Saved by the bell: the role of telephone helpline services in the context of mass-media anti-smoking campaigns.
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Advertising↗
Biomedical subjects
R Borland
Publications and source records attributed to R Borland.
Sun protection and sunburn in primary school children: the influence of age, gender, and coloring.
BACKGROUND: Childhood is a high-risk period for skin damage due to excessive sun exposure. This damage may lead to skin cancer later in life. METHODS: The present study measured children's knowledge and attitudes, and reported usual behavior relevant to sun protection and parents' encouragement of their children's sun protection among a sample of 735 primary school students and their parents, in Victoria, Australia. The incidence of sunburn among the children over late spring and early summer was monitored weekly for 8 weeks. RESULTS: The results indicate that children's knowledge of sun protection is moderately high and that positive sun protection attitudes, reported frequency of parents encouraging protection, and children carrying out sun protection are generally high. Trends for age indicate that while knowledge of sun protection increases with age, attitudes and behaviors supportive of sun protection decline. Sunburn rates increase with age. There was some evidence to suggest that children with fairer coloring receive greater encouragement from parents to protect themselves and are marginally better protected than children with darker coloring. However, this highly susceptible group still suffers more burns. There was little variation based on children's gender. CONCLUSIONS: The mid-primary school years may be a critical time for interventions promoting sun protection.
Adolescent↗
Direct measurement of sun protection in primary schools.
BACKGROUND: "Kidskin" is an intervention study involving children at 33 primary schools in Perth, Western Australia. This study includes measurement of changes in implementation of schools' sun protection policies. This paper reports on measurement of observable aspects of sun protection. METHODS: Hat use was assessed from videos of children in the playground. Shade use was measured using UVR-sensitive polysulfone badges worn by a random sample of children. Shade provision was measured from aerial photographs of the schools. Principals were surveyed about school policies and practices. RESULTS: Eighty-seven percent of children wore a hat during lunch time at school, although only 14% wore the most protective styles of hats. The mean proportion of ambient UVR exposure received by Year 1 children was 15.5%; children spent less time in the sun on sunnier days. On average, 14.5% of the playground was shaded; this was not associated with children's sun exposure. Correlations between these results and the principals' estimates were poor. CONCLUSIONS: Children should be encouraged to wear more protective styles of hats and to avoid sun exposure, even on less sunny days during spring and summer. Principals' estimates of shade provision and children's sun protection behavior at school are of little value.
Analysis of Variance↗
A strategy for involving general practitioners in smoking control.
OBJECTIVE: In 1991, the Victorian Smoking and Health Program introduced a simple intervention strategy for general practitioners that could be integrated conveniently and inexpensively into the routine care of patients who smoke. The aim of this study was to determine whether there had been a change over time in whether or not GPs advised their patients not to smoke. METHOD: The extent to which smokers remembered GPs talking to them about smoking was assessed in population-based surveys of adults in Victoria in 1990 (prior to the implementation of the intervention) and in 1992, 1994 and 1996. RESULTS: Over time there was a significant increase in the proportion of smokers who reported that their GP had provided them with help or information to stop smoking (chi 2 = 17.58, p < 0.001). In 1996, 9% of smokers said their doctor had advised them to contact Quit. CONCLUSION: Levels of recalled advice and provision of information regarding smoking cessation have increased by 10% over the past six years. However, nearly half the smokers in this study reported that they had been given inappropriate advice or no advice at all. IMPLICATIONS: A brief intervention by GPs, supplemented by appropriate referrals, has the potential to assist significant numbers of smokers to quit and may be more practical for GPs who are unable to personally provide all of the support smokers may need to quit.
Chi-Square Distribution↗
Trends in environmental tobacco smoke restrictions in the home in Victoria, Australia.
OBJECTIVE: To assess the extent to which smokers and non-smokers in Victoria, Australia attempt to keep their homes smoke free and to determine whether the proportion of people attempting to do so has changed over time. DESIGN: Face to face surveys conducted in Victoria each year from 1989 to 1997. PARTICIPANTS: Approximately 2500 randomly selected adults each year. MAIN OUTCOME MEASURES: Proportion of respondents who discourage their visitors from smoking; proportion of smokers who always smoke outside their own homes; behaviour of smokers when they are around children. Changes in each of these measures over time. RESULTS: Reports of visitors being discouraged from smoking rose from 27% in 1989 to 53% in 1997. Smokers who reported always smoking outside the home rose from 20% in 1995 to 28% in 1997. Not smoking in the presence of children rose from 14% in 1989 to 33% in 1996. Indoor restrictions on smoking were associated with the presence of children in the household and even more strongly with the presence of non-smoking adults. People who worked in places where smoking was totally banned were more likely to ask their visitors not to smoke than those who worked where smoking was allowed. CONCLUSIONS: The results indicate a strong move towards homes and towards protecting children from smoke. Efforts to support and facilitate this social change should be further encouraged.
Adolescent↗
Skin cancer prevention for children: a critical review.
Increasing sun protection for children may reduce their risk for skin cancer, so many health authorities recommend comprehensive sun safety for children. Sun protection of children in North America and Europe is generally lower than desired and lower than in Australia. This article provides a critical review of evaluations on the effects of 24 sun protection programs for children under age 14. Programs are classified based on the target population, setting, and features. Most programs improved sun safety knowledge, but changes in sun protection attitude and behaviors were smaller. Multiunit presentations were more effective than short-duration presentations. Peer education was effective but needs further evaluation. Some programs for parents have been shown to increase sun protection for children. Strategies to improve sun safety policies need further study. A few community-wide programs have effectively improved sun protection. Future research should address innovative strategies and issues of design and measurement. There is no gold standard for measuring sun protection behavior, but self-report, prospective diaries, and observational techniques show small positive correlations.
Adolescent↗
The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States.
OBJECTIVES: This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States. METHODS: Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed. The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. RESULTS: Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. CONCLUSIONS: If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States.
Australia↗
Instability in smoking patterns among school leavers in Victoria, Australia.
OBJECTIVE: To describe patterns of smoking in a cohort of young adults over the first 15 months after leaving school. DESIGN: A four-wave, longitudinal survey design was used to gather data. Final-year students from 93 schools completed the recruitment questionnaire at an average age of 17 years. Follow-up questionnaires were posted to their home addresses three months, nine months and 15 months after the end of school. SETTING: Victoria, Australia. PARTICIPANTS: A cohort of 1903 respondents who completed and returned all four questionnaires. MAIN OUTCOME MEASURES: Self-labelled smoking status ("heavy smoker", "light smoker", "occasional smoker", "ex-smoker", and "non-smoker"), daily cigarette consumption, and maximum daily cigarette consumption. RESULTS: At school, 72% of the sample were "non-smokers", 5% "ex-smokers", 11% "occasional", 8% "light", and 5% "heavy smokers". At 15 months after school, these proportions had shifted to 64%, 8%, 11%, 9%, and 7%, respectively. Over the study, "light smokers" and "heavy smokers" substantially increased their daily consumption; "occasional" and "ex-smokers" did not. There was relatively high stability in self-labelled smoking status at one wave and the next. However, over the four waves, 38% of the sample changed their self-labelled smoking status, and 41% of these had been "non-smokers" at school. A reduced second-order Markov chain model was found to fit this four-wave behavioural sequence. Detailed description of smoking status changes revealed greater progression to higher levels of smoking than transition to lower levels. CONCLUSIONS: There is considerable flux in smoking patterns among young adults after leaving school, suggesting an opportunity to intervene with smoking prevention programmes at this stage of development.
Adolescent↗
Public perceptions of drugs causing most deaths in Australia 1986-93.
Drug use is a major cause of preventable mortality and morbidity in Australia. Tobacco is by far the largest cause of drug-related deaths. This paper reports changes in public awareness of the relative morbidity risks of different drugs between 1986 and 1993, a period of considerable activity for drug education and control. Broadly representative samples of Australians were surveyed in the two years using the same methods. Results indicate a significant increase in identification of tobacco as the largest cause of death, from a list of six drugs, although only a minority of respondents were correct in 1993. Alcohol was the second most identified drug, consistent with it being responsible for most drug deaths not attributable to tobacco. These results are discussed in the context of other studies. It is concluded that while improvement in knowledge has occurred, it is unlikely to be sufficiently strong to motivate action.
Journal Article↗
Effects of photographs and written descriptors on melanoma detection.
Two studies are reported on the effects of photographic and written information on performance in an experimental melanoma detection task. Subjects were shown slides of four types of skin lesions, including melanoma, and were asked what they would do if the lesion was on their skin. Four response options were provided from seeing a doctor immediately to doing nothing. In Experiment 1, no clear differences in performance were found as a function of prior instruction using four, eight or 16 photographs of each of the four lesion types. In Experiment 2, the effects of written and photographic instructional material were compared. The written material contained descriptions of each lesion type and details of the ABCD criteria for melanoma detection. Eight photographs were provided for each lesion type. Photographic information resulted in superior performance (P < 0.001) for seborrhoeic keratoses and a combination of both types of information was superior (P < 0.05) for melanoma. The two kinds of instructional material produced different effects, suggesting that a brochure offering a combination of photographs and written information is likely to be most useful in helping members of the public identify early melanoma as suspicious.
Adolescent↗
The effects of smoking outside workplaces on non-regular smokers.
The introduction of workplace smoking bans has resulted in smokers smoking outside their workplaces (exiled smoking). Social identity theory postulates that this may cause antagonism between smokers and non-smokers, or where non-smokers were friends with smokers, pressure on non-smokers to smoke. This study examines perceptions and beliefs about exiled smoking in 166 non-smoking workers. They saw smokers as having a work benefit not available to them, but otherwise they were generally not drawn to the activity. Half had joined smokers outside for breaks, but of these only one-third had ever smoked. Those would smoked reported that they did not have a regular pattern of joining the same group of smokers. Although it may provide a conduit for susceptible non-smokers to take up smoking, exiled smoking does not appear to influence those who are not otherwise vulnerable.
Adult↗
Prevalence of workplace smoking bans in Victoria.
Restrictions on smoking in the Victorian workplace have been measured since 1988. This paper investigates whether the trend of increasing prevalence of total bans found between 1988 and 1992 has continued. Estimates are based on workers' reports of the restrictions on smoking that apply at their workplaces. For indoor workers a total ban on smoking restrictions in the workplace has increased from 58% in 1992 to 66% in 1995. White collar workers continue to enjoy a higher rate of protection than blue collar workers. Factories, warehouses, hotels and restaurants are the worksites least likely to have restrictions. Bans result in considerable exiled smoking: half the smokers reported going out to smoke during working hours on their last work day.
Data Collection↗
Delayed compensatory cigarette consumption after a workplace smoking ban.
OBJECTIVES: To evaluate the impact of workplace smoking bans on cigarette consumption among continuing smokers over a two-year period. DESIGN: Two cross-sectional surveys and a longitudinal sample of smokers questioned about their smoking behaviour six months and two years after implementation of a workplace smoking ban. SUBJECTS: Workers in 46 government offices in Australia. The cross-sectional survey six months after the ban included 3388 workers, whereas the survey two years after the ban included 3982 workers. The longitudinal cohort study included 107 workers who were identified as current smokers in both surveys. MAIN OUTCOME MEASURES: Smokers were asked to report usual daily cigarette consumption on both workdays and leisure days one month before implementation of the ban, and six months, and two years afterwards. RESULTS: From six months to two years after the ban, the cross-sectional data showed an increase in cigarette consumption of 1.3 cigarettes per day. The longitudinal sample of smokers reported an increase in workday cigarette consumption of 1.7 cigarettes per day. A previous study of workers in the same worksites found a reduction in consumption of 5.2 cigarettes per day from before the ban to six months after. Over a two-year period we estimate that the net effect of the workplace smoking ban was to reduce cigarette consumption by about 3.5 cigarettes per day. CONCLUSIONS: Reductions in cigarette consumption among smokers frequently seen after implementation of a worksite smoking ban may diminish over time. This effect is more likely to occur when the initial response to a smoking ban is a large reduction in cigarette consumption.
Australia↗
Initial impact of the new Australian tobacco health warnings on knowledge and beliefs.
BACKGROUND: New health warnings and contents labelling on tobacco products were introduced in Australia in 1995. OBJECTIVE: To assess awareness of the new warnings at a time when a mix of packs with old and new warnings were being sold and on changes in relevant knowledge and attitudes from shortly before the implementation of the new warnings. DESIGN AND SUBJECTS: Approximately 500 smokers and 500 non-smokers were surveyed in December 1994, before implementation of the new warnings. Similar numbers were also surveyed in May 1995, part-way through implementation. Respondents were selected by random-digit dialling of telephone numbers in Australia. Smokers were oversampled. In addition, 243 smokers from the initial survey were re-surveyed in May 1995. MAIN OUTCOME MEASURES: Awareness of change to health warnings, knowledge of health warnings and tobacco smoke constituents, beliefs about the health effects of smoking, and perceived impact of the warnings. RESULTS: There was high awareness of the new warnings, particularly among smokers, with the increased size of the new warnings being the most salient feature. More than a third of smokers reported being affected by the warnings, with reductions in consumption and talking about warnings being the most common effects. Among smokers, there was an increase in knowledge about the main constituents of tobacco smoke. The number of types of health effects mentioned also increased as did the number of warnings correctly recalled. Overall beliefs about the six warning statements became stronger. Few changes were found for non-smokers. The knowledge and recall effects were replicated in the re-contact subsample, but the belief changes were not. CONCLUSIONS: These results suggest the new health warnings are resulting in better informed smokers and thus suggest that informative health warnings can play an important role in better informing consumers.
Adolescent↗
The path to Australia's tobacco health warnings.
Australia introduced new health warnings and contents labelling on cigarettes and other tobacco products from January 1995. The changes were based on recommendations emerging from research commissioned for that purpose. The research demonstrated the need for changes that changes could increase the noticeability of the warnings and contribute to an increase in relevant knowledge, and that the changes were acceptable to the public. The tobacco industry fought the changes and some modifications resulted, but new stronger warnings with elaborations on the back of the pack, an information number to call and elaborated contents labelling have been implemented.
Australia↗
Leaving work to smoke.
Work-place smoking bans have not only reduced work-day cigarette consumption but also been associated with going outside to smoke during working hours. We examined the extent of "exiled smoking", estimated how much work-day cigarette consumption can be attributed to it, and examined proximal predictors of both these two variables. Some 794 smokers from 42 medium-sized work-places were surveyed as the baseline for an intervention study. A self-completed questionnaire assessed smoking behaviour on work and non-working days, leaving work to smoke, and beliefs and opinions about smoking and smoking bans. Multiple regressions were used to examine predictors of leaving work to smoke, and of the amount smoked when doing so. Smokers reported consuming an average of 5.4 cigarettes during work breaks, 3.5 of which were associated with deliberately seeking opportunities to smoke; 39% reported leaving work to smoke one or more times per day during non-break periods. Indices of addiction were significant predictors of both leaving work to smoke and of cigarette consumption while doing so. Leaving work to smoke is in part an activity of addicted smokers, presumably to maintain blood nicotine levels. There is the potential to further reduce rates of cigarette consumption associated with work-place smoking bans if this "exiled smoking" can be reduced. This may be easier to achieve in light smokers.
Adult↗
Tobacco health warnings and smoking-related cognitions and behaviours.
AIMS: To explore whether the introduction onto cigarette packs of new larger, more prominent health warnings in black on white would lead to an increase in: noticing warnings, thoughts about the effects of smoking, and consequent behaviours of not smoking a planned cigarette and/or prematurely stubbing out one already lit. In addition evidence was sought linking these effect to smoking cessation. DESIGN: Two national cross-sectional surveys of broadly representative samples of smokers: one about 2 weeks before the mandated introduction date of the warnings, and a follow-up 6 months later, part-way through implementation. A longitudinal subsample of smokers from the initial baseline survey was resurveyed at follow-up. SETTING: In Australia, new health warnings and strengthened contents labelling of cigarette packets were mandated for cigarettes manufactured from 1 January 1995. PARTICIPANTS: Broadly representative samples of Australian smokers: 510 at baseline, and 512 at follow-up. Two hundred and forty-three of the baseline sample were also resurveyed. MEASUREMENTS: Self-report on effects of warnings and smoking cessation activity. FINDINGS: In the cross-sectional sample at follow-up, 66% of smokers reported at least sometimes noticing the health warnings when taking out a cigarette (compared with 37% at baseline), and 14% reported they had refrained from smoking on at least one occasion as a result (compared with 7% at baseline). Not smoking as a result of noticing the (old) warnings at baseline was predictive of quitting at follow-up. Frequency of stubbing out cigarettes before they were finished as a result of thinking about smoking-related harm was not affected by the new warnings, but was predictive of making quit attempts. CONCLUSIONS: The new health warnings were more potent at stimulating both thoughts about negative effects of smoking and the appropriate consequent action of not smoking the planned cigarette. This is important as spontaneous rejection of cigarettes predicted subsequent cessation.
Adolescent↗
Patients' beliefs about cancer management.
The results of a questionnaire answered by 205 medical patients are reported (100 patients with cancer and 105 with other medical conditions). The questionnaire examined beliefs and preferences regarding various aspects of cancer, including expectations of medical management and treatment. The issues examined relate to beliefs and preferences about information giving, trust of doctors' control of decision making, expectations of help, expectations of treatment, the treatment of cancer pain including morphine use, and issues of terminal care. Some patients appear to hold the inconsistent beliefs that doctors should tell them all they want to know, but that doctors do not know a lot of what they would like to be told. They were also ambivalent about who should make decisions, patient or doctor, suggesting a preference for collaborative consensus decision making. It may be important to inform patients more clearly about what doctors can and cannot reasonably be expected to know and do. Some incorrect beliefs about management were related to fear about having cancer. The results suggest the need for better communication between patients and their professional carers and the need for accessible health information about cancer management to be available to the general public.
Adult↗