaesthetic to a child, and to identify the factors that influence that decision. The research involved group discussions and in-depth interviewing as a method of investigating attitudes and behaviour in greater detail. The results indicated that parents are not able to make informed choices about general anaesthesia being used on their child; the dentist has the greatest influence on the decision to use general anaesthesia; and that this decision is often influenced by non-clinical factors. These non-clinical factors were identified as: the norms of the dentist, overall attitudes to general anaesthesia and how general anaesthesia provision was structured locally. The findings suggest that any attempt to reduce the current levels of general anaesthesia further must address these factors, whilst taking into account the needs of patients and dentists.

Scottish attitudes to blood donation and AIDS.

OBJECTIVE: To see whether the issue of AIDS has influenced the observed decline in blood donation in Scotland. DESIGN: Two methods: a quantitative survey using personal interviews based on a questionnaire and a qualitative survey based on group discussions. SETTING: Interviews based on the questionnaire were conducted in the respondents' homes. The group discussions were held in the homes of professional market research interviewers. PARTICIPANTS: For the quantitative survey a representative sample of 976 Scottish adults was selected by multistage sampling. In the qualitative survey 16 groups of five to eight respondents assigned according to donating experience and sociodemographic criteria took part. MAIN RESULTS: AIDS was not mentioned as a discouraging factor in donation, and off putting aspects identified before AIDS became a public issue remained salient--for example, fear of needles. Many (75%) thought it unlikely that donation entailed a risk of developing AIDS. Nevertheless, respondents were reluctant to consider the AIDS issue personally. Being asked to do so, as in the routine screening of donors, aroused fears and resentment. CONCLUSIONS: The issue of AIDS, including fear of infection, has not directly influenced the declining numbers of donors, but the unpleasant associations of AIDS have had an indirect effect, particularly in undermining the emotional benefits of giving blood. For example, the screening process, which requires potential donors to consider their personal risk from AIDS, had had the effect of discouraging donors in general. Redressing the balance is difficult as screening must be universally applied. Rather than minimising the issue of AIDS, publicity needs urgently to reassert the positive benefits of and rewards from giving blood.

Cigarette advertising and children's smoking: why Reg was withdrawn.

OBJECTIVE: To examine the appeal of the Embassy Regal "Reg" campaign to young people. DESIGN: Three quantitative surveys and one piece of qualitative research: (a) self completion questionnaire administered in classrooms, (b) questionnaire led interviews with children, (c) questionnaire led interviews with adults, and (d) group discussions with children and adults. SETTINGS: (a) Secondary and middle schools in England; (b) north of England, Scotland, and Wales; (c) north of England, Scotland, and Wales; and (d) Glasgow. SUBJECTS: (a) 5451 schoolchildren aged 11-15 recruited by stratified random sampling; (b) 437 children aged 5-10 recruited by quota sampling; (c) 814 adults aged 15-65 recruited by quota sampling; and (d) 12 groups of children aged 10-15, three groups of adults aged 18-24, and three groups of adults aged 35-55. RESULTS: Children were familiar with cigarette advertising and in particular the Reg campaign. Although younger children struggled to understand the creative content of the adverts, older and smoking children could understand and appreciate the humour. They considered Reg to be amusing and could relate to the type of joke used in the advert. In addition Reg's flippant attitude towards serious issues appealed to the children. While adults aged 18-24 understood the campaign they did not identify with it, and 35-55 year olds (the campaign's supposed target) were unappreciative of the campaign. CONCLUSIONS: The Reg campaign was getting through to children more effectively than it was to adults and held most appeal for teenagers, particularly 14-15 year old smokers. It clearly contravened the code governing tobacco advertising, which states that advertising must not appeal to children more than it does to adults, and it may have had a direct impact on teenage smoking. In view of these findings the Advertising Standards Authority's decision to withdraw the Reg campaign seems appropriate.

Scottish attitudes to AIDS.

PIP: Recently many approaches have been used to educate the public about the human immunodeficiency virus (HIV) infection and the acquired immune deficiency syndrome (AIDS). The impact of various campaigns and interventions is difficult to measure, but some indication of the cumulative effect can be monitored over time. This is a report of the results of such a study carried out in Scotland in which the general public's awareness of and attitudes towards HIV and AIDS were measured in July 1986 and again 1 year later. 3 trends emerge from the surveys. 1) There is evidence of increasing awareness about the broader risk from AIDS to the general public as well as to high risk groups of drug misusers and homosexuals. 2) It is clear that there is still great concern about AIDS, with increasing proportions of the population seeing it as a serious social problem. 3) There is a demand for more information about AIDS, especially from young people. Knowledge of the broader risk to heterosexuals from AIDS therefore seems to be getting across, although it is clear that there is now considerable anxiety about AIDS, particularly among young people. The findings also suggest that any campaign whose objective is making the public aware of the connection between drug injection and AIDS is unnecessary, as almost everyone knows this already. The results also show that there is little to be gained by trying to induce fear or anxiety to reinforce existing knowledge of the connection between drugs and AIDS to deter potential intravenous drug users. Finally, there is a need to address the fact that some people inject drugs despite their knowledge of and fear about the risk of AIDS.^ieng

Predisposing effects of cigarette advertising on children's intentions to smoke when older.

Six hundred and forty Glasgow children, initially aged between 11 and 14 years, were interviewed twice, with approximately one year between interviews. Children whose intentions to smoke when older became more positive between the two interviews tended to be more aware of cigarette advertising at the time of the first interview (compared with children whose intentions to smoke were negative at both interviews). Children whose intentions to smoke became more negative between the interviews tended to be less appreciative of cigarette advertisements at the time of the first interview (compared with children whose intentions to smoke were positive at both interviews). Since both groups differed from their respective contrast groups before their declared intentions changed, these findings support the view that cigarette advertising has predisposing as well as reinforcing effects on children's attitudes and behaviour with respect to smoking.