Digital Manipulation of Images of Models' Appearance in Advertising: Strategies for Action Through Law and Corporate Social Responsibility Incentives to Protect Public Health.

CONTEXT: Widespread digital retouching of advertising imagery in the fashion, beauty, and other consumer industries promotes unrealistic beauty standards that have harmful effects on public health. In particular, exposure to misleading beauty imagery is linked with greater body dissatisfaction, worse mood, poorer self-esteem, and increased risk for disordered eating behaviors. Moreover, given the social, psychological, medical, and economic burden of eating disorders, there is an urgent need to address environmental risk factors and to scale up prevention efforts by increasing the regulation of digitally altered advertising imagery. METHODS: This manuscript summarizes the health research literature linking digital retouching of advertising to increased risk of eating disorders, disordered weight and appearance control behaviors, and body dissatisfaction in consumers, followed by a review of global policy initiatives designed to regulate digital retouching to reduce health harms to consumers. Next, we turn to the US legal context, reporting on findings generated through legal research via Westlaw and LexisNexis, congressional records, federal agency websites, law review articles, and Supreme Court opinions, in addition to consulting legal experts on both tax law and the First Amendment, to evaluate the viability of various policy initiatives proposed to strengthen regulation on digital retouching in the United States. FINDINGS: Influencing advertising practices via tax incentives combined with corporate social responsibility initiatives may be the most constitutionally feasible options for the US legal context to reduce the use of digitally alternated images of models' bodies in advertising. CONCLUSIONS: Policy and corporate initiatives to curtail use of digitally altered images found to be harmful to mental and behavioral health of consumers could reduce the burden of eating disorders, disordered weight and appearance control behaviors, and body dissatisfaction and thereby improve population health in the United States.

Associations between tobacco control mass media campaign expenditure and smoking prevalence and quitting in England: a time series analysis.

BACKGROUND: It has been established that mass media campaigns can increase smoking cessation rates, but there is little direct evidence estimating associations between government expenditure on tobacco control mass media campaigns and smoking cessation. This study assessed the association over 8 years between mass media expenditure in England and quit attempts, smoking cessation and smoking prevalence. METHODS: Autoregressive integrated moving average modelling with exogenous variables (ARIMAX) was applied to monthly estimates from the Smoking Toolkit Study between June 2008 and February 2016. We assessed the association between the trends in mass media expenditure and (1) quit attempts in the last two months, (2) quit success among those who attempted to quit and (3) smoking prevalence. Analyses were adjusted for trends in weekly spending on tobacco by smokers, tobacco control policies and the use of established aids to cessation. RESULTS: Monthly spending on mass media campaigns ranged from nothing to £2.4 million, with a mean of £465 054. An increase in mass media expenditure of 10% of the monthly average was associated with a 0.51% increase (of the average) in success rates of quit attempts (95% CI 0.10% to 0.91%, p=0.014). No clear association was detected between changes in mass media expenditure and changes in quit attempt prevalence (ß=-0.03, 95% CI -2.05% to 2.00%, p=0.979) or smoking prevalence (ß=-0.03, 95% CI -0.09% to 0.03%, p=0.299). CONCLUSION: Between 2008 and 2016, higher monthly expenditure on tobacco control mass media campaigns in England was associated with higher quit success rates.

Cost-Effectiveness of Decision Support Strategies in Acute Bronchitis.

BACKGROUND: A recent clinical trial suggests that printed (PDS) and computer decision support (CDS) interventions are safe and effective in reducing antibiotic use in acute bronchitis relative to usual care (UC). OBJECTIVE: Our aim was to evaluate the cost-effectiveness of decision support interventions in reducing antibiotic use in acute bronchitis. DESIGN: We conducted a clinical trial-based cost-effectiveness analysis comparing UC, PDS and CDS for management of acute bronchitis. We assumed a societal perspective, 5-year program duration and 30-day time horizon. PATIENTS: The U.S. population aged 13-64 years presenting with acute bronchitis in the ambulatory setting. INTERVENTIONS: Printed and computer decision support interventions relative to usual care. MAIN MEASURES: Cost per antibiotic prescription safely avoided. KEY RESULTS: In the base case, PDS dominated UC and CDS, with lesser total costs (PDS: $2,574, UC: $2,768, CDS: $2,805) and fewer antibiotic prescriptions (PDS: 3.79, UC: 4.60, CDS: 3.95) per patient over 5 years. In one-way sensitivity analyses, PDS dominated UC across all parameter values, except when antibiotics reduced work loss by ≥ 1.9 days or the probability of hospitalization within 30 days was ≥ 0.9 % in PDS (base case: 0.2 %) or ≤ 0.4 % in UC (base case: 1.0 %). The dominance of PDS over CDS was sensitive both to probability of hospitalization and plausible variation in the adjusted odds of antibiotic use in both strategies. CONCLUSIONS: A PDS strategy to reduce antibiotic use in acute bronchitis is less costly and more effective than both UC and CDS strategies, although results were sensitive to variation in probability of hospitalization and the adjusted odds of antibiotic use. This simple, low-cost, safe, and effective intervention would be an economically reasonable component of a multi-component approach to address antibiotic overuse in acute bronchitis.

Economic evaluations of tobacco control mass media campaigns: a systematic review.

BACKGROUND: International evidence shows that mass media campaigns are effective tobacco control interventions. However, they require substantial investment; a key question is whether their costs are justified by their benefits. The aim of this study was to systematically and comprehensively review economic evaluations of tobacco control mass media campaigns. METHODS: An electronic search of databases and grey literature was conducted to identify all published economic evaluations of tobacco control mass media campaigns. The authors reviewed studies independently and assessed the quality of studies using the Drummond 10-point checklist. A narrative synthesis was used to summarise the key features and quality of the identified studies. RESULTS: 10 studies met the inclusion criteria and were included in the review. All the studies included a cost effectiveness analysis, a cost utility analysis or both. The methods were highly heterogeneous, particularly in terms of the types of costs included. On the whole, studies were well conducted, but the interventions were often poorly described in terms of campaign content and intensity, and cost information was frequently inadequate. All studies concluded that tobacco control mass media campaigns are a cost effective public health intervention. CONCLUSIONS: The evidence on the cost effectiveness of tobacco control mass media campaigns is limited, but of acceptable quality and consistently suggests that they offer good value for money.

Earned media and public engagement with CDC's "Tips from Former Smokers" campaign: an analysis of online news and blog coverage.

BACKGROUND: In March 2012, the US Centers for Disease Control and Prevention (CDC) launched the first-ever paid national tobacco education campaign. At a cost of US $54 million, "Tips from Former Smokers" (Tips) ran for 3 months across multiple media, depicting the suffering experienced by smokers and their families in graphic detail. The potential impact and reach of the Tips campaign was not limited to that achieved through paid media placements. It was also potentially extended through "earned media", including news and blog coverage of the campaign. Such coverage can shape public understanding of and facilitate public engagement with key health issues. OBJECTIVE: To better understand the contribution of earned media to the public's engagement with health issues in the current news media environment, we examined the online "earned media" and public engagement generated by one national public health campaign. METHODS: We constructed a purposive sample of online media coverage of the CDC's 2012 Tips from Former Smokers television campaign, focusing on 14 influential and politically diverse US news outlets and policy-focused blogs. We identified relevant content by combining campaign and website-specific keywords for 4 months around the campaign release. Each story was coded for content, inclusion of multimedia, and measures of audience engagement. RESULTS: The search yielded 36 stories mentioning Tips, of which 27 were focused on the campaign. Story content between pieces was strikingly similar, with most stories highlighting the same points about the campaign's content, cost, and potential impact. We saw notable evidence of audience engagement; stories focused on Tips generated 9547 comments, 8891 Facebook "likes", 1027 tweets, and 505 story URL shares on Facebook. Audience engagement varied by story and site, as did the valence and relevance of associated audience comments. Comments were most oppositional on CNN and most supportive on Yahoo. Comment coding revealed approximately equal levels of opposition and support overall. We identified four common arguments among oppositional comments: government intrusion on personal behaviors, problematic allocation of governmental spending, questionable science, and challenges regarding campaign efficacy. Supportive comments tended to convey personal stories and emotions. CONCLUSIONS: The Tips campaign received limited coverage on either online news or blog sources, but the limited number of stories generated engagement among online audiences. In addition to the content and volume of blog and news coverage, audience comments and websites' mechanisms for sharing stories via social media are likely to determine the influence of online earned media. In order to facilitate meaningful evaluation of public health campaigns within the rapidly advancing media environment, there is a need for the public health community to build consensus regarding collection and assessment of engagement data.

[Tobacco farming in Italy receives more funds in comparison to tobacco control]. / La tabacchicoltura in Italia riceve più fondi del controllo del tabagismo.

In the European Union almost 300,000 tons of raw tobacco are produced every year, contributing for 4% of the world production. In Italy, tobacco crop produces around 90,000 tons/year and is concentrated in Veneto, Tuscany, Umbria and Campania Regions. In 1970, Common Market Organisation provided a virtually unlimited support for European tobacco production. After 2004, funds progressively has been cut by half, even though the other half has been given for restructuring or reconversion of tobacco farms through the Rural Development Plan. The Framework Convention on Tobacco Control recommends conversion of tobacco crops, although there are no effective measures. Tobacco production requires large quantities of chemicals (pesticides, growth regulators, fertilisers), with significant workers' exposure if applied without personal protective equipments. Pesticides may have genotoxic, teratogenic, immunotoxic, hormonal, and carcinogenic effects. Tobacco itself may cause also a disease called "Green tobacco sickness" syndrome, as a consequence of nicotine dermal absorption due to skin exposure to tobacco leaves. In Italy, financial resources for tobacco production and restructuring/conversion to other crops of previously tobacco planted fields are available. On the contrary, anti-smoking media interventions do not receive funds comparatively relevant as those for tobacco production.

Cost-effectiveness of interventions for reducing road traffic injuries related to driving under the influence of alcohol.

OBJECTIVE: To determine the cost-effectiveness of interventions to reduce road traffic injuries caused by driving under the influence of alcohol in Thailand. METHODS: We used generalized cost-effectiveness analysis and included costs from a health sector perspective. The model considered road traffic crash victims who were injured, disabled, or died. We obtained proportions of alcohol-related crashes from the Thai Injury Surveillance system. Intervention effectiveness was derived from published reviews and a study in one province of Thailand. Random breath testing, selective breath testing, and mass media campaigns, both current and intervention scenarios, were compared with a "do-nothing" scenario. We calculated intervention costs and cost offsets of prevented treatment costs in 2004 Thai baht (US $1 = 41 baht) and measured benefits in terms of disability-adjusted life-years averted. Interventions with incremental cost-effectiveness ratios below 110,000 Thai baht (1×gross domestic product per capita) per disability-adjusted life-year (US $2,680) were considered very cost-effective. RESULTS: Compared with doing nothing, mass media campaigns, random breath testing, and selective breath testing are all cost saving. When averted treatment costs are ignored and only intervention costs are included, all three interventions are very cost-effective, with incremental cost-effectiveness ratios of 10,300, 14,300 and 13,000 baht/disability-adjusted life-year, respectively. The current mix of mass media campaigns and sobriety checkpoints is therefore also cost-effective, but underinvestment in checkpoints limits its overall effect. CONCLUSIONS: A greater intensity of conducting sobriety checkpoints in Thailand is recommended to complement the investment in mass media campaigns. Together these interventions have the potential to reduce the burden of alcohol-related road traffic injuries by 24%.

Can donated media placements reach intended audiences?

Donated media placements for public service announcements (PSAs) can be difficult to secure, and may not always reach intended audiences. Strategies used by the Centers for Disease Control and Prevention's (CDC) Screen for Life: National Colorectal Cancer Action Campaign (SFL) to obtain donated media placements include producing a diverse mix of high-quality PSAs, co-branding with state and tribal health agencies, securing celebrity involvement, monitoring media trends to identify new distribution opportunities, and strategically timing the release of PSAs. To investigate open-ended recall of PSAs promoting colorectal cancer screening, CDC conducted 12 focus groups in three U.S. cities with men and women either nearing age 50 years, when screening is recommended to begin, or aged 50-75 years who were not in compliance with screening guidelines. In most focus groups, multiple participants recalled exposure to PSAs promoting colorectal cancer screening, and most of these individuals reported having seen SFL PSAs on television, in transit stations, or on the sides of public buses. Some participants reported exposure to SFL PSAs without prompting from the moderator, as they explained how they learned about the disease. Several participants reported learning key campaign messages from PSAs, including that colorectal cancer screening should begin at age 50 years and screening can find polyps so they can be removed before becoming cancerous. Donated media placements can reach and educate mass audiences, including millions of U.S. adults who have not been screened appropriately for colorectal cancer.

The role of evidence-based media advocacy in the promotion of tobacco control policies.

This article discusses the role of evidence-based media advocacy in the promotion of tobacco control policies. Evidence is a driving force for campaigns seeking to implement a tobacco control policy. An effective campaign is based in evidence that demonstrates why a policy should be implemented, and what the potential benefits are. Media advocacy is the process of disseminating information through the communications media where the aim is to effect action, such as a change of policy, or to alter the public's view of an issue. Discussion focuses on: 1) the importance of, and methods for, collecting and communicating evidence and information to make it clear and usable for legislators, the media, and the public; and 2) the role of earned and paid media in advancing tobacco control issues. The discussion is made within the context of a specific advocacy example; in this case the 2010 campaign to increase the tobacco tax in Mexico.

Football's coming home?: Digital reterritorialization, contradictions in the transnational coverage of sport and the sociology of alternative football broadcasts.

This article critically utilizes the work of Manuel Castells to discuss the issue of parallel imported broadcasts (specifically including live-streams) in football. This is of crucial importance to sport because the English Premier League is premised upon the sale of television rights broadcasts to domestic and overseas markets, and yet cheaper alternative broadcasts endanger the price of such rights. Evidence is drawn from qualitative fieldwork and library/Internet sources to explore the practices of supporters and the politics involved in the generation of alternative broadcasts. This enables us to clarify the core sociological themes of 'milieu of innovation' and 'locale' within today's digitally networked global society.

Overturning anti-miscegenation laws: news media coverage of the Lovings' legal case against the state of Virginia.

This study fills a gap in scholarship by exploring historical news coverage of interracial relationships. It examines coverage by The New York Times, Washington Post and Times-Herald, and Chicago Tribune of the progression of the landmark civil rights case of Loving v. Virginia, in which the Supreme Court overturned Virginia's anti-miscegenation law, which prohibited marriage between any White and non-White person. An analysis of the frames and sources used in these publications' news stories about the case indicate all three publications' coverage favored the Lovings.

Pull-to-center is not just for newsvendors.

The pull-to-center effect is a systematically observed suboptimal behavior in newsvendor experiments. Various explanations have been forward for this phenomenon, some of which are based on structural properties of the task while others are based upon the inventory context of the problem. To help distinguish between these two types of explanations, we compare behavior in a newsvendor game to behavior in a new, mathematically isomorphic, price gouging game. Our laboratory experiments replicate the standard results for newsvendors and yield the equivalent pattern in the price gouging game. This suggests previously observed newsvendor behavior is driven by structural aspects of the task consistent with models like prospect theory and impulse balance rather than context specific explanations pertaining to inventory management.

A single institution's 1-year experience with uterine fibroid embolization marketing.

PURPOSE: To assess the impact of various marketing techniques on the referral pattern for uterine fibroid embolization (UFE) at an academic interventional radiology practice over a 1-year period. MATERIALS AND METHODS: All referrals to the interventional radiology clinic for UFE from January 1, 2009, to December 31, 2009, were retrospectively reviewed. A standard intake sheet was completed by the interventional clinic secretary at the time of initial patient contact that included the source of the referral (radio, television, newspaper, mailing, Internet, physician, friend, other). All patients who proceeded to consultation were seen in the interventional radiology clinic by attending interventional radiologists in a university-based academic center. The referral pattern was analyzed with respect to the number of patients who contacted the clinic, the number of actual clinic visits, the number of magnetic resonance (MR) imaging examinations performed before and after the procedure, the total number of embolization cases performed, and the subsequent downstream revenue. RESULTS: During the 1-year period, 344 patients contacted the interventional radiology clinic regarding UFE resulting in 171 consultations and 100 pelvic MR imaging examinations performed before the procedure. Sixty-two patients proceeded to UFE, and 32 patients underwent follow-up pelvic MR imaging. These results show a significant increase from eight cases the previous year and are presumably attributable almost entirely to the directed marketing campaign. The marketing initiative consisted primarily of print and radio advertisements, with the latter being the most effective. The total advertising cost for the year was approximately $24,706, of which $20,520 was for radio advertisements. The radio advertisements generated 69% (237 of 344) of the referrals and 69% (43 of 62) of the UFE procedures. Using Medicare reimbursement rates, the radio advertisements generated $281,994 in UFE technical fees and $50,329 in MR imaging technical fees. CONCLUSIONS: Direct patient marketing techniques can promote significant growth for a fibroid embolization practice. In our market, radio advertisements proved to be the most cost-effective strategy.

Mass media campaigns within reach: effective efforts with limited resources in Russia's capital city.

Mass media campaigns, while often expensive, are proven, cost-effective interventions and should not be considered out-of-reach, especially where governments have some sway over media markets, where large media discounts are possible or where other novel strategies can be employed.

Charitable collaborations in Bronzeville, 1928-1944: the "Chicago Defender" and the Regal Theater.

In the twentieth century, race-based residential and commercial segregation that supported racial oppression and inequality became an elemental characteristic of urban black communities. Conflict-ridden, black-white relationships were common. However, the Chicago Defender Charities, Inc., the entity that sponsors the largest African American parade in the country and that emerged in 1947, embodied a tradition of charitable giving, self-help, and community service initiated in 1921 by Chicago Defender newspaper founder and editor, Robert S. Abbott. The foundation of this charitable tradition matured as a result of an early and sustained collaboration between Chicago's white-owned Regal Theater and the black-owned Chicago Defender newspaper. Thus, in segregated African American communities, black and white commercial institutions, under certain conditions, were able to find important points of collaboration to uplift the African American communities of which they were a part.

Neuroscience, power and culture: an introduction.

In line with their vast expansion over the last few decades, the brain sciences -- including neurobiology, psychopharmacology, biological psychiatry, and brain imaging -- are becoming increasingly prominent in a variety of cultural formations, from self-help guides and the arts to advertising and public health programmes. This article, which introduces the special issue of "History of the Human Science" on "Neuroscience, Power and Culture," considers the ways that social and historical research can, through empirical investigations grounded in the observation of what is actually happening and has already happened in the sciences of mind and brain, complement speculative discussions of the possible social implications of neuroscience that now appear regularly in the media and in philosophical bioethics. It suggests that the neurosciences are best understood in terms of their lineage within the "psy"-disciplines, and that, accordingly, our analyses of them will be strengthened by drawing on existing literatures on the history and politics of psychology -- particularly those that analyze formations of knowledge, power and subjectivity associated with the discipline and its practical applications. Additionally, it argues against taking today's neuroscientific facts and brain-targetting technologies as starting points for analysis, and for greater recognition of the ways that these are shaped by historical, cultural and political-economic forces.

Population-level predictors of changes in success rates of smoking quit attempts in England: a time series analysis.

AIMS: To quantify associations between the success of smoking quit attempts and factors that have varied throughout 2007-2018 at a population level. DESIGN: time series analysis using Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling. SETTING AND PARTICIPANTS: Data were aggregated from 54 847 past-year smokers taking part in the Smoking Toolkit Study which involves monthly repeated cross-sectional household surveys of individuals aged 16+ in England. MEASUREMENTS: The input series were: (1) attempts at smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy (NRT); (2) use during a quit attempt of (a) e-cigarettes, (b) NRT over-the-counter, (c) medication on prescription and (d) face-to-face behavioural support; (3) use of roll-your-own tobacco; (4) prevalence of (a) smoking and (b) non-daily smoking; (5) tobacco control mass media expenditure; (6) expenditure on smoking; (7) smoker characteristics in the form of (a) high motivation to quit, (b) average age, (c) socio-economic status and (d) cigarette consumption; (8) implementation of tobacco control policies; and (9) quit attempt rate. FINDINGS: The licensing of NRT for harm reduction was associated with a 0.641% [95% confidence interval (CI) = 0.073-1.209, P = 0.027] increase in the mean point prevalence of the success rate of quit attempts. For every 1% increase in the mean point prevalence of e-cigarette use and use of prescription medication during a quit attempt, the mean point prevalence of successful quit attempts increased by 0.106% (95% CI = 0.011-0.201, P = 0.029) and 0.143% (95% CI = 0.009-0.279, P = 0.038), respectively. For every 1% increase in the mean expenditure on tobacco control mass media, the mean point prevalence of successful quit attempts increased by 0.046% (95% CI = 0.001-0.092, P = 0.046). Other associations were not statistically significant. CONCLUSION: In England between 2007 and 2018, licensing of nicotine replacement therapy for use in harm reduction, greater use of e-cigarettes and prescription medications during a quit attempt and higher expenditure on tobacco control mass media were all associated with higher success rates of quit attempts.

Recruiting participants with peripheral arterial disease for clinical trials: experience from the Study to Improve Leg Circulation (SILC).

OBJECTIVE: To describe the success of diverse recruitment methods in a randomized controlled clinical trial of exercise in persons with peripheral arterial disease (PAD). METHODS: An analysis of recruitment sources conducted for the 746 men and women completing a baseline visit for the study to improve leg circulation (SILC), a randomized controlled trial of exercise for patients with PAD. For each recruitment source, we determined the number of randomized participants, the rate of randomization among those completing a baseline visit, and cost per randomized participant. RESULTS: Of the 746 individuals who completed a baseline visit, 156 were eligible and randomized. The most frequent sources of randomized participants were newspaper advertising (n = 67), mailed recruitment letters to patients with PAD identified at the study medical center (n = 25), and radio advertising (n = 18). Costs per randomized participant were $2750 for television advertising, $2167 for Life Line Screening, $2369 for newspaper advertising, $3931 for mailed postcards to older community dwelling men and women, and $5691 for radio advertising. Among those completing a baseline visit, randomization rates ranged from 10% for those identified from radio advertising to 32% for those identified from the Chicago Veterans Administration and 33% for those identified from posted flyers. CONCLUSION: Most participants in a randomized controlled trial of exercise were recruited from newspaper advertising and mailed recruitment letters to patients with known PAD. The highest randomization rates after a baseline visit occurred among participants identified from posted flyers and mailed recruitment letters to PAD patients.

Increasing youths' exposure to a tobacco prevention media campaign in rural and low-population-density communities.

OBJECTIVES: We examined the effectiveness of a program to increase exposure to national "truth" tobacco countermarketing messages among youths in rural and low-population-density communities. METHODS: A longitudinal survey of 2618 youths aged 12 to 17 years was conducted over 5 months in 8 media markets receiving supplemental advertising and 8 comparison markets receiving less than the national average of "truth" messages. RESULTS: Confirmed awareness of "truth" increased from 40% to 71% among youths in treatment markets while remaining stable in comparison markets. Over 35% of all youths who were unaware of the campaign at baseline became aware of it as a direct result of the increased advertising. Youths living in rural and low-population-density communities were receptive to the campaign's messages. CONCLUSIONS: Through purchase of airtime in local broadcast media, the reach of a national tobacco countermarketing campaign was expanded among youths living in rural and low-population-density areas. This strategy of augmenting delivery of nationally broadcast antitobacco ads can serve as a model for leveraging limited tobacco control resources to increase the impact of evidence-based tobacco prevention campaigns.