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The public health white paper for England Choosing Health: Making Healthy Choices Easier (Department of Health (DH) 2004) was published last November. The RCN welcomed the white paper, which signalled [...]

Public health policy often involves implementing cost-efficient, large-scale interventions. When mandating or forbidding a specific behaviour is not permissible, public health professionals may draw on behaviour change interventions to achieve socially beneficial policy objectives. Interventions can have two main effects: (i) a direct effect on people initially targeted by the intervention; and (ii) an indirect effect mediated by social influence and by the observation of other people's behaviour. However, people's attitudes and beliefs can differ markedly throughout the population, with the result that these two effects can interact to produce unexpected, unhelpful and counterintuitive consequences. Public health professionals need to understand this interaction better. This paper illustrates the key principles of this interaction by examining two important areas of public health policy: tobacco smoking and vaccination. The example of antismoking campaigns shows when and how public health professionals can amplify the effects of a behaviour change intervention by taking advantage of the indirect pathway. The example of vaccination campaigns illustrates how underlying incentive structures, particularly anticoordination incentives, can interfere with the indirect effect of an intervention and stall efforts to scale up its implementation. Recommendations are presented on how public health professionals can maximize the total effect of behaviour change interventions in heterogeneous populations based on these concepts and examples. Les politiques de sante publique impliquent souvent I'organisation de campagnes rentables a grande echelle. Lorsqu'il est impossible d'imposer ou d'interdire certains comportements, les professionnels de la sante publique ont parfois recours a des actions induisant un changement de comportement afin d'atteindre des objectifs benefiques pour la societe. Ces actions sont susceptibles d'entrainer deux effets: (i) un effet direct sur les personnes initialement visees par la campagne; et (ii) un effet indirect provoque par la pression sociale et l'observation du comportement d'autres personnes. Neanmoins, les attitudes et croyances peuvent considerablement varier au sein de la population; ainsi, ces deux effets peuvent interagir et avoir des consequences imprevues, inefficaces et contre-intuitives. Les professionnels de la sante publique ont besoin de mieux comprendre cette interaction. Le present document en illustre donc les principes majeurs en examinant deux domaines cles des politiques de sante publique: le tabagisme et la vaccination. Lexemple des campagnes antitabac montre quand et comment les acteurs de la sante publique peuvent accentuer l'impact d'une action destinee a faire evoluer les comportements en optant pour l'approche indirecte. L'exemple des campagnes de vaccination met en lumiere la maniere dont les structures d'incitation sous-jacentes, en particulier celles favorisant l'anticoordination, peuvent interferer avec l'effet indirect d'une action et aneantir les efforts deployes pour la mettre en reuvre. Plusieurs recommandations sont formulees afin d'aider les professionnels de la sante publique a amplifier l'effet global des actions de changement comportemental au sein d'une population heterogene, en s'appuyant sur ces concepts et exemples. La politica de salud publica suele incluir la aplicacion de intervenciones rentables y a gran escala. Cuando no es posible imponer o prohibir un comportamiento especifico, los profesionales de la salud publica pueden recurrir a intervenciones de cambio de comportamiento para lograr objetivos politicos que sean favorables para la sociedad. Es posible que las intervenciones generen dos efectos principales: i) un efecto directo sobre las personas a las que en principio se dirige la intervention; y ii) un efecto indirecto mediado por la influencia social y por la observation del comportamiento de otras personas. Sin embargo, las actitudes y creencias de las personas pueden ser muy diferentes en toda la poblacion, por lo que estos dos efectos pueden interactuar y producir consecuencias inesperadas, poco utiles y contraproducentes. Los profesionales de la salud publica deben comprender mejor esta interaccion. Este documento explica los principios clave de esta interaccion al analizar dos areas importantes de la politica de salud publica: el tabaquismo y la vacunacion. El ejemplo de las campanas antitabaco muestra cuando y como los profesionales de la salud publica pueden aumentar los efectos de una intervention de cambio de comportamiento si se aprovecha el procedimiento indirecto. El ejemplo de las campanas de vacunacion explica como las estructuras subyacentes de incentivos, en particular los incentivos de descoordinacion, pueden interferir con el efecto indirecto de una intervention y detener los esfuerzos para ampliar su aplicacion. A partir de estos conceptos y ejemplos, se formulan recomendaciones sobre como los profesionales de la salud publica pueden maximizar el efecto total de las intervenciones de cambio de comportamiento en poblaciones heterogeneas., Introduction Public health policy objectives often conflict with local culture. (1-3) Thus, to avoid a backlash when trying to change people's behaviour, policy-makers may often resist policies that forbid or [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jpolmod.2008.12.006 Byline: Rajeev K. Goel Keywords: Cigarette advertising; Demand; Elasticities; Master Settlement Agreement Abstract: The effect of advertising on cigarette demand has been widely studied. Yet the demand-advertising nexus is not completely understood and there is little consensus in the literature. This paper sheds new light on the issue by examining the relationship using state-level data for the United States over three decades. Additional contributions include examining the effects of the Master Settlement Agreement, and studying the dynamic effects of advertising and smoking. Findings show that U.S. cigarette demand is inelastic, the income effects are mixed, advertising elasticities are relatively small, post-MSA advertising seems smoking-reducing and that the full effects of the MSA are probably still unfolding. Smoking habits tend to linger, while the effects of antismoking messages accompanying cigarette advertisements take time to be effective. Policy implications are discussed. Author Affiliation: Department of Economics, Illinois State University, Normal, IL 61790-4200, USA Article History: Received 1 April 2008; Revised 1 October 2008; Accepted 1 December 2008

The World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and Canadian Public Health Association (CPHA) developed the Global Tobacco Surveillance System (GTSS) to assist all 192 WHO Member States in collecting data on youth and adult tobacco use. The flexible GTSS system includes common data items but allows countries to include important unique information at their discretion. It uses a common survey methodology, similar field procedures for data collection, and similar data management and processing techniques. The GTSS includes collection of data through three surveys: the Global Youth Tobacco Survey (GYTS) for youth, and the Global School Personnel Survey (GSPS) and the Global Health Professional Survey (GHPS) for adults. GTSS data potentially can be applied in four ways. First, countries and research partners can disseminate data through publications, presentations, and an active GTSS web site. Second, countries can use GTSS data to inform politicians about the tobacco problem in their country, leading to new policy decisions to prevent and control tobacco use. Third, GTSS can provide countries with valuable feedback to evaluate and improve Country National Action Plans or develop new plans. Fourth, in response to the WHO FCTC call for countries to use consistent methods and procedures in their surveillance efforts, GTSS offers such consistency in sampling procedures, core questionnaire items, training in field procedures, and analysis of data across all survey sites. The GTSS represents the most comprehensive tobacco surveillance system ever developed and implemented. As an example, this paper describes development of the GYTS and discusses potential uses of the data. Sample data were drawn from 38 sites in 24 countries in the African Region, 82 sites in 35 countries in the Americas Region, 20 sites in 17 countries and the Gaza Strip/West Bank region in the Eastern Mediterranean Region, 25 sites in 22 countries in the European Region, 34 sites in six countries in the Southeast Asia Region, and 25 sites in 14 countries in the Western Pacific Region., Global Tobacco Surveillance System Collaborating Group Public health surveillance involves 'the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public [...]