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Evidence suggests that inflammation may be associated with a higher risk of endometrial cancer, but previous reviews have typically examined a limited number of biomarkers. This study aimed to critically appraise the evidence on the effect of 13 circulating inflammatory biomarkers on endometrial cancer risk. MEDLINE and EMBASE databases were searched for prospective cohort, (nested) case-control and case-cohort studies, and Mendelian randomization (MR) studies published up to 31 March 2023. We performed a random-effects meta-analysis to estimate the pooled risk ratio and 95 % confidence interval (CI) for the association between each biomarker and endometrial cancer risk. Heterogeneity between studies was assessed using the I 2 statistic. Eight studies were included in the meta-analysis. Comparing groups with the highest versus lowest concentration of biomarker, adiponectin levels were inversely associated with risk of endometrial cancer (risk ratio (RR) =0.75, 95 % CI: 0.57-0.99, I2: 9 %). Higher levels of CRP (RR=1.18, 95 % CI: 1.05-1.33, I 2 : 2 %) and TNF-α (RR=1.58, 95 % CI: 1.13-2.21, I 2 : 0 %) were positively associated with risk of endometrial cancer. There was suggestive evidence for a positive association was also found for IL-6 (RR=1.29, 95 % CI: 0.88-1.88, I 2 : 0 %) and leptin (RR=1.50, 95 % CI: 0.83-2.71, I 2 : 0 %). Our findings suggest that circulating inflammatory biomarkers are likely involved in the carcinogenesis of endometrial cancer. Future studies should consider prospective or MR design and measure a wider range of inflammatory markers., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Brigid M Lynch reports administrative support was provided by Cancer Council Victoria. Brigid M Lynch reports a relationship with Australasian Epidemiological Association that includes: board membership. Brigid M Lynch serves as an Associate Editor for Cancer Epidemiology If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Australia's National Bowel Cancer Screening Program (NBCSP) offers two-yearly screening to 50-74-year-olds for the prevention and early detection of colorectal cancer (CRC). Internationally, detailed reporting of participation across multiple screening rounds - also known as longitudinal adherence - is becoming more common, but remains limited in Australia. We described the longitudinal screening adherence of individuals by age and sex invited to the NBCSP at least once, and quantified longitudinal adherence among individuals who received four NBCSP invitations., Methods: We obtained aggregate national data for individuals who received at least one NBCSP invitation between 1 August 2006 and 31 March 2022. We described screening adherence patterns including longitudinal adherence among individuals who received four invitations, and evaluated prior longitudinal adherence and adherence at most recent invitation as predictors of future participation., Results: Over the study period, 8.5 million individuals were invited to screen in the NBCSP; 51.9% of these individuals screened at least once. Of the >2.5 million individuals who received four invitations, 23.3% consistently screened, 38.3% never screened, and 38.3% inconsistently screened. The longitudinal adherence at the fourth invitation round for individuals who previously returned none, one, two, or three of their previous three invitations was 9.5%, 37.4%, 70.1% and 88.8%, respectively. Both longitudinal adherence and adherence at the most recent invitation were significant predictors of future participation., Conclusion: Our study is the first detailed report of longitudinal adherence to the NBCSP in >2 screening rounds. These insights into long-term behaviours can inform planning for interventions to improve screening participation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: It was previously estimated that 1814 (1.6 % of incident cancers) were attributable to physical inactivity in Australia in 2010, when only three sites were considered. We estimated the burden of cancer due to physical inactivity in Australia for 13 sites., Design: The population attributable fraction estimated site-specific cancer cases attributable to physical inactivity for 13 cancers. The potential impact fraction was used to estimate cancers that could have been prevented in 2015 if Australian adults had increased their physical activity by a modest amount in 2004-05., Methods: We used 2004-05 national physical activity prevalence data, 2015 national cancer incidence data, and contemporary relative-risk estimates for physical inactivity and cancer. We assumed a 10-year latency period., Results: An estimated 6361 of the cancers observed in 2015 were attributable to physical inactivity, representing 4.8 % of all cancers diagnosed. If Australian adults had increased their physical activity by one category in 2004-05, 2564 cases (1.9 % of all cancers) could have been prevented in 2015., Conclusions: More than three times as many cancers are attributable to physical inactivity than previously reported. Physical activity promotion should be a central component of cancer prevention programmes in Australia., Competing Interests: Declaration of interest statement None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Tobacco harm reduction has potential to improve individual and population health. However, little research exists on low-intensity interventions, such as encouraging longer-term NRT or e-cigarette use. We aimed to determine whether: (1) encouraging use of nicotine products as long-term tobacco substitutes is more effective for smoking abstinence than standard treatment, and (2) offering e-cigarettes is more effective than NRT., Methods: An open-label, parallel-group randomized trial was conducted in Australia between 2014 and 2015, with 1563 adult daily smokers, randomized to: (A) standard cessation advice and NRT: advice to use NRT short-term, (B) quit or substitute advice and NRT: advice to use NRT as a longer-term substitute for smoking if required to maintain smoking cessation, or (C) Quit or substitute advice and NRT and/or e-cigarettes. Participants were offered an initial supply of products they could then purchase for up to 7 months. The primary outcome was self-reported continuous smoking abstinence at 7 months. Point prevalence, dual use, and cigarette reduction were secondary outcomes., Results: At 7 months, 2.8% (N = 9) of group A (N = 324) were abstinent, compared with 1.8% (N = 11) in B (N = 620) and 1.3% (N = 8) in C (N = 619) (adjusted odds ratio [ORs]: B vs. A 0.66, 95% confidence interval [CI]: 0.27-1.63; C vs. A 0.46, 95% CI: 0.17-1.21; C vs. B 0.69, 95% CI 0.27-1.73). There were no suspected unexpected serious adverse reactions associated with trial products., Conclusion: A free trial of NRT and first generation e-cigarettes and advice on long-term substitution was no better for smoking abstinence than usual care., Clinical Trial Registration: The trial was registered with the Australian Therapeutic Goods Administration under their Clinical Trials Notification scheme and the Australian and New Zealand Clinical Trials Registry (ACTRN12612001210864)., Implications: This pragmatic trial allowed the comparison of existing and alternative policy options under semi-realistic conditions, such as product choice and financial cost. All trial arms had low rates of smoking cessation. The findings suggest that providing unflavored cigalike e-cigarettes without additional support may not increase quitting compared with advice to use standard NRT in a general population of Australians who smoke. More intensive support and education, and/or opportunity to try a range of e-cigarette products, may be required to motivate quit attempts using e-cigarettes., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

No smoking signs (NSSs) that combine smoking symbols (SSs) and prohibition symbols (PSs) represent common examples of reward and prohibition competition. To evaluate how SSs within NSSs influence their effectiveness in guiding reward vs. prohibition, we studied 93 male smokers. We collected self-reported craving ratings (N=30), cue reactivity under fMRI/EEG (N=33), and smoking-behavior anticipation for paired NSSs and SSs (N=30). We found that NSS-induced cravings were negatively correlated with SS-induced cravings and PS-induced inhibition. fMRI indicated that both correlations were mediated by activation of the inferior frontal gyrus and precuneus, suggesting that the effects of SSs and PSs interact with each other. EEG revealed that the prohibition response occurs after the cigarette response, indicating that the cigarette response might be precluded by the prohibition, supporting the effect of SSs in discouraging smoking. Moreover, stronger SSs induced stronger slow positive waves and late positive potentials, and the stronger the late positive potentials, the stronger the late positive potentials. Both the amplitudes of late positive potentials and slow positive waves were positively correlated with the amplitude of N2, which was positively correlated with the attention grabbed score by the NSS. In addition, the weaker the NSS-induced craving, the greater the smoking behavior anticipation reduction, indicating the capability of NSSs to decrease smoking behavior. Our study provides empirical evidence for selecting the most effective NSSs: those combining strong SS and PS, offering insights about competition between cigarette reward and prohibition and providing neural evidence on how cigarette reward and prohibition interact., Competing Interests: Declaration of Competing Interest The authors report no biomedical financial interests or potential conflicts of interest., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: To evaluate the pattern of use of single-fraction conformal radiation therapy (SF-RT) and advanced radiation therapy techniques (ART), including stereotactic body radiation therapy (SBRT), for management of bone metastases (BM) in a population-based cohort of Australian men with prostate cancer (PCa) PATIENT AND METHODS: We reviewed men with metastatic PCa who received RT for BM between 2012 and 2017 as captured in the statewide Victorian Radiotherapy Minimum Data Set (VRMDS). The primary outcomes were: proportion of RT courses using SF-RT and ART. The Cochrane-Armitage test for trend was used to evaluate the changing pattern of SF-RT and ART over time. Multivariate analyses were used to identify factors associated with the primary outcomes RESULTS: Of the 4,324 courses of palliative RT for BM, 767 (17.7%) were SF-RT, and 615 (14.2%) were ART. There was no evidence of change in SF-RT use over time (P-trend=0.13). In multivariate analyses, increasing age at RT, site of BM (rib, shoulder, pelvis, and extremities), patients' area of residence (regional and remote), and treatment in public and metropolitan centres were associated with increased likelihood of SF-RT use. There was marked increase in ART use from 0.2% in 2012 to 24% in 2017 (11% intensity modulated RT, 13% SBRT) (P-trend<0.001). In multivariate analyses, younger age at RT, site of BM (rib and pelvis), higher socioeconomic status, and treatment in private and metropolitan centres were associated with increased likelihood of ART use., Conclusion: SF-RT continues to be a clear minority of RT schedules employed in management of BM in PCa, and the adoption of SF-RT use should be encouraged in men with limited prognosis. There has been increasing use of ART, especially SBRT, for BM in PCa over time, and we expect this will continue to increase in the era of metastatic-directed treatment for PCa., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Sugar-sweetened beverage (SSB) consumption is associated with obesity and other severe negative health consequences. The present study examined the effectiveness of two types of health warning labels (HWLs) in modulating dietary choices for SSBs: specific HWLs, presenting health consequences associated with consuming SSBs, and general HWLs, presenting health consequences of an unhealthy diet and obesity. While electroencephalography (EEG) was recorded, 63 participants completed a computer-based task in which they were first randomly allocated to view either SBB-specific, general, or non-warning control HWLs. They then viewed images of a range of SSB products, varying on perceived healthiness and tastiness, and rated their willingness to consume (WTC) each one. Linear mixed-effect model analyses revealed that general and specific HWLs both decreased WTC SSBs perceived as tasty, compared to the control condition. For general HWLs, this effect was reduced for SSBs perceived to be healthy, suggesting that specific HWLs may be more effective at reducing SSB consumption. The EEG data showed that SSBs considered unhealthy elicited greater N1 amplitudes, and tasty SSBs elicited greater late positive potential (LPP) amplitudes, possibly reflecting attentional allocation and craving responses, respectively. However, no strong differences between HWL types were found. Taken together, the results suggest that graphic HWLs, both general and specific, have the potential to reduce SSB consumption, but they do not strongly modulate craving-related neural responses to SSBs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: To estimate the extent of measurement error in the Active Australia questionnaire, and to examine the impact of measurement error on the association of moderate-vigorous physical activity (MVPA) with obesity., Design: Accelerometer Validation Study, cross-sectional; data from the third wave of a prospective cohort (Australian Diabetes, Obesity, and Lifestyle (AusDiab) Study))., Methods: Self-reported physical activity data were obtained from 4005 participants of the third wave of the AusDiab study via the Active Australia questionnaire. Accelerometer-derived physical activity data were obtained from a subsample of 670 participants. Validity coefficients and attenuation factors were estimated from a measurement error model. A regression calibration method was applied to a logistic regression model examining the association between self-reported MVPA and obesity to adjust observed odds ratios (OR) for measurement error., Results: The validity coefficient was 0.35 (0.28, 0.43) and the attenuation factor was 0.16 (0.13, 0.20) in models adjusted for age and sex. The uncorrected OR for obesity for 210min/week of MVPA (50th percentile) relative to 80min/week (25th percentile) was 0.87 (0.85, 0.90). The attenuation factor was used to adjust this OR for measurement error, giving a corrected OR of 0.43 (0.32, 0.55)., Conclusions: Substantial measurement error (relative to accelerometry) was evident in the Active Australia questionnaire, leading to attenuation of the association of MVPA with obesity. A regression-calibration method can be used to adjust risk estimates for associations between self-reported MVPA and health-related outcomes for measurement error specific to self-report. These corrected risk estimates reflect associations that would be expected if MVPA were measured by accelerometry., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: The Movember funded TrueNTH Global Registry (TNGR) aims to improve care by collecting and analysing a consistent dataset to identify variation in disease management, benchmark care delivery in accordance with best practice guidelines and provide this information to those in a position to enact change. We discuss considerations of designing and implementing a quality of care report for TNGR., Methods: Eleven working group sessions were held prior to and as reports were being built with representation from clinicians, data managers and investigators contributing to TNGR. The aim of the meetings was to understand current data display approaches, share literature review findings and ideas for innovative approaches. Preferred displays were evaluated with two surveys (survey 1: 5 clinicians and 5 non-clinicians, 83% response rate; survey 2: 17 clinicians and 18 non-clinicians, 93% response rate)., Results: Consensus on dashboard design and three data-display preferences were achieved. The dashboard comprised two performance summary charts; one summarising site's relative quality indicator (QI) performance and another to summarise data quality. Binary outcome QIs were presented as funnel plots. Patient-reported outcome measures of function score and the extent to which men were bothered by their symptoms were presented in bubble plots. Time series graphs were seen as providing important information to supplement funnel and bubble plots. R Markdown was selected as the software program principally because of its excellent analytic and graph display capacity, open source licensing model and the large global community sharing program code enhancements., Conclusions: International collaboration in creating and maintaining clinical quality registries has allowed benchmarking of process and outcome measures on a large scale. A registry report system was developed with stakeholder engagement to produce dynamic reports that provide user-specific feedback to 132 participating sites across 13 countries.

Demand characteristics are thought to undermine the validity of psychological research, but the extent to which participant awareness of study hypotheses affects laboratory-measured eating behaviour studies has received limited attention. Participants (N = 84) attended two laboratory sessions in which food intake was measured. In session 1 baseline food intake was measured. In session 2 participants were allocated to either a 'hypothesis aware' or 'hypothesis unaware' condition. Participants were led to believe in the 'hypothesis aware' condition that they were expected to increase their food intake in session 2 relative to session 1. Participants in the 'hypothesis unaware' condition were not provided with hypothesis information. Contrary to our pre-registered predictions, the experimental manipulation of hypothesis awareness did not affect session 2 food intake. However, the manipulation was less effective than anticipated as some participants did not appear to believe the hypothesis information provided. Post-hoc exploratory analyses revealed that participants who believed the study hypothesis was that their food intake would increase in session 2 ate more in session 2 than participants who did not believe this was the study hypothesis. Further confirmatory research is required to understand the causal effect that participant awareness of study hypotheses has on laboratory measured eating behaviour., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Causes of variations in outcomes from cancer care in developed countries are often unclear. Australia has developed health system pathways describing consensus standards of optimal cancer care across the phases of prevention through to follow-up or end-of-life. These Optimal Care Pathways (OCP) were introduced from 2013 to 14. We investigated whether care consistent with the OCP improved outcomes for colon cancer patients., Methods: Colon patients diagnosed from 2008 to 2014 were identified from the Australian State of Victoria Cancer Registry (VCR) and cases linked with State and Federal health datasets. Surrogate variables describe OCP alignment in our cohort, across three phases of the pathway; prevention, diagnosis and initial treatment and end-of-life. We assessed the impact of alignment on (1) stage of disease at diagnosis and (2) overall survival., Findings: Alignment with the prevention phase of the OCP occurred for 88% of 13,539 individuals and was associated with lower disease stage at diagnosis (OR = 0.33, 95% confidence interval 0.24 to 0.42), improved crude three-year survival (69.2% versus 62.2%; p < 0.001) and reduced likelihood of emergency surgery (17.7% versus 25.6%, p < 0.001). For patients treated first with surgery (n = 10,807), care aligned with the diagnostic and treatment phase indicators (44% of patients) was associated with a survival benefit (risk-adjusted HR non-aligned vs aligned  = 1.23, 95% confidence interval 1.13 to 1.35), better perioperative outcomes and higher alignment with follow-up and end-of-life care. The survival benefit persists adjusting for potential confounding factors, including age, sex, disease stage and comorbidity.Interpretation.This population-based study shows that care aligned to a pathway based on best principles of cancer care is associated with improved outcomes for patients with colon cancer., Funding: None., Competing Interests: All authors declare no competing interests., (© 2019 Published by Elsevier Ltd.)

Aims: In Australia, sales of nicotine containing electronic cigarettes (also known as e-cigarette) are banned unless approved as a therapeutic good. The aims of this study were to estimate the prevalence of e-cigarette use and its correlates in Australia using a nationally representative survey., Method: We analysed data from the largest drug use survey in Australia (the National Drug Strategy Household Survey [NDSHS]; N = 22,354)., Results: We estimated that 227,000 Australians (1.2% of the population) were current e-cigarettes users, and 97,000 (0.5%) used them daily. Individuals who were male, younger, had higher level of psychological distress, and smoked were more likely to use electronic cigarettes. Among smokers, an intention to quit and reduction in smoking was associated with experimentation and daily use of e-cigarette, but not with occasional use. Recent quitting was associated with daily use., Conclusion: Overall, the prevalence of e-cigarette use was low in 2016 in Australia. Smoking status was the strongest correlates of e-cigarette use. Patterns of vaping were differentialy associated with an intention to quit smoking, smoking reduction and recent quitting. Some smokers may attempt to use e-cigarettes to cut-down their tobacco use, and those who vaped daily were mostly likely to be recent quitters., (Copyright © 2019. Published by Elsevier Ltd.)

The association between obesity and bronchial hyperresponsiveness (BHR) is incompletely characterised. Using the 2006 follow-up of the Tasmanian Longitudinal Health Study, we measured the association between obesity and BHR and whether it was mediated by small airway closure or modified by asthma and sex of the patient.A methacholine challenge measured BHR. Multivariable logistic regression measured associations between body mass index (BMI) and BHR, adjusting for sex, asthma, smoking, corticosteroid use, family history and lung function. Mediation by airway closure was also measured.Each increase in BMI of 1 kg·m -2 was associated with a 5% increase in the odds of BHR (OR 1.05, 95% CI 1.01-1.09) and 43% of this association was mediated by airway closure. In a multivariable model, BMI (OR 1.06, 95% CI 1.00-1.16) was associated with BHR independent of female sex (OR 3.26, 95% CI 1.95-5.45), atopy (OR 2.30, 95% CI 1.34-3.94), current asthma (OR 5.74, 95% CI 2.79-11.82), remitted asthma (OR 2.35, 95% CI 1.27-4.35), low socioeconomic status (OR 2.11, 95% CI 1.03-4.31) and forced expiratory volume in 1 s/forced vital capacity (OR 0.86, 95% CI 0.82-0.91). Asthma modified the association with an increasing probability of BHR as BMI increased, only in those with no or remitted asthma.An important fraction of the BMI/BHR association was mediated via airway closure. Conflicting findings in previous studies could be explained by failure to consider this intermediate step., Competing Interests: Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com, (Copyright ©ERS 2017.)

Purpose: Evaluate the perceived effectiveness of key antismoking messages among highly disadvantaged smokers and assess the impact of nicotine dependence and cessation cognitions on message processing., Design: The experimental crossover trial, undertaken between March and December 2012, randomly exposed participants to two of three antismoking advertisements delivered via touchscreen computer., Setting: Welfare recipients were recruited from a community service organization in New South Wales, Australia., Subjects: Subjects were 354 smokers (79% response rate). Participants resided in government rental housing (52%), earned less than AUD$400/wk (72%), and received their primary income from government welfare (95%)., Intervention: Three 30-second antismoking television advertisements representing common campaign themes: why to quit (graphic imagery), why to quit (personal testimonial), or how to quit., Measures: An 11-item scale assessed perceived effectiveness and message acceptance. An eight-item cessation cognitions index assessed motivations and readiness to quit, and the heaviness of smoking index was used to classify nicotine dependence., Analysis: Descriptive statistics, generalized linear mixed models, and multiple linear regression analyses are reported., Results: Why-to-quit advertisements were perceived as significantly more effective than the how-to-quit advertisement (all p < .0001). Smokers with positive cessation cognitions were more likely to accept antismoking messages (p = .0003) and perceive them as effective (p < .0001). Nicotine dependence level did not influence message acceptance (p = .7322) or effectiveness (p = .8872)., Conclusion: Highly emotive advertisements providing good reasons to quit may be the most effective in promoting the antismoking message among groups with high smoking rates.

This paper provides a brief introduction to CEOS theory, a comprehensive theory for understanding hard to maintain behaviour change. The name CEOS is an acronym for Context, Executive, and Operational Systems theory. Behaviour is theorised to be the result of the moment by moment interaction between internal needs (operational processes) in relation to environmental conditions, and for humans this is augmented by goal-directed, executive action which can transcend immediate contingencies. All behaviour is generated by operational processes. Goal-directed behaviours only triumph over contingency-generated competing behaviours when operational processes have been sufficiently activated to support them. Affective force can be generated around executive system (ES) goals from such things as memories of direct experience, vicarious experience, and emotionally charged communications mediated through stories the person generates. This paper makes some refinements and elaborations of the theory, particularly around the role of feelings, and of the importance of stories and scripts for facilitating executive action. It also sketches out how it reconceptualises a range of issues relevant to behaviour change. CEOS provides a framework for understanding the limitations of both informational and environmental approaches to behaviour change, the need for self-regulatory strategies and for taking into account more basic aspects of human functioning., (© 2016 The Authors. Applied Psychology: Health and Well-Being published by John Wiley & Sons Ltd on behalf of International Association of Applied Psychology.)

Background and Aims: Little is known about the factors associated with retention in smoking cessation trials, especially for low-socioeconomic status (low-SES) smokers. This study examined the factors associated with retention of low-SES smokers in the Australian Financial Interventions for Smoking Cessation Among Low-Income Smokers (FISCALS) trial., Design: A two-group parallel block randomised open-label trial with allocation concealment., Setting: Australia. The study was conducted primarily by telephone-based interviews with nicotine replacement therapy delivered via mail., Participants: 1047 low-SES smokers interested in quitting smoking were randomised., Measurements: Participants completed computer assisted telephone interviews (CATIs) at baseline, 2-month and 8-month follow-up. Smoking-related, substance use, mental or physical health, general psychological constructs, sociodemographic and recruitment sources association with retention at 8-month follow-up were examined using binary logistic regression., Findings: 946 participants (90%) completed the 2-month follow-up interview and 880 participants (84%) completed the 8-month follow-up interview. Retention at 8-months was associated with higher motivation to quit (OR: 1.15; 95% CI: 1.04, 1.27 p<0.01), more recent quit attempts (OR: 1.20; 95% CI: 1.04, 1.40 p<0.05), increasing age (OR: 1.05; 95% CI: 1.03, 1.07 p<0.01), and higher level of education (OR: 2.24; 95% CI: 1.45, 3.46 p<0.01). Lower retention at 8-months occurred for those participants recruited from posters placed in Department of Human Service Centrelink Offices (OR: 0.56; 95% CI: 0.35, 0.89, p<0.05) compared to participants recruited from Quitline services. No significant differences in retention were found for participants recruited via newspaper advertisements or word of mouth compared to Quitline services. No significant associations were found between health-related or behavioural factors and retention., Conclusions: In the context of high overall retention rates from disadvantaged smokers in a randomised trial, retention was greater in those smokers with higher motivation to quit, more recent quit attempts, increased age, higher level of education and for those recruited through Quitline or newspaper advertisements., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Previous research has shown that front-of-pack labels (FoPLs) can assist people to make healthier food choices if they are easy to understand and people are motivated to use them. There is some evidence that FoPLs providing an assessment of a food's health value (evaluative FoPLs) are easier to use than those providing only numerical information on nutrients (reductive FoPLs). Recently, a new evaluative FoPL (the Health Star Rating (HSR)) has been introduced to Australia and New Zealand. The HSR features a summary indicator, differentiating it from many other FoPLs being used around the world. The aim of this study was to understand how consumers of all ages use and make sense of reductive FoPLs and evaluative FoPLs including evaluative FoPLs with and without summary indicators. Ten focus groups were conducted in Perth, Western Australia with adults (n = 50) and children aged 10-17 years (n = 35) to explore reactions to one reductive FoPL (the Daily Intake Guide), an existing evaluative FoPL (multiple traffic lights), and a new evaluative FoPL (the HSR). Participants preferred the evaluative FoPLs over the reductive FoPL, with the strongest preference being for the FoPL with the summary indicator (HSR). Discussions revealed the cognitive strategies used when interpreting each FoPL (e.g., using cut offs, heuristics, and the process of elimination), which differed according to FoPL format. Most participants reported being motivated to use the evaluative FoPLs (particularly the HSR) to make choices about foods consumed as part of regular daily meals, but not for discretionary foods consumed as snacks or deserts. The findings provide further evidence of the potential utility of evaluative FoPLs in supporting healthy food choices and can assist policy makers in selecting between alternative FoPL formats., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Unlabelled: Hepatocellular carcinoma (HCC) incidence is rising rapidly in many developed countries. Primary epidemiological data have invariably been derived from cancer registries that are heterogeneous in data quality and registration methodology; many registries have not adopted current clinical diagnostic criteria for HCC and still rely on histology for classification. We performed the first population-based study in Australia using current diagnostic criteria, hypothesizing that HCC incidence may be higher than reported. Incident cases of HCC (defined by American Association for the Study of Liver Diseases diagnostic criteria or histology) were prospectively identified over a 12-month period (2012-2013) from the population of Melbourne, Australia. Cases were captured from multiple sources: admissions to any of Melbourne's seven tertiary hospitals; attendances at outpatients; and radiology, pathology, and pharmacy services. Our cohort was compared to the Victorian Cancer Registry (VCR) cohort (mandatory notified cases) for the same population and period, and incidence rates were compared for both cohorts. There were 272 incident cases (79% male; median age: 65 years) identified. Cirrhosis was present in 83% of patients, with hepatitis C virus infection (41%), alcohol (39%), and hepatitis B virus infection (22%) the commonest etiologies present. Age-standardized HCC incidence (per 100,000, Australian Standard Population) was 10.3 (95% confidence interval [CI]: 9.0-11.7) for males and 2.3 (95% CI: 1.8 to 3.0) for females. The VCR reported significantly lower rates of HCC: 5.3 (95% CI: 4.4 to 6.4) and 1.0 (95% CI: 0.7 to 1.5) per 100,000 males and females respectively (P < 0.0001)., Conclusions: HCC incidence in Melbourne is 2-fold higher than reported by cancer registry data owing to under-reporting of clinical diagnoses. Adoption of current diagnostic criteria and additional capture sources will improve registry completeness. Chronic viral hepatitis and alcohol remain leading causes of cirrhosis and HCC., (© 2015 by the American Association for the Study of Liver Diseases.)

Aim: To examine whether peripheral blood methylation is associated with risk of developing mature B-cell neoplasms (MBCNs)., Materials & Methods: We conducted a case-control study nested within a large prospective cohort. Peripheral blood was collected from healthy participants. Cases of MBCN were identified by linkage to cancer registries. Methylation was measured using the Infinium(®) HumanMethylation450., Results: During a median of 10.6-year follow-up, 438 MBCN cases were evaluated. Global hypomethylation was associated with increased risk of MBCN (odds ratio: 2.27, [95% CI: 1.59-3.25]). Within high CpG promoter regions, hypermethylation was associated with increased risk (odds ratio: 1.76 [95% CI: 1.25-2.48]). Promoter hypermethylation was observed in HOXA9 and CDH1 genes., Conclusion: Aberrant global DNA methylation is detectable in peripheral blood collected years before diagnosis and is associated with increased risk of MBCN, suggesting changes to DNA methylation are an early event in MBCN development.

Objective: To assess whether body mass index (BMI) modifies the associations of lipids with coronary heart disease (CHD)., Methods: In the Asia Pacific Cohort Studies Collaboration, total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and triglycerides (TG) were measured for 333,297, 71,777 and 84,015 participants, respectively. All participants had measured BMI, categorized into underweight, normal, high-normal, overweight and obese, using standard definitions. For each BMI subgroup the effects of lipids on CHD were estimated per 1 standard deviation (SD) increase using Cox proportional hazard models, stratified by study and sex, adjusted for age and smoking. They were compared across the BMI groups, testing for interactions., Results: In the analyses for TC, HDLC and TG, there were 3121, 714 and 808 CHD events during a mean follow-up of 6.7 years. The risk of CHD increased monotonically with increasing TC and decreasing HDLC in all BMI subgroups without evidence of heterogeneity (p for interaction > 0.4). In contrast, the hazard ratio for CHD for a one SD increase in log-transformed TG increased from 1.07 (95%CI 0.72-1.59) in underweight, 1.26 (1.10-1.44) in normal weight, 1.27 (1.08-1.49) in high-normal weight, 1.37 (1.22-1.55) in overweight, to 1.61(1.30-1.99) in obesity (p = 0.01 for interaction trend). These associations were attenuated (p = 0.07 for interaction) but remained significant in the overweight and obese after further adjustment for TC and HDLC., Conclusions: Greater excess body weight exacerbated the effects of TG, but not TC or HDLC, on CHD, suggesting that additional effort is required to reduce TG in the overweight and obese.

Background: Successful obesity prevention will require a leading role for governments, but internationally they have been slow to act. League tables of benchmark indicators of action can be a valuable advocacy and evaluation tool., Objective: To develop a benchmarking tool for government action on obesity prevention, implement it across Australian jurisdictions and to publicly award the best and worst performers., Design: A framework was developed which encompassed nine domains, reflecting best practice government action on obesity prevention: whole-of-government approaches; marketing restrictions; access to affordable, healthy food; school food and physical activity; food in public facilities; urban design and transport; leisure and local environments; health services, and; social marketing. A scoring system was used by non-government key informants to rate the performance of their government. National rankings were generated and the results were communicated to all Premiers/Chief Ministers, the media and the national obesity research and practice community., Results: Evaluation of the initial tool in 2010 showed it to be feasible to implement and able to discriminate the better and worse performing governments. Evaluation of the rubric in 2011 confirmed this to be a robust and useful method. In relation to government action, the best performing governments were those with whole-of-government approaches, had extended common initiatives and demonstrated innovation and strong political will., Conclusion: This new benchmarking tool, the Obesity Action Award, has enabled identification of leading government action on obesity prevention and the key characteristics associated with their success. We recommend this tool for other multi-state/country comparisons., (Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Aims: To examine the association between diabetes, and ageing 12 years later., Methods: Subjects reporting angina, cancer, heart attack or stroke at baseline (1990-1994) were excluded. Diabetes at baseline was identified by self-report or elevated plasma glucose (≥ 7.0 mmol/l fasting or ≥ 11.1 mmol/l non-fasting). 6431 eligible men and women had survived to age 70 years at follow-up (2003-2007), and 5704 with complete data were included in these analyses. Those without ischemic heart disease, stroke, and cancer, no perceived major difficulty with physical functioning, and no evidence of psychological distress were considered to have aged successfully, irrespective of diabetes at follow-up (n=1271). Logistic regression was used to examine the independent association between baseline diabetes and successful ageing., Results: At baseline 216 eligible people were identified with diabetes. This was inversely associated with successful ageing at follow-up independent of smoking, physical activity, alcohol use and obesity (OR 0.65, 95% 0.42-0.99), Of the people with diabetes at follow-up, only 12.5% did not have another condition characteristic of usual ageing, compared with 22.7% of people who did not have diabetes., Conclusions: Diabetes is strongly associated with factors characterising less successful ageing, suggesting that the impact of diabetes may be larger than currently estimated., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: While television advertisements (ads) that communicate the serious harms of smoking are effective in prompting quitting-related thoughts and actions, little research has been conducted among smokers in low- to middle-income countries to guide public education efforts., Method: 2399 smokers aged 18-34 years in 10 low- to middle-income countries (Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey and Vietnam) viewed and individually rated the same five anti-smoking ads on a standard questionnaire and then engaged in a structured group discussion about each ad. Multivariate logistic regression analysis, with robust SEs to account for the same individual rating multiple ads, was performed to compare outcomes (message acceptance, perceived personalised effectiveness, feel uncomfortable, likelihood of discussing the ad) across ads and countries, adjusting for covariates. Ads by country interactions were examined to assess consistency of ratings across countries., Results: Three ads with graphic imagery performed consistently highly across all countries. Two of these ads showed diseased human tissue or body parts, and a third used a disgust-provoking metaphor to demonstrate tar accumulation in smokers' lungs. A personal testimonial ad performed more variably, as many smokers did not appreciate that the featured woman's lung cancer was due to smoking or that her altered physical appearance was due to chemotherapy. An ad using a visual metaphor for lung disease was also more variable, mostly due to lack of understanding of the term 'emphysema'., Conclusion: Television ads that graphically communicate the serious harms of tobacco use are likely to be effective with smokers in low- to middle-income countries and can be readily translated and adapted for local use. Ads with complex medical terms or metaphors, or those that feature personal testimonials, are more variable and at least require more careful pre-testing and adaptation to maximise their potential.

Issue Addressed: To examine the prevalence and socio-demographic distribution of adherence to national dietary and physical activity recommendations among Australian secondary school students., Methods: Cross-sectional survey of 12,188 students in Years 8 to 11 (aged 12-17 years). Students' self-reported eating, physical activity and sedentary behaviours were assessed using validated instruments administered via an online questionnaire., Results: Less than one-quarter of students (24%) reported meeting the daily requirement of at least four serves of vegetables, while 41% reported consuming the recommended three or more daily serves of fruit. Just 15% of students reported engaging in at least 60 minutes of moderate-to-vigorous activity every day, and only one in five students met the recommendation of spending no more than two hours per day in small screen recreation. Males were performing better than females in terms of fruit intake and physical activity, but worse in relation to frequency of consumption of sugary drinks and fast food, and time spent using electronic media. The proportion of students meeting fruit and vegetable recommendations declined with advancing year level, while lower socio-economic position (SEP) students were faring less well than those from high SEP neighbourhoods, particularly with regards to healthy eating., Conclusions: There is considerable scope for improving young people's health behaviours in line with national dietary and physical activity recommendations.

Objective: To assess interest in quitting smoking and quitting activity, and the use of pharmacotherapy and behavioural cessation support, among Australian smokers between 2002 and 2009., Methods: Data were taken from 3303 daily smokers taking part in a minimum of two consecutive waves of the International Tobacco Control Four Country Survey. Using weighted data to control for sampling and attrition, we explored any effects due to age, sex, whether living in a metropolitan or regional area, and nicotine dependence., Results: Around 40% of smokers reported trying to quit and, of these, about 23% remained abstinent for at least one month when surveyed. Low socioeconomic smokers were less likely to be interested in quitting and less likely to make a quit attempt. Reported use of prescription medication to quit smoking rose sharply at the last wave with the addition of varenicline to the pharmaceutical benefits scheme. Among those who tried, use of help rose gradually from 37% in 2002 to almost 59% in 2009 (including 52% using pharmacotherapy and 15% using behavioural forms of support)., Implications: Use of help to quit is now the norm, especially among more dependent smokers. This may reflect a realization among smokers that quitting unassisted is more likely to fail than quitting with help, as well as the cumulative effect of promoting the use of help. Given the continuing high levels of failed quit attempts, services need to be able to expand to meet this increasing demand., (© 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.)

This paper explores the application of fuzzy causal networks (FCNs) to evaluating effect of health warnings in influencing Australian smokers' psychosocial and quitting behaviour. The sample data used in this study are selected from the International Tobacco Control Policy Evaluation Survey project. Our research findings have demonstrated that new health warnings implemented in Australia have obvious impacts on smokers' psychosocial and quitting behaviours. FCN is a useful framework to investigate such impacts that overcome the limitation of using traditional statistical techniques, such as linear regression and logistics regression, to analyse non-linear data.

Objective: To replicate findings that risk-minimizing and self-exempting beliefs lower quit intentions, and to extend this by testing their capacity to prospectively predict smoking cessation., Method: 13,324 adult (> or =18 years) cigarette smokers from the USA, Canada, UK, and Australia from one of the first three waves (2002-2004) of the International Tobacco Control 4-Country survey were employed for the predictive analysis where beliefs measured in one wave (1-3) of a cohort were used to predict cessation outcomes in the next wave (2-4)., Results: Both types of belief were negatively associated with both intention to quit in the same wave and making a quit attempt at the next wave. When taken together and controlling for demographic factors, the risk-minimizing beliefs continued to be predictive, but the self-exempting belief was not. Some of the effects of risk-minimizing beliefs on quit attempts seem to be independent of intentions, but not consistently independent of other known predictors. There were no consistent predictive effects on sustained cessation among those who made attempts to quit for either measure., Conclusions: Countering risk-minimizing beliefs may facilitate increased quitting, but this may not be so important for self-exempting beliefs.

Objective: To compare trends in smoking prevalence between 1996 and 2005 among Indigenous and non-Indigenous secondary students across Australia., Methods: Representative random samples of secondary students aged 12-17 years completed self-report anonymous surveys. Questionnaires assessed any cigarette smoking in lifetime, and smoking in past month, week and on at least three of the previous seven days. Intention to smoke in the next 12 months was assessed on a 7-point scale. Students self-identified as being of Aboriginal or Torres Strait Islander descent., Results: Three to four per cent of students identified as being Indigenous at each survey. Smoking was more common among Indigenous than non-Indigenous students. Between 1996 and 2005, the proportion of smoking declined among both Indigenous and non-Indigenous students. However, among 12-15 year olds, the rate of decline was different for the two groups. Among non-Indigenous students in this age group, prevalence decreased steadily between 1996 and 2005. Among Indigenous students, the decrease mainly occurred between 1999 and 2002. Smoking intention was higher for Indigenous than non-Indigenous students. The mean intention decreased between 1996 and 2005 among both student groups., Conclusions: Smoking prevalence decreased among both Indigenous and non-Indigenous students between 1996 and 2005., Implications: Reductions in Indigenous students' tobacco use and intentions coincided with a period of increased tobacco control activity, suggesting that these activities may positively influence smoking behaviours.

Bladder cancer is a major health concern for older males in Western populations. About 30 years ago there was a suggestion that nutrition may have a role in the aetiology of the disease. Although the literature has been accumulating since then, owing to heterogeneity between studies results have often been inconsistent and unclear. The aim of this paper was to present an updated summary of the scientific evidence on the association between nutrition, total fluid intake and bladder cancer. A search of computerized databases, PubMed, ISI, Embase and Cochrane Library, was conducted to identify all epidemiological studies published between 1966 and October 2007. The level of scientific evidence for the various nutritional factors and total fluid intake was ranked according to the number of studies reporting a statistically significant association and the existence of mechanistic evidence. The levels of association were based on a ranking of statistically significant relative risks. Fruit and yellow-orange vegetables, particularly carrots and selenium, are probably associated with a moderately reduced risk of bladder cancer. Citrus fruits and cruciferous vegetables were also identified as having a possible protective effect. Possible risk factors are salted and barbecued meat, pork, total fat, pickled vegetables, salt, soy products, spices and artificial sweeteners. No clear association could be determined for beef, eggs, processed meats and total fluid intake. In conclusion, specific fruit and vegetables may act to reduce the risk of bladder cancer. Future studies on bladder cancer should investigate the effect of food categorization, amount and gender.

Recent cross-sectional data suggests that smokers tend to reduce smoking following a failed self-initiated quit attempt, possibly motivated by the need to reduce harms or to facilitate future quitting or both. This study prospectively examined changes in cigarette consumption among adult smokers who relapsed from a quit attempt. It uses data from the first three waves of the International Tobacco Control Four-Country Survey (ITC-4), a random digit-dialed telephone survey of a cohort of over 9,000 adult smokers from the United Kingdom, United States, Canada, and Australia, followed up annually. Compared with those who did not make a quit attempt, relapsers were more likely to reduce consumption (average reduction of 0.7 vs. 3.4, respectively) over a mean period of 7 months between waves 1 and 2. Of the relapsers, 52% reduced their consumption by 5% or more, but 22% increased it. Smokers who smoked heavily at baseline, whose last quit attempt ended more recently, was of longer duration, and quit via a gradual cut-down method were all independently associated with reducing smoking following a failed attempt. These findings were similar across all four countries and were successfully replicated using waves 2-3 data. Change in consumption between waves 1 and 2 (whether increase or decrease) was maintained by a substantial number a year later (wave 3), but change did not undermine nor promote quitting between waves 2 and 3.

Objective: To identify models of peer support for cancer patients and systematically review evidence of their effectiveness in improving psychosocial adjustment., Methods: CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and PsychINFO databases were used to identify relevant literature published from 1980 to April 2007. Data on characteristics of the peer-support program, sample size, design, measures, and findings were extracted and papers were also rated with respect to research quality (categories 'poor', 'fair' or 'good')., Results: Forty-three research papers that included data from at least 1 group were reviewed in detail, including 26 descriptive papers, 8 non-randomized comparative papers, and 10 papers reporting eight randomized controlled trials (RCTs). Five models of peer support were identified: one-on-one face-to-face, one-on-one telephone, group face-to-face, group telephone, and group Internet., Conclusion: Papers indicated a high level of satisfaction with peer-support programs; however, evidence for psychosocial benefit was mixed., Practice Implications: One-on-one face-to-face and group Internet peer-support programs should be given priority when considering ways to offer peer support. Nevertheless, the other models discussed in this review should not be dismissed until further research is conducted with a wide range of cancer populations.

Television (TV) food advertising has attracted criticism for its potential role in promoting unhealthy dietary practices among children. Content analyses indicate junk food advertising is prevalent on Australian children's TV; healthy eating is rarely promoted. This paper presents (a) a cross-sectional survey examining associations between children's regular TV viewing habits and their food-related attitudes and behaviour; and (b) an experiment assessing the impact of varying combinations of TV advertisements (ads) for unhealthy and healthy foods on children's dietary knowledge, attitudes and intentions. The experimental conditions simulated possible models for regulating food ads on children's TV. Participants were 919 grade five and six students from schools in Melbourne, Australia. The survey showed that heavier TV use and more frequent commercial TV viewing were independently associated with more positive attitudes toward junk food; heavier TV use was also independently associated with higher reported junk food consumption. The experiment found that ads for nutritious foods promote selected positive attitudes and beliefs concerning these foods. Findings are discussed in light of methodological issues in media effects research and their implications for policy and practice. It is concluded that changing the food advertising environment on children's TV to one where nutritious foods are promoted and junk foods are relatively unrepresented would help to normalize and reinforce healthy eating.

The objective of this study was to determine the feasibility and acceptability of a referral and outcall programme from a telephone-based information and support service, for men newly diagnosed with colorectal or prostate cancer. A block randomized controlled trial was performed involving 100 newly diagnosed colorectal and prostate cancer patients. Patients were referred to the Cancer Information Support Service (CISS) through clinicians at diagnosis. Clinicians were randomized into one of three conditions. Active referral 1: specialist referral with four CISS outcalls: (1)

Aims: To describe and compare the extent of exposure among youth and adults to antitobacco advertising funded by tobacco control agencies, and to smoking-related advertising from tobacco and pharmaceutical companies., Design: Archival records of television advertising exposures from Nielsen Media Research for the largest 75 media markets in the United States from 1999 to 2003., Measurements: Mean monthly advertising exposures for households with televisions and adolescents aged 12-17 years for: state tobacco control programs; the national American Legacy Foundation (Legacy) program; tobacco company advertising for youth smoking prevention, parent advertising and corporate image; pharmaceutical company advertising for nicotine replacement therapy and Zyban; and other miscellaneous tobacco-related advertising., Findings: Combined tobacco company youth/parent advertising exposures matched those for combined State/Legacy campaigns (4.56 advertisements/month versus 4.97 advertisements/month among households; 3.05 advertisements/month versus 3.38 advertisements/month among adolescents). Tobacco company corporate image advertising averaged 3.25 advertisements/month among households and 0.73 advertisements/month among adolescents. Tobacco company advertising exceeded public health-sponsored advertising by a factor of 1.57-1, and among youth by 1.11-1. Pharmaceutical companies were the largest sponsor of tobacco-related advertising for households (10.37 advertisements/month) and provided significant exposure among adolescents (2.61 advertisements/month)., Conclusions: This is the first study to demonstrate systematically that public health-sponsored antitobacco campaigns in the United States are matched or exceeded by tobacco company advertising, as well as pharmaceutical cessation product advertising. Research is needed to determine whether such advertising may dilute or undermine the established benefits of tobacco control-sponsored campaigns.

When faced with high cigarette prices, smokers can potentially control cigarette expenditures by limiting consumption or seeking cheaper cigarettes. The present study examined both these options and whether the use of price-minimizing strategies (the second option) could counteract a further price increase without smokers having to reduce consumption. Data for 5,109 smokers who purchased manufactured cigarettes were from the 2002 cross-sectional, population-based, random-digit-dialed California Tobacco Survey. We used logistic regression to examine which smokers used consumption-limiting or price-minimizing strategies, and multiple linear regression to determine how much price-minimizing strategies reduced the average price paid per pack. Overall, 32.3% of California smokers said they limited consumption and 74.1% used at least one of the five price-minimizing strategies identified: choosing cheaper retail outlets (61.1%), using promotional offers (35.2%), choosing cheaper brands (28.7%), purchasing by the carton (27.7%), and using low-tax or nontaxed sources (6.3%). Different groups of smokers used different strategies. Except for the use of promotional offers, all price-minimizing strategies significantly reduced the price paid per pack. Carton purchasers saved 1.01 US dollars/pack, and those buying from low-tax or nontaxed sources saved 1.23 US dollars/pack. However, pack buyers were reluctant to purchase cartons, mostly because they thought they might smoke too much, or because they considered the upfront cost unaffordable. The average California smoker could potentially save 0.33-0.66 US dollars/pack or 6.00-12.00 US dollars/month by using other price-minimizing strategies. Reducing consumption by 3 cigarettes/day could save a smoker 18.00 US dollars/month. Whereas price-minimizing strategies appeared to save money, cutting consumption could save even more. Thus further substantial tax increases would likely have the desired effect.

Objective: To examine the association between smoke-free policies, exposure to secondhand smoke (SHS) at work, and self-reported respiratory and sensory symptoms of workers., Method: Ninety-one nonsmoking workers recruited from three workplaces with varying smoking policies completed a telephone-administered questionnaire and provided saliva samples (before and after usual work shift) for cotinine analysis., Results: Mean before-after shift saliva cotinine per hour worked was significantly higher among club (0.42 ng/mL/hr worked) than casino workers (0.18 ng/mL/hr worked) (P < 0.001), club than office workers (0.03 ng/mL/hr worked) (P < 0.001), and casino than office workers (P < 0.001). Casino and club workers reported similar levels of respiratory morbidity and were more likely to have sore eyes (odds ratio [OR] = 5.5, P < 0.01) and a sore throat (OR = 4.3, P < 0.05) compared with office employees., Conclusion: Air-conditioning interventions reduce, but fail to eliminate, exposure of hospitality workers to SHS. Such exposure is associated with measurable increases in the risk of respiratory symptoms.

This study examined reported use of, and beliefs about, so-called light cigarettes among adult smokers in four countries: Australia (Aus), Canada (Can), the United Kingdom (U.K.) and the United States (U.S.). The method used was parallel telephone surveys among 9,046 smokers across the four countries. The results indicated that more than half of all smokers in each country except the U.K. reported smoking light cigarette brands. A majority of smokers surveyed in each country except Canada continue to believe that light cigarettes offer some health benefit compared to regular cigarettes (Canada 43%, U.S. 51%, Australia 55%, U.K. 70%). A majority of smokers in all four countries believed that light cigarettes are smoother on the throat and chest than regular cigarettes. Predictors of use of light cigarettes and beliefs about possible benefits were very similar in the four countries. These results demonstrate an ongoing need for public education about why light cigarettes do not reduce harm and do not make quitting easier. The results provide further evidence for the need for regulatory measures in all four countries to prohibit the use of misleading light and mild descriptors including package imagery in product marketing (as prescribed in Article 11 of the Framework Convention on Tobacco Control), abandon the use of standard FTC/ISO tar and nicotine yields as consumer information, and adopt policies to regulate deceptive design features of cigarettes, such as ventilated filters.

Aims: To demonstrate that intentions predict long-term future levels of smoking, irrespective of level of past smoking experience. A growing body of research suggests that intentions about future smoking might play an important role in addition to the influence of past smoking experience on the likelihood of smoking in future., Design: Using logistic regression analyses, we assessed the relationship between baseline smoking experience and a firm intention 'not to be smoking cigarettes 5 years from now' with four outcome measures of smoking at follow-up: 30-day smoking at a 3/4- and 5/6-year follow-up and current established smoking (self-described regular smokers or former smokers who had smoked in the past 30 days) at a 3/4- and 5/6-year follow-up., Participants: US nationally representative samples of 12th graders who responded to the Monitoring the Future (MTF) survey from the years 1976 to 1993, inclusive. For these panels, we linked stage of smoking and intentions at 12th grade to follow-up measures of smoking collected at 3/4 years after baseline and 5/6 years after baseline., Findings: Analysis of 3/4-year follow-up data (weighted n = 4544) and 5/6-year follow-up data (weighted n = 3885) for both definitions of smoking outcome indicated that there was a dose-response relationship between levels of baseline smoking experience and the likelihood of future smoking. In addition, independent of baseline smoking experience, there was a statistically significant protective effect for a firm intention not to smoke in five year's time on future smoking behavior., Conclusions: The findings suggest that evaluative studies of tobacco control policies and programs might usefully employ smoking uptake categories that incorporate smoking intentions as early indicators of outcome.

This article documents design changes in Australian cigarettes since the adoption of a "low-tar" harm reduction strategy in 1966. It also determines the relative contributions of specific technologies to machine-tested tar and nicotine yields in 1980 and 1994, using data from tobacco industry documents. Our findings are consistent with a first generation of low-tar cigarettes, which relied primarily on filtration efficiency, being displaced by a second generation, which relied heavily on filter ventilation and were more attractive to consumers. In 1980, both tar and nicotine yields correlated most strongly with filter density (r=-.66, p<.01, and r=-.70, p<.01), whereas in 1994 both tar and nicotine yields correlated most strongly with percentage filter ventilation (r=-.97, p<.01, and r=-.95, p<.01). We also found that median percentage alkaloid content of tobacco rods rose from 2.16% in 1980 to 2.4% in 1994, despite median nicotine yield declining from 1.0 mg to.58 mg. These changes can be expected to reduce the utility of the FTC/ISO yield testing system.

Background: This study compared the sun exposure and sun protection behaviours of adolescent students between 1993 and 1999., Methods: Schools from all Australian states and the two territories participated in each of the 1993, 1996, and 1999 surveys and a sample of students from years 7 to 12 were surveyed. In each of the states and territories a random sample of schools was selected within each education sector (government, Catholic, independent). The questionnaire was a self-completed booklet with questions about sunburn history during the previous summer, tan preferences, skin-type, and usual reported behaviour. Data from a total of 78,032 students were available for analysis., Results: From 1993 to 1999 there was a significant increase in the number of students reporting sunburn during the previous summer (chi(2) = 225.77, df = 2, P < 0.01). However, the percentage of students who preferred no tan at all increased over the same period (chi(2) = 184.47, df = 2, P < 0.01). The percentage of students who usually or always wore clothing that covered most of their body decreased between 1993 and 1999 (chi(2) = 20.46, df = 2, P < 0.01); the percentage of students usually or always wearing maximum protection sunscreen decreased over time (chi(2) = 27.71, df = 2, P < 0.01). Staying in the shade increased from 1993 (26%) to 1996 (32%) but decreased slightly in 1999 (30%). Across all survey years, only 11% of students routinely followed all three protective behaviours of wearing a hat, sunscreen, and clothes that cover the body., Conclusions: Sun protection practices among adolescents are still below optimal levels. Future educational programs require innovative approaches that aims to change attitudes toward tanning as being healthy and attractive and modify adolescent behaviours in relation to sun exposure.

This paper provides a thematic frame analysis of Australian newspaper reporting of the outcome and implications of the trial of Rolah McCabe versus British American Tobacco Australasia (BATA). In this trial, a Melbourne woman was awarded A$700,000 damages for smoking-attributable lung cancer when the defendant, BATA, had its case dismissed due to document destruction. In 60 commentaries from Australian national or capital city newspapers between 12 April and 9 May 2002, a total of 79 instances of eight tobacco-related frames were identified. Overall, 43% of the 79 instances were positive for tobacco control, 46% were negative for tobacco control and 11% were neutral. The most common frame that was negative for tobacco control (in 35% of articles) was the conception that smokers exert 'free will' in deciding to smoke and should therefore be personally responsible for their smoking and any disease that arises as a result of it. A related, but less commonly employed frame (in 18% of articles) was the expressed fear of a 'slippery slope' of litigation, which portrayed smoking as similar to eating fast food or other 'vices'. The most common frame that was positive for tobacco control (in 35% of articles) was the notion that the tobacco industry was 'evil' and, to a lesser extent, that the government should 'do more' to control smoking (15% of articles). These findings provide a sobering public health challenge to improve public communication efforts about the powerful forces that conspire to induce people to start smoking and keep them smoking for decades, despite a strong desire to quit. There is a need to fund public education programs and quit smoking services more adequately to address the complex education task of understanding the nature of addiction to tobacco and the enormity of the health risk.

Objectives: To examine adolescents' awareness of and response to an adult focused anti-smoking advertising campaign., Design and Setting: Data were obtained from two cross sectional surveys of adolescents. The first study, a national evaluation study, involved a telephone survey of a randomly selected sample of 400 14-17 year olds across Australia in 1998. The second study involved a survey of 3714 students aged 12-17 years, randomly selected from a probability sample of secondary schools in the Australian State of Victoria., Main Outcome Measures: In both surveys, adolescents answered questions on their awareness of the advertising campaign and actions taken in response to the campaign. Adolescents in the national evaluation study also answered questions assessing knowledge of health effects of smoking, impact of the campaign on adolescents, and relevance of the campaign for adolescents and other groups. Responses for smokers and nonsmokers were examined., Results: Among the national evaluation sample, 85% of adolescent smokers thought the campaign was relevant to them. Fifty three per cent indicated that the campaign had led some teenagers to at least try to quit and 85% thought it made smoking seem less cool and desirable. Among students who were established smokers the campaign generated quitting activity, with 27% cutting down the number of cigarettes they smoked and 26% having thought about quitting., Conclusion: Results indicate that adolescents were very aware of this adult focused anti-smoking campaign and thought it relevant to them. The findings suggest that a graphic health effects cessation focused campaign may have been successful in promoting anti-smoking attitudes among adolescents.