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Introduction: We examined the prevalence of price promotions (i.e., proportion of products on price promotion) and the magnitude of price promotions (i.e., size of the price discount compared to the regular price) among online alcohol retailers., Methods: In August 2023, we web-scraped product information for all alcoholic beverages available for sale in the online stores of two leading alcohol retailers in Sydney, Australia. Products were classified into five primary alcohol categories: wine, spirits, beer, cider and premix drinks. We considered three types of price promotion: temporary price discounts (e.g., 'was $5 now $4'), multi-buy discounts (e.g., buy one get one free) and 'any six' discounts (e.g., 5% off when purchased in a bundle of any six similar products). The prevalence and mean magnitude of price promotions were estimated overall and by product category and price promotion type., Results: In total, data for 11,184 products were collected. Of these, 62% were the subject of at least one of the assessed forms of price promotion. The most frequently price-promoted category was wine (91% of products), followed by spirits (35%), premix drinks (30%), cider (28%) and beer (21%). Of all price promotions, 61% were 'any six' discounts, 31% were temporary price discounts, and 7% were multi-buy discounts. Across all price promotions, the mean magnitude of price discount relative to the regular price was 11% and ranged from less than 1% to 71%., Discussion and Conclusions: Policymakers should consider restricting price promotions as part of a suite of strategies to reduce alcohol-related harms., (© 2024 The Author(s). Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Objective: To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population., Design: Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model., Findings: In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures., Conclusions: Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: On January 1, 2017, Philadelphia implemented a beverage excise tax. The study's objective was to determine whether beverage advertising expenditures and the number of beverage ads purchased changed in Philadelphia compared to Baltimore because of this tax., Methods: Monthly beverage ad expenditures and the number of beverage ads purchased by brand from January 2016 through December 2019 were obtained. Ads were coded as being for taxed or not taxed beverages and analyzed in 2023. The primary outcomes were quarterly taxed beverage ad expenditures and number of ads purchased. A controlled interrupted time series design on segmented linear regression models was used. Models (aggregated and stratified by internet, spot TV, and local radio) compared whether levels and trends in the outcomes changed from pre- to post-tax in Philadelphia compared to Baltimore., Results: There were no significant differences in taxed beverage advertising expenditures between Philadelphia and Baltimore for trends pretax, at implementation, or post-tax. There were 0.13 (95% CI: -0.25, -0.003) fewer quarterly taxed beverage ads purchased per 100 households in Philadelphia versus Baltimore at baseline. Among internet advertising, there were 0.42 (95% CI: -0.77, -0.06) fewer quarterly taxed beverage ads purchased per 100 households in Philadelphia versus Baltimore immediately post-tax. For spot TV ads, the percentage of taxed beverages ads purchased per quarter was greater at baseline in Philadelphia by 28.0 percentage points (95% CI: 1.9, 54.1)., Conclusions: This study found little evidence of changes in mass media advertising on the examined platforms between 2016 and 2019 due to the Philadelphia beverage tax., (Copyright © 2024. Published by Elsevier Inc.)

Shared manufacturing is a new business form that focuses on all aspects of production and manufacturing, mainly relying on the shared manufacturing platform to achieve the optimal allocation of idle resources. For enterprises, in the process of deciding to lease idle resources, the pricing and advertising investment efficiency of the shared manufacturing platform is a valuable research issue. The shared manufacturing model in this paper consists of one manufacturer and one shared manufacturing platform, which will invest in cooperative advertising while the shared manufacturing process is completed. The cooperative advertising involves four models: the traditional cooperation model, the cost-sharing contract model, the revenue-sharing contract model, and the bilateral cost-sharing contract model. We investigate the impact of some key parameters on the prices and profits of the manufacturer and the shared manufacturing platform based on the differential game. The numerical examples demonstrate the viability of the model. Finally, we provide suggestions based on the decision-making of the manufacturer and the shared manufacturing platform under different cooperative advertising models., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wu, Liu. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The financial motivation to earn advertising revenue has been widely conjectured to be pivotal for the production of online misinformation 1-4 . Research aimed at mitigating misinformation has so far focused on interventions at the user level 5-8 , with little emphasis on how the supply of misinformation can itself be countered. Here we show how online misinformation is largely financed by advertising, examine how financing misinformation affects the companies involved, and outline interventions for reducing the financing of misinformation. First, we find that advertising on websites that publish misinformation is pervasive for companies across several industries and is amplified by digital advertising platforms that algorithmically distribute advertising across the web. Using an information-provision experiment 9 , we find that companies that advertise on websites that publish misinformation can face substantial backlash from their consumers. To examine why misinformation continues to be monetized despite the potential backlash for the advertisers involved, we survey decision-makers at companies. We find that most decision-makers are unaware that their companies' advertising appears on misinformation websites but have a strong preference to avoid doing so. Moreover, those who are unaware and uncertain about their company's role in financing misinformation increase their demand for a platform-based solution to reduce monetizing misinformation when informed about how platforms amplify advertising placement on misinformation websites. We identify low-cost, scalable information-based interventions to reduce the financial incentive to misinform and counter the supply of misinformation online., (© 2024. The Author(s).)

Background: The promotion of the latest medicines produced by the pharmaceutical industry is an important issue both from an ethical point of view (the level of accessibility, the way research is carried out) and from the point of view of marketing and especially from the lobbying issues raised., Areas of Uncertainty: The ethical dilemmas raised by the promotion of new drugs revolve between the need to discover new molecules important for treating a wide range of diseases and the need to establish a battery of ethical rules, absolutely necessary for regulations in the field to be compliant with all ethical principles., Data Sources: A literature search was conducted through PubMed, MEDLINE, Plus, Scopus, and Web of Science (2015-2023) using combinations of keywords, including drugs, medical publicity, and pharma marketing plus ethical dilemma., Ethics and Therapeutic Advances: The promotion of medicines is governed by advertising laws and regulations in many countries, including at EU level, based on the need for countries to ensure that the promotion and advertising of medicines is truthful, based on information understood by consumers. The ethical analysis of the issues raised is more necessary and complex as the channels used for promotion are more accessible to the population, and the information, easier to obtain, can be the cause of increased self-medication and overeating. Large amounts of money invested in the development of new molecules, but also the risk of scientific fraud through manipulation of data during clinical trials, selective or biased publication of information can have repercussions on the health of the population., Conclusions: The development of new pharmaceutical molecules is necessary to intervene and treat as many conditions as possible, but marketing must not neglect the observance of ethical principles. The promotion of medicines should be the attribute especially of the medical staff, which should also be a mandatory part of the mechanism for approving the marketing methods and means used by the pharmaceutical companies., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016-18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Restricting the advertisement of products with high fat, salt, and sugar (HFSS) content has been recommended as a policy tool to improve diet and tackle obesity, but the impact on HFSS purchasing is unknown. This study aimed to evaluate the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases., Methods and Findings: Over 5 million take-home food and drink purchases were recorded by 1,970 households (London [intervention], n = 977; North of England [control], n = 993) randomly selected from the Kantar Fast Moving Consumer Goods panel. The intervention and control samples were similar in household characteristics but had small differences in main food shopper sex, socioeconomic position, and body mass index. Using a controlled interrupted time series design, we estimated average weekly household purchases of energy and nutrients from HFSS products in the post-intervention period (44 weeks) compared to a counterfactual constructed from the control and pre-intervention (36 weeks) series. Energy purchased from HFSS products was 6.7% (1,001.0 kcal, 95% CI 456.0 to 1,546.0) lower among intervention households compared to the counterfactual. Relative reductions in purchases of fat (57.9 g, 95% CI 22.1 to 93.7), saturated fat (26.4 g, 95% CI 12.4 to 40.4), and sugar (80.7 g, 95% CI 41.4 to 120.1) from HFSS products were also observed. Energy from chocolate and confectionery purchases was 19.4% (317.9 kcal, 95% CI 200.0 to 435.8) lower among intervention households than for the counterfactual, with corresponding relative reductions in fat (13.1 g, 95% CI 7.5 to 18.8), saturated fat (8.7 g, 95% CI 5.7 to 11.7), sugar (41.4 g, 95% CI 27.4 to 55.4), and salt (0.2 g, 95% CI 0.1 to 0.2) purchased from chocolate and confectionery. Relative reductions are in the context of secular increases in HFSS purchases in both the intervention and control areas, so the policy was associated with attenuated growth of HFSS purchases rather than absolute reduction in HFSS purchases. Study limitations include the lack of out-of-home purchases in our analyses and not being able to assess the sustainability of observed changes beyond 44 weeks., Conclusions: This study finds an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products. These findings provide support for policies that restrict HFSS advertising as a tool to reduce purchases of HFSS products., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: JA is an Academic Editor for PLOS Medicine.

Ecological compensation is an important means of basin pollution control, the existing researches mainly focus on the government level ignoring the important role of enterprises. Therefore, this paper introduces enterprises into the process of ecological compensation. Firstly, suppose the ecological compensation system composed of government and enterprises, the government is in the dominant position. The ecological compensation input of the government and enterprise will produce social reputation, and the ecological compensation of enterprise will also produce advertising effect. Consumer demand will be affected by social reputation and advertising effect. Then, the compensation strategies of the government and enterprise are analyzed by constructing the differential game model. The research shows that under certain conditions, the cost-sharing mechanism can realize the Pareto improvement of the benefits of government, enterprise and the whole system. Under the cooperative mechanism, the benefit of the government, enterprise and the whole system is optimal. Finally, the validity of the conclusion is verified by case analysis, and the sensitivity analysis of the relevant parameters is carried out. The conclusion can provide reference for government to establish sustainable watershed ecological compensation mechanism., Competing Interests: The authors have declared that no competing interests exist.

Objective: The aim of this study was to describe advertising expenditure for sugary drinks compared with alternative cold non-alcoholic beverages (artificially sweetened beverages, plain water, plain milk) between 2016 and 2018 across Australian media channels., Methods: Monthly estimates of advertising expenditure for non-alcoholic beverages were obtained from Nielsen Media and aggregated by product type and media., Results: Total sugary drink advertising expenditure between 2016 and 2018 ($129.5M) significantly exceeded expenditure on artificially sweetened drinks ($23.26M), plain water ($14.27M), and plain milk ($31.30M). Television and out-of-home advertising accounted for the largest share of sugary drink advertising (45%, 35%). Expenditure on out-of-home advertising was more heavily dominated by sugary drinks (75%) than advertising in all media combined (65%). Sugary drink advertising peaked in warmer months and was lowest in August. Soft drinks (26%), flavoured milks (24%) and energy drinks (21%) accounted for the majority of sugary drink advertising., Conclusions: Cold non-alcoholic beverage advertising in Australian media is dominated by the advertising of sugary drinks. Implications for public health: Restricting unhealthy beverage advertising on television and out-of-home media may be most effective initially. However, comprehensive restrictions capturing a broader range of media and settings would be optimal to prevent displacement and limit advertising reach and exposure., (© 2021 The Authors.)

Quitlines are effective, evidence-based tobacco cessation interventions that help tobacco users quit through a variety of services. The present study was done to evaluate the cost effectiveness of the National Tobacco Quitline Service (NTQLS). We calculated twoyear program use and costs for establishment, salary of the staff, media promotions, intervention services, Quitline registration calls and the number of quitters since inception of NTQLS in the year 2016, we examined whether NTQLS is cost-effective or not. Out of 63,350 callers, 9420 (97.9% males) callers with the mean ±SD age at 37.5±12.6 years; were registered for tobacco cessation counselling services at the National Tobacco Quitline Services (NTQLS) between 30th May 2016 and 31st May 2018. 3012 (32%) quitted their tobacco use till the last proactive calls. Average cost per completed counselling was 22.37 US$. Our study concludes that Tobacco Quitline as a tobacco control intervention is an excellent investment and cost-effective measure in India. Average cost per quitter at 69.96 US$ is comparatively very low to other country's Quitline, representing the ideal utilization of funds.

Background: Restrictions on the advertising of less-healthy foods and beverages is seen as one measure to tackle childhood obesity and is under active consideration by the UK government. Whilst evidence increasingly links this advertising to excess calorie intake, understanding of the potential impact of advertising restrictions on population health is limited., Methods and Findings: We used a proportional multi-state life table model to estimate the health impact of prohibiting the advertising of food and beverages high in fat, sugar, and salt (HFSS) from 05.30 hours to 21.00 hours (5:30 AM to 9:00 PM) on television in the UK. We used the following data to parameterise the model: children's exposure to HFSS advertising from AC Nielsen and Broadcasters' Audience Research Board (2015); effect of less-healthy food advertising on acute caloric intake in children from a published meta-analysis; population numbers and all-cause mortality rates from the Human Mortality Database for the UK (2015); body mass index distribution from the Health Survey for England (2016); disability weights for estimating disability-adjusted life years (DALYs) from the Global Burden of Disease Study; and healthcare costs from NHS England programme budgeting data. The main outcome measures were change in the percentage of the children (aged 5-17 years) with obesity defined using the International Obesity Task Force cut-points, and change in health status (DALYs). Monte Carlo analyses was used to estimate 95% uncertainty intervals (UIs). We estimate that if all HFSS advertising between 05.30 hours and 21.00 hours was withdrawn, UK children (n = 13,729,000), would see on average 1.5 fewer HFSS adverts per day and decrease caloric intake by 9.1 kcal (95% UI 0.5-17.7 kcal), which would reduce the number of children (aged 5-17 years) with obesity by 4.6% (95% UI 1.4%-9.5%) and with overweight (including obesity) by 3.6% (95% UI 1.1%-7.4%) This is equivalent to 40,000 (95% UI 12,000-81,000) fewer UK children with obesity, and 120,000 (95% UI 34,000-240,000) fewer with overweight. For children alive in 2015 (n = 13,729,000), this would avert 240,000 (95% UI 65,000-530,000) DALYs across their lifetime (i.e., followed from 2015 through to death), and result in a health-related net monetary benefit of £7.4 billion (95% UI £2.0 billion-£16 billion) to society. Under a scenario where all HFSS advertising is displaced to after 21.00 hours, rather than withdrawn, we estimate that the benefits would be reduced by around two-thirds. This is a modelling study and subject to uncertainty; we cannot fully and accurately account for all of the factors that would affect the impact of this policy if implemented. Whilst randomised trials show that children exposed to less-healthy food advertising consume more calories, there is uncertainty about the nature of the dose-response relationship between HFSS advertising and calorie intake., Conclusions: Our results show that HFSS television advertising restrictions between 05.30 hours and 21.00 hours in the UK could make a meaningful contribution to reducing childhood obesity. We estimate that the impact on childhood obesity of this policy may be reduced by around two-thirds if adverts are displaced to after 21.00 hours rather than being withdrawn., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: RV MO RS KS report a grant for the Obesity Policy Research Unit, funded through the National Institute for Health Research (NIHR) to inform the work of the Department for Health and Social Care; OM was an advisor to the Health Select Committee during their inquiry into childhood obesity (2017-18).

Objective: The inclusion and design of age restriction warnings, harm reduction messages and terms and conditions (T&Cs) in gambling advertising is self-regulated in the United Kingdom. Our study examines the visibility and nature of this information in a sample of paid-for gambling adverts., Study Design: A content analysis of a stratified random sample of gambling adverts (n = 300) in the United Kingdom from eight paid-for advertising channels (March 2018)., Methods: For each advert, we assessed whether any age restriction warnings, harm reduction messages and T&Cs were present. If so, visibility was scored on a five-point scale ranging from very poor (≤10% of advert space) to very good (≥26% of advert), which had high inter-rater reliability. Descriptive information on position, design and tone of language was recorded., Results: One in seven adverts (14%) did not feature an age restriction warning or harm reduction message. In adverts that did, 84% of age restriction warnings and 54% of harm reduction messages had very poor visibility. At least one in ten adverts did not contain T&Cs. In adverts that did, 73% had very poor visibility. For age restriction warnings, harm reduction messages and T&Cs, most appeared in small fonts and outside the main advert frame. Most harm reduction messages did not actually reference gambling-related harms., Conclusion: Age restriction warnings, harm reduction messages and T&Cs do not always appear in paid-for gambling advertising. When they do, visibility is often very poor and the messaging not clear. The findings do not support a self-regulatory approach to managing this information in gambling adverts., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Tobacco point-of-sale advertising, particularly in retailers surrounding schools, is associated with youth tobacco use and must be monitored. This study examines how the point-of-sale environment surrounding youth changed over time with regard to diverse tobacco products., Methods: Each spring from 2015 to 2018, research staff visited the same tobacco retailers ( n = 141) within a half-mile of New Jersey high schools. For cigarettes, cigars, electronic cigarettes, and smokeless tobacco, advertisement presence, volume, and share of advertising voice (SAV) were measured for both the exterior and interior of the store. Analyses examined changes over time by product, controlling for store type and poverty., Results: Over time, exterior cigarette advertisements declined in presence (61% to 49%) and SAV (50% to 40%), whereas interior advertisements maintained stable presence, volume, and SAV. In contrast, cigar advertisements increased in presence (exterior 11% to 23%; interior 19% to 30%) and volume (exterior mean 0.2 to 0.5; interior 0.3 to 0.8). For electronic cigarettes, exterior and interior advertising presence, volume, and SAV decreased from 2015 to 2017 but increased in 2018. Smokeless tobacco advertising was infrequent and stayed consistent except in volume in the interior of stores (mean 0.2 to 0.3). When there were any differences by store type, chain convenience stores had the most exterior and interior advertising for all products., Conclusions: The longitudinal changes observed for each product's advertising reflect national youth use rates of the corresponding products. The point-of-sale environment around schools may be influencing youth tobacco use and must be monitored and regulated., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

This research explores how the level of consumers' need for cognition (NFC) is associated with celebrity endorser credibility and examines its effects on advertising-related attitudes. A 3 (endorser types: actor/actress, athlete, TV personality/ talent ) × 2 (endorser's gender) factorial experiment with 435 Japanese consumers was conducted. Concerning Japanese OTC drug advertising, lower NFC individuals perceived celebrity endorsers as more credible in comparison to higher NFC individuals. The main effects of NFC and endorser type on endorser credibility existed; however, no interaction between the two variables was found. The endorser type had an influence on attitudes toward ads and the advertised brand.

: Background: To determine how many adolescents follow food/beverage brands on Instagram and Twitter, and examine associations between brands' youth-targeted marketing practices and percentages of adolescent followers., Methods: We purchased data from Demographics Pro to characterize the demographics of Twitter and Instagram users who followed 27 of the most highly advertised fast food, snack, and drink brands in 2019. We used one-sample t -tests to compare percentages of adolescent followers of the selected brands' accounts versus all social media accounts, independent samples t -tests to compare followers of sugary versus low-calorie drink brands, and linear regression to examine associations between youth-targeted marketing practices and the percentages of adolescent followers., Results: An estimated 6.2 million adolescents followed the selected brands. A higher percentage of adolescents followed the selected brands' accounts (9.2%) compared to any account on Twitter (1.2%) ( p < 0.001), but not Instagram. A higher percentage of adolescents followed sugary (7.9%) versus low-calorie drink brands (4.3%) on Instagram ( p = 0.02), but we observed the opposite pattern for adults on Twitter and Instagram. Television advertising expenditures were positively associated with percentages of adolescent followers of the selected brands on Twitter ( p = 0.03), but not Instagram., Conclusions: Food and sugary drink brands maintain millions of adolescent followers on social media., Competing Interests: The authors declare no conflict of interest.

Objective: This article provides a guide for the behavioral scientist to understand and judge econometric studies of alcohol advertising., Method: The requirements for causal evidence in an econometric study include an empirical scenario in which alcohol advertising is not affected by alcohol consumption and in which both consumption and advertising are not affected by a common third variable. The articles included in this review were a sampling of older studies to illustrate the problems with these studies and newer studies, not covered by existing reviews, which try to directly address causality., Results: The results from many prior studies are suspect by current econometric standards. However, a few newer econometric studies address causality and find a small positive effect of alcohol advertising on consumption., Conclusions: Many prior studies and some newer studies of alcohol advertising in the econometric literature have not addressed causality, and the results from these studies should be considered as descriptive only.

Internet-based recruitment can be effective in reaching large numbers of geographically diverse individuals. Geosocial sexual networking apps on smartphones have emerged as the modal way in which men who have sex with men (MSM) meet sex partners, and as venues for sexual health research. We report on the performance of three types of ads-text-only, text with male figure (no face), and text with male figure (with face)-used on a geosocial sexual networking app to advertise free at-home HIV testing and to enroll in an online study. We ran five 2-week-long ads on a popular MSM geosocial app between fall 2017 and spring 2018 (~2.19 million impressions). Ads were evaluated in terms of the click-through rate (CTR = advertisement clicks/advertisement impressions), conversion rates (CR = number of enrolled participants/ad-generated clicks), cost per enrolled participant, and demographic composition of survey respondents. We enrolled n = 4,023 individuals, n = 2,430 of whom completed HIV testing-$6.21 spent on advertising per participant enrolled and $10.29 spent for everyone who completed HIV testing. Cost per enrolled participant was associated with the content of the ad used-ads featuring male figures (with or without a face shown) were more cost efficient than ads featuring text alone. These ads also outperformed text-only ads across a range of metrics, including responsiveness among younger MSM as well as MSM of color. Advertising materials that combine text with images may have greater appeal among priority populations.

Competing Interests: Competing interests: TD is an Associate Editor of Tobacco Control with respect to Product Marketing and Promotion. He has served as an expert witness in tobacco and vaping litigation on behalf of governments whose policies have undergone constitutional challenges.

Background: Point of sale (POS) advertising is associated with smoking initiation, current smoking, and relapse among former smokers. Price promotion bans and antismoking advertisements (ads) are 2 possible interventions for combating POS advertising., Objective: The purpose of this analysis was to determine the influence of antismoking ads and promotions on urges to smoke and tobacco purchases., Methods: This analysis examined exposure to graphic (graphic images depicting physical consequences of tobacco use) and supportive (pictures of and supportive messages from former smokers) antismoking ads and promotions in a virtual convenience store as predictors of urge to smoke and buying tobacco products among 1200 current cigarette smokers and 800 recent quitters recruited via a Web-based panel (analytical n=1970). We constructed linear regression models for urge to smoke and logistic regression models for the odds of purchasing tobacco products, stratified by smoking status., Results: The only significant finding was a significant negative relationship between exposure to supportive antismoking ads and urge to smoke among current smokers (beta coefficient=-5.04, 95% CI -9.85 to -0.22; P=.04). There was no significant relationship between graphic antismoking ads and urge to smoke among current smokers (coefficient=-3.77, 95% CI -8.56 to 1.02; P=.12). Neither relationship was significant for recent quitters (graphic: coefficient=-3.42, 95% CI -8.65 to 1.81; P=.15 or supportive: coefficient=-3.82, 95% CI -8.99 to 1.36; P=.20). There were no significant differences in urge to smoke by exposure to promotions for current smokers (coefficient=-1.06, 95% CI -4.53 to 2.41; P=.55) or recent quitters (coefficient=1.76, 95% CI -2.07 to 5.59; P=.37). There were also no differences in tobacco purchases by exposure to graphic (current smokers: coefficient=0.93, 95% CI 0.67 to 1.29; P=.66 and recent quitters: coefficient=0.73, 95% CI 0.44 to 1.19; P=.20) or supportive (current smokers: coefficient=1.05, 95% CI 0.75 to 1.46; P=.78 and recent quitters: coefficient=0.73, 95% CI 0.45 to 1.18; P=.20) antismoking ads or price promotions (current smokers: coefficient=1.09, 95% CI 0.86 to 1.38; P=.49 and recent quitters: coefficient=0.90, 95% CI 0.62 to 1.31; P=.60)., Conclusions: The results of this analysis support future research on the ability of supportive antismoking ads to reduce urges to smoke among current cigarette smokers. Research on urges to smoke has important tobacco control implications, given the relationship between urge to smoke and smoking cigarettes, time to next smoke, and amount smoked., (©Lauren McCarl McCarl Dutra, James Nonnemaker, Brian Bradfield, Nathaniel Taylor, Jamie Guillory, Ashley Feld, Annice Kim. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.10.2019.)

Background: The MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) Network recruited into five randomized clinical trials (n = 100-350) through mass mailings. The fifth trial tested two interventions for postmenopausal vulvovaginal symptoms (itching, pain, irritation, dryness, or pain with sex) and thus required a high level of sensitivity to privacy concerns. For this trial, in addition to mass mailings we pilot tested a social media recruitment approach. We aimed to evaluate the feasibility of recruiting healthy midlife women with bothersome vulvovaginal symptoms to participate in the Vaginal Health Trial through Facebook advertising., Methods: As part of a larger advertising campaign that enrolled 302 postmenopausal women for the 12-week randomized, double-blind, placebo-controlled Vaginal Health Trial from April 2016 to February 2017, Facebook advertising was used to recruit 25 participants. The target population for recruitment by mailings and by Facebook ads included women aged 50-70 years and living within 20 miles of study sites in Minneapolis, MN and Seattle, WA. Design of recruitment letters and Facebook advertisements was informed by focus group feedback. Facebook ads were displayed in the "newsfeed" of targeted users and included a link to the study website. Response rates and costs are described for both online ads and mailing., Results: Facebook ads ran in Minneapolis for 28 days and in Seattle for 15 days, with ads posted and removed from the site as needed based on clinic flow and a set budget limit. Our estimated Facebook advertising reach was over 200,000 women; 461 women responded and 25 were enrolled at a cost of US$14,813. The response rate per estimated reach was 0.22%; costs were US$32 per response and US$593 per randomized participant. The social media recruitment results varied by site, showing greater effectiveness in Seattle than in Minneapolis. We mailed 277,000 recruitment letters; 2166 women responded and 277 were randomized at a cost of US$98,682. The response rate per letter sent was 0.78%; costs were US$46 per response and US$356 per randomized participant. Results varied little across sites., Conclusion: Recruitment to a clinical trial testing interventions for postmenopausal vaginal symptoms is feasible through social media advertising. Variability in observed effectiveness and costs may reflect the small sample sizes and limited budget of the pilot recruitment study.

Background: Opioid use disorder (OUD) has become an increasingly grave public health concern, especially in the United States where approximately 80% of the global opioid supply is consumed. Despite greater awareness of the present overdose crisis, potentially life-saving OUD pharmacotherapy (medications for opioid use disorder or MOUD) utilization remains low. This study examines the extent of provider-directed marketing (detailing) for MOUD drugs and identifies any associations between a provider's receipt of detailing and their prescribing of MOUD drugs to Medicare Part D beneficiaries., Method: We combined Open Payments data on all provider-directed payments from pharmaceutical manufacturers with physician-level data on all MOUD prescriptions filled in Medicare Part D. We estimated the adjusted difference in Medicare days supply for all MOUD drugs (collectively) and separately for each MOUD drug that was associated with receipt of payments., Results: The Open Payments data show that $7.0 million MOUD-specific promotional payments were made by pharmaceutical manufacturers to 12,056 US physicians from 2014 to 2016, which is <1/6th of the $50.3 million made in overall non-MOUD opioid-related promotional payments to 76,992 US physicians during that same period. Prescribers who received any MOUD-specific payments prescribed 1080 daily MOUD-related doses per year more than peers who did not receive any MOUD-specific payments (p < 0.001). The data also show the relatively greater association between receipt of detailing and Suboxone prescriptions compared to Vivitrol., Conclusions: Provider-directed marketing by MOUD manufacturers has been found to be significantly and positively associated with incidence of MOUD prescribing in Medicare Part D, as well as with the quantity of MOUD prescribed., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Nigeria is a significant tobacco market and influential country in Africa. Nigeria ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005. We reviewed Nigeria's tobacco control legislation since 2000 and compliance of the National Tobacco Control Act (NTCA) 2015 with the FCTC., Methods: We reviewed the National Tobacco Control Bills 2011 (proposed by legislature) and 2014 (proposed by Executive), the NTCA 2015, and media stories on tobacco control from 2008 to 2017., Results: The NTCA, despite being more comprehensive than Nigeria's first Tobacco Smoking (Control) law of 1990, maintained provisions promoted by the tobacco industry, for example: allowing designated smoking areas in hospitality venues, higher educational institutions, and transportation venues; a loophole in the advertising restrictions allowing communications with consenting adults; and having the Manufacturers Association of Nigeria (MAN) (which includes tobacco companies) on the National Tobacco Control Committee charged with working with the Ministry of Health to implement the law. The industry is also directly involved with the Standards Organisation of Nigeria (SON) in preparing regulations on cigarette constituents and emissions. In an unprecedented step globally, the law requires that implementing regulations be approved by the National Assembly, giving the industry another opportunity to weaken this law further by lobbying the legislators to favor the industry. As of January 2018, the law was still not being enforced., Conclusion: The NTCA can be strengthened through implementation guidelines still being developed. The industry should be prevented from interfering with through MAN and SON, as required by FCTC Article 5.3., Implications: The tobacco industry works to block Framework Convention on Tobacco Control implementation even after a country ratifies the treaty. The Nigerian case illustrates that it is essential for health authorities to remain vigilant and ensure that the tobacco industry does not play a decision-making role in the process of tobacco legislation and regulation either directly or indirectly. The unprecedented step of requiring approval of implementing regulations for the Nigerian law should not be allowed to become a precedent in other countries., (© The Author(s) 2018. 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.)

Introduction: Reducing tobacco retailer density is suggested to be a key component of tobacco endgames. Where tobacco retail reduction policies exist, 'grandfathering' is typically used, where existing retailers are exempt from restrictions aimed at reducing outlet density. We examined the possible impact on tobacco outlet density in New Zealand of a policy preventing new retail outlets from selling tobacco, but allowing existing retail outlets to continue selling tobacco until they ceased trading or relocated., Methods: We obtained data on numbers of tobacco outlets and the number of outlet closures recorded annually from 2006 to 2016. We calculated the mean and the lowest and highest 3-year rolling average closure rates for each type of tobacco outlet. We projected decreases in the number of tobacco outlets that would hypothetically be permitted to sell tobacco from 2020 onwards and estimated when the combined number of tobacco outlets would decline by 50% and 95%., Results: Based on mean annual closure rates, the total number of tobacco outlets would decrease by 50% by 2032 and a 95% reduction could be achieved by 2072. By 2025, the number of tobacco outlets would decrease by 27%; by 2050, this reduction would reach 84%., Conclusion: A tobacco retail reduction policy that prevented new retail outlets from selling tobacco and grandfathered existing retailers would be unlikely to achieve New Zealand's target of a 95% reduction in tobacco outlet density within several decades of being enacted. Nonetheless, this policy could achieve a 50% reduction in tobacco retail availability in the first decade of implementation., Competing Interests: Competing interests: Although we do not consider it a competing interest, for the sake of full transparency we note that authors have undertaken work for health-sector agencies working in tobacco control., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Alternative tobacco products (ATPs), such as cigars, smokeless tobacco, and electronic nicotine delivery systems (ENDS), have a strong presence in the US retail environment amid declining cigarette consumption. This study documented the promotion of ATPs in tobacco retailers in New York City and examined associations with neighborhood demographics., Methods: Data on product availability and advertising were collected from a stratified, random sample of tobacco retailers in 2017 (n = 796). Multilevel models estimated adjusted prevalence ratios (aPRs) for each outcome by neighborhood racial/ethnic composition and median household income., Results: Nearly half (49.8%) of retailers carried 99-cent cigarillos, but availability was significantly greater in neighborhoods in the highest (vs. lowest) quartile for the percentage of Black residents [68.2%, aPR: 1.59 (1.19, 2.11)] and in the lowest (vs. highest) income quartile [67.3%, aPR: 1.56 (1.04, 2.35)]. Conversely, retailers in neighborhoods with the highest percentage of White residents were significantly more likely to carry ENDS [66.4%, aPR: 1.71 (1.11, 2.62)]. Advertisements for ENDS were less common in neighborhoods in the highest (vs. lowest) quartiles for the percentage of Black and Hispanic residents [20.3%, aPR: 0.64 (0.41, 0.99); 22.9%, aPR: 0.62 (0.40, 0.98)]., Conclusions: The marketing of inexpensive, combusted tobacco products disproportionately saturates low-income, minority communities, while potentially lower risk, noncombusted products are more accessible in largely White and higher income neighborhoods. This pattern may exacerbate tobacco-related inequities. Public health policies should prioritize reducing the appeal and affordability of the most harmful tobacco products to help reduce health disparities., Implications: Although cigarette promotion at the point-of-sale is well documented in the literature, questions remain about the ways in which alternative tobacco products (ATPs) are marketed in communities. Importantly, these products fall on a continuum of harm, with combusted tobacco overwhelmingly responsible for tobacco-related death and disease. We found that retailers in minority and low-income communities were more likely to carry and advertise inexpensive ATPs such as cigarillos, while potentially less risky, noncombusted products such as smokeless tobacco and e-cigarettes were more accessible in higher income and predominantly White neighborhoods. Policies aligned with product risk may help reduce health disparities., (© The Author(s) 2018. 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.)

Introduction: The US Tobacco Control Act restricts advertising or labeling that suggests one tobacco product is less harmful than another. We sought to examine how "organic," "natural," and "additive-free" advertising claims and corresponding disclaimers affect perceptions of cigarettes' harm., Methods: Participants were a national probability sample of adults in the United States (n = 1114, including 344 smokers). We conducted a 5 (claim) × 2 (disclaimer) between-subjects factorial experiment. Participants viewed a Natural American Spirit cigarettes ad claiming they were "organic," "natural," "additive-free," "light," or "regular;" and with or without a corresponding disclaimer. The outcome was perceived harm of the advertised cigarettes. Among smokers, we also assessed interest in switching within their current brand to cigarettes with this characteristic (eg, "additive-free")., Results: Claims in the ad had a large effect on perceived harm (Cohen's d = 0.87, 95% CI = 0.47 to 1.29). Claims of cigarettes being "organic," "natural," or "additive-free" reduced perceived harm from the advertised cigarettes, as compared with "regular" and "light" claims. Disclaimers had a small effect, increasing perceived harm (d = 0.25, 95% CI = 0.08 to 0.41). The problematic claims also increased smokers' interest in switching. Disclaimers had no effect on smokers' interest in switching., Conclusions: "Organic," "natural," and "additive-free" claims may mislead people into thinking that the advertised cigarettes are less harmful than other cigarettes. Disclaimers did not offset misperceptions of harm created by false claims. The US Food and Drug Administration should restrict the use of these misleading claims in tobacco advertising., Implications: "Organic," "natural," and "additive-free" cigarette advertising claims decrease perceptions of harm among the public and increase interest in switching to such cigarettes among smokers. Disclaimers do not counteract the reduced perceptions of harm or increased interest in switching to these cigarettes. The US Food and Drug Administration should restrict the use of "organic," "natural," and "additive-free" claims in tobacco marketing., (© The Author(s) 2018. 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.)

Introduction: As adolescent tobacco use shifts from traditional cigarettes to alternative products, it is important to understand the influence of point-of-sale (POS) advertising on product use. This research investigated whether the percentage of POS advertising for a particular product, known as the share of advertising voice (SAV), moderated the relationship between exposure to POS tobacco advertisements and tobacco use among at-risk youth., Methods: Longitudinal self-report data from 746 students attending 20 alternative high schools in southern California was merged with observational data cataloging 2101 advertisements for cigarettes, e-cigarettes, cigars, and smokeless tobacco from 87 tobacco retail outlets within a half mile of the schools. Four multilevel Poisson regression models examined whether SAV interacted with POS tobacco advertising exposure to influence the use of tobacco products 1 year later., Results: Adolescent exposure to POS tobacco advertisements was significantly associated with increased use of all four tobacco products (p < .02). When SAV was added to the model as a moderator, the results showed a significant interaction, such that increasing the SAV for e-cigarettes was associated with greater use of that product (β = 0.27, SE = 0.07, p < .001). The same moderating effect was found for smokeless tobacco (β = 0.56, SE = 0.19, p = .004) but no moderating effect was observed for cigarettes or cigars., Conclusion: POS SAV has the potential to influence at-risk students' use of alternative tobacco products and may be a contributing factor to recent nationwide shifts in youth tobacco use., Implications: Future studies should monitor changes in SAV to gain insight into POS marketing trends that may be impacting youth tobacco use. In addition, state and local governments should consider implementing policies that limit the volume and proportion of POS tobacco advertising for all nicotine and tobacco products available in retail environments near schools. Restrictions placed on a single product may cause unintended shifts in product selection rather than a reduction in youth tobacco use., (© The Author(s) 2018. 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.)

Background: Smartphones are increasingly available and some high quality apps are available for smoking cessation. However, the cost-effectiveness of promoting such apps has never been studied. We therefore aimed to estimate the health gain, inequality impacts and cost-utility from a five-year promotion campaign of a smoking cessation smartphone app compared to business-as-usual (no app use for quitting)., Methods: A well-established Markov macro-simulation model utilising a multi-state life-table was adapted to the intervention (lifetime horizon, 3% discount rate). The setting was the New Zealand (NZ) population (N = 4.4 million). The intervention effect size was from a multi-country randomised trial: relative risk for quitting at 6 months = 2.23 (95%CI: 1.08 to 4.77), albeit subsequently adjusted to consider long-term relapse. Intervention costs were based on NZ mass media promotion data and the NZ cost of attracting a smoker to smoking cessation services (NZ$64 per person)., Results: The five-year intervention was estimated to generate 6760 QALYs (95%UI: 5420 to 8420) over the remaining lifetime of the population. For Māori (Indigenous population) there was 2.8 times the per capita age-standardised QALY gain relative to non-Māori. The intervention was also estimated to be cost-saving to the health system (saving NZ$115 million [m], 95%UI: 72.5m to 171m; US$81.8m). The cost-saving aspect of the intervention was maintained in scenario and sensitivity analyses where the discount rate was doubled to 6%, the effect size halved, and the intervention run for just 1 year., Conclusions: This study provides modelling-level evidence that mass-media promotion of a smartphone app for smoking cessation could generate health gain, reduce ethnic inequalities in health and save health system costs. Nevertheless, there are other tobacco control measures which generate considerably larger health gains and cost-savings such as raising tobacco taxes.

Objectives: This experiment tested whether introducing graphic antitobacco posters at point-of-sale (POS) had any effect on adolescents' susceptibility to future cigarette smoking and whether these effects were moderated by adolescents' baseline risk of cigarette smoking., Methods: The study was conducted in the RAND StoreLab, a life-sized replica of a convenience store that was developed to experimentally evaluate how changing aspects of tobacco advertising displays in retail POS environments influence tobacco use risk and behavior during simulated shopping experiences. In this study, 441 adolescents were randomized to one of the four conditions in a 2 (graphic antismoking poster placed near the tobacco power wall: no, yes) × 2 (graphic antismoking poster placed near the cash register: no, yes) experimental design. The outcome of interest was susceptibility to future cigarette smoking., Results: The addition of antismoking posters at POS led to a significant increase in future smoking susceptibility among those adolescents who already were at high risk for smoking in the future (p < .045). The introduction of graphic antismoking posters had no impact on committed never smokers, regardless of poster location; never smokers' susceptibility to future smoking was uniformly low across experimental conditions., Conclusions: Introducing graphic antismoking posters at POS may have the unintended effect of further increasing cigarette smoking susceptibility among adolescents already at risk.

Objectives: To estimate the relationship between data breaches and hospital advertising expenditures., Study Design: Observational data on hospital expenditures were analyzed using a propensity score-matched regression. The regression was specified as a generalized linear model using a gamma distribution and log link., Methods: The study sample included Medicare hospitals captured by a survey of traditional media outlets. Hospitals included were nonfederal acute care inpatient hospitals from 2011 to 2014. Voicetrak provided data on hospital advertising expenditures. The Healthcare Cost Report Information System provided data on hospital characteristics and financial variables. Study groups were matched using observable characteristics, such as revenue, number of beds, discharges, ownership, and teaching status. The study excluded hospitals in Maryland and the US territories for financial reporting consistency. Data breaches included theft, loss, unauthorized access/disclosure, improper disposal, and hacking. Advertising expenditures were collected from media outlets including television, radio, newspapers and business journals, and local magazines in a city/metropolitan area., Results: Breached hospitals (n = 72) were more likely to be large, teaching, and urban hospitals relative to the control group (unweighted n = 915). A data breach was associated with a 64% (95% CI, 7.2%-252%; P = .023) increase in annual advertising expenditures, holding observable characteristics constant., Conclusions: Breached hospitals were associated with significantly higher advertising expenditures in the 2 years after the breach. Efforts to repair the hospital's image and minimize patient loss to competitors are potential drivers of the increased spending. Advertising costs subsequent to a breach are another cost to the healthcare system that could be avoided with better data security.

Objective: Young children use mobile devices on average 1 hour/day, but no studies have examined the prevalence of advertising in children's apps. The objective of this study was to describe the advertising content of popular children's apps., Methods: To create a coding scheme, we downloaded and played 39 apps played by children aged 12 months to 5 years in a pilot study of a mobile sensing app; 2 researchers played each app, took detailed notes on the design of advertisements, and iteratively refined the codebook (interrater reliability 0.96). Codes were then applied to the 96 most downloaded free and paid apps in the 5 And Under category on the Google Play app store., Results: Of the 135 apps reviewed, 129 (95%) contained at least 1 type of advertising. These included use of commercial characters (42%); full-app teasers (46%); advertising videos interrupting play (e.g., pop-ups [35%] or to unlock play items [16%]); in-app purchases (30%); prompts to rate the app (28%) or share on social media (14%); distracting ads such as banners across the screen (17%) or hidden ads with misleading symbols such as "$" or camouflaged as gameplay items (7%). Advertising was significantly more prevalent in free apps (100% vs 88% of paid apps), but occurred at similar rates in apps labeled as "educational" versus other categories., Conclusion: In this exploratory study, we found high rates of mobile advertising through manipulative and disruptive methods. These results have implications for advertising regulation, parent media choices, and apps' educational value.

Importance: Manufacturers, companies, and health care professionals and organizations use an array of promotional activities to sell and increase market share of their products and services. These activities seek to shape public and clinician beliefs about laboratory testing, the benefits and harms of prescription drugs, and some disease definitions., Objective: To review the marketing of prescription drugs, disease awareness campaigns, health services, and laboratory tests and the related consequences and regulation in the United States over a 20-year period (1997-2016)., Evidence: Analysis (1997-2016) of consumer advertising (Kantar Media data for spending and number of ads); professional marketing (IQVIA Institute for Human Data Science, Open Payments Data [Centers for Medicare & Medicaid Services]); regulations and legal actions of the US Food and Drug Administration (FDA), Federal Trade Commission (FTC), state attorneys general, and US Department of Justice; and searches (1975-2018) of peer-reviewed medical literature (PubMed), business journals (Business Source Ultimate), and news media (Lexis Nexis) for articles about expenditures, content, and consequences and regulation of consumer and professional medical marketing. Spending is reported in 2016 dollars., Findings: From 1997 through 2016, spending on medical marketing of drugs, disease awareness campaigns, health services, and laboratory testing increased from $17.7 to $29.9 billion. The most rapid increase was in direct-to-consumer (DTC) advertising, which increased from $2.1 billion (11.9%) of total spending in 1997 to $9.6 billion (32.0%) of total spending in 2016. DTC prescription drug advertising increased from $1.3 billion (79 000 ads) to $6 billion (4.6 million ads [including 663 000 TV commercials]), with a shift toward advertising high-cost biologics and cancer immunotherapies. Pharmaceutical companies increased DTC marketing about diseases treated by their drugs with increases in disease awareness campaigns from 44 to 401 and in spending from $177 million to $430 million. DTC advertising for health services increased from $542 million to $2.9 billion, with the largest spending increases by hospitals, dental centers, cancer centers, mental health and addiction clinics, and medical services (eg, home health). DTC spending on advertising for laboratory tests (such as genetic testing) increased from $75.4 million to $82.6 million, although the number of ads increased more substantially (from 14 100 to 255 300), reflecting an increase in less expensive electronic media advertising. Marketing to health care professionals by pharmaceutical companies accounted for most promotional spending and increased from $15.6 billion to $20.3 billion, including $5.6 billion for prescriber detailing, $13.5 billion for free samples, $979 million for direct physician payments (eg, speaking fees, meals) related to specific drugs, and $59 million for disease education. Manufacturers of FDA-approved laboratory tests paid $12.9 million to professionals in 2016. From 1997 through 2016, the number of consumer and professional drug promotional materials that companies submitted for FDA review increased from 34 182 to 97 252, while FDA violation letters for misleading drug marketing decreased from 156 to 11. Since 1997, 103 financial settlements between drug companies and federal and state governments resulted in more than $11 billion in fines for off-label or deceptive marketing practices. The FTC has acted against misleading marketing by a single for-profit cancer center., Conclusions and Relevance: Medical marketing increased substantially from 1997 through 2016, especially DTC advertising for prescription drugs and health services. Pharmaceutical marketing to health professionals accounted for most spending and remains high even with new policies to limit industry influence. Despite the increase in marketing over 20 years, regulatory oversight remains limited.

Objective: The purpose of this study was to document exposure to alcohol advertising by sex, age, and the level and type of alcohol people consume., Method: We use unique marketing survey data that link the media individuals consume and advertising appearing in those media. Our sample of 306,451 men and women represents the population age 18 and older living in the 48 contiguous United States between 1996 and 2009. We measure advertising exposure not with the standard expenditure data but with counts of actual advertisements people likely saw. We relate advertising exposure across groups defined by age, gender, and the amount of beer, wine, and spirits consumed., Results: We found that drinkers, particularly young male drinkers, see much more alcohol advertising. Men, especially younger men, see more advertisements for alcohol of all types than do women. Their higher exposure is largely explained by sex differences in the propensity to read sports and adult magazines and to watch sports and gambling television programs., Conclusions: The evidence highlights the need to recognize, and when possible, control for the fact that a selected group of individuals is more likely to see alcohol advertising. Firms successfully place advertising on programs and in magazines viewed by youth and drinkers. To estimate whether seeing advertising causes people to drink (more), researchers need to develop clever identification strategies.

Aims: To examine how pharmaceutical products that were first marketed between 1950 and 1980 were promoted to physicians through advertisements and briefly review advertising regulations and accuracy of the advertisements in the light of modern knowledge., Methods: We systematically reviewed advertisements promoting drugs for specific therapeutic areas, namely central nervous system disorders (anxiety and sleep disorders, depression, psychoses, and Parkinson's disease), respiratory disorders, cardiovascular disorders, and gastrointestinal disorders. We examined about 800 issues of the British Medical Journal (1950-1980) and about 150 issues of World Medicine (1965-1984)., Results: Advertising material was minimally regulated until the mid-1970s. Many drugs were marketed with little preclinical or clinical knowledge and some with the expectation that prescribers would obtain further data. The peak of advertising occurred in parallel with the surge in the release of novel drugs during the 1960s, but declined markedly after the mid-1970s. Advertisements generally contained little useful prescribing information. The period we investigated saw the release of many novel pharmaceuticals in the therapeutic areas we examined, and many (or their class successors) still play important therapeutic roles, including benzodiazepines, tricyclic antidepressants, phenothiazines, levodopa, selective and non-selective β-adrenoceptor antagonists, thiazide diuretics, β-adrenoceptor agonists, and histamine H 2 receptor antagonists., Conclusions: Advertising pharmaceuticals in the BMJ and World Medicine in 1950-1980 was poorly regulated and often lacked rigour. However, advertisements were gradually modified in the light of increasing clinical pharmacological knowledge, and they reflect an exciting period for the introduction of many drugs that continue to be of benefit today., (© 2018 The British Pharmacological Society.)

Objective: The Loi Évin legislation restricts alcohol advertising in France and is more comprehensive than the self-regulation-based U.K. approach. Through contributions to news media and parliamentary processes, stakeholders can play an important role in framing the debate around public policy. This project therefore aimed to analyze how the Loi Évin has been represented since its inception in U.K. media and Parliament by the advertising and alcohol industries, politicians, and nongovernmental organizations., Method: Qualitative analysis of media and parliamentary documents using the hermeneutic method, analyzing contexts in which the Loi Évin was mentioned by stakeholders in the media and in Parliament. Print and trade media articles referencing the Loi Évin were retrieved from the ProQuest media archive [from 1985 to 2016]. U.K. parliamentary representations referencing the Loi Évin were obtained from the parliamentary database for publications and the Hansard parliamentary record. A total of 109 documents referencing the Loi Évin were identified, of which 71 met the inclusion criteria and were included for analysis., Results: The alcohol and advertising industries have framed the Loi Évin as incompatible with European Union principles, irrational and ineffective, with arguments changing over time in response to landmark events and rulings. Supporters of Loi Évin-style legislation failed to counter industry framing of advertising as not contributing to increased consumption., Conclusions: The portrayal of the Loi Évin by industry in the United Kingdom is an important example of policy framing and provides evidence of the synergy between advertising and alcohol industry representatives in combatting legislation that could harm profits.

Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising until 9:30 pm, and to examine how health benefits and healthcare cost-savings differ by SEP. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by area-level SEP. A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M⁻AUD7M), resulting in modelled reductions in energy intake (mean 115 kJ/day) and body mass index (BMI) (mean 0.352 kg/m²). The intervention is likely to be cost-saving, with 1.4 times higher total cost-savings and 1.5 times higher health benefits in the most disadvantaged socioeconomic group (17,512 HALYs saved (95% UI 10,372⁻25,155); total cost-savings AUD126.3M (95% UI AUD58.7M⁻196.9M) over the lifetime) compared to the least disadvantaged socioeconomic group (11,321 HALYs saved (95% UI 6812⁻15,679); total cost-savings AUD90.9M (95% UI AUD44.3M⁻136.3M)). Legislation to restrict HFSS TV advertising is likely to be cost-effective, with greater health benefits and healthcare cost-savings for children with low SEP., Competing Interests: The authors declare no conflict of interest.

Background/aims: Despite widespread Internet adoption, online advertising remains an underutilized tool to recruit participants into clinical trials. Whether online advertising is a cost-effective method to enroll participants compared to other traditional forms of recruitment is not known., Methods: Recruitment for the Survivorship Promotion In Reducing IGF-1 Trial, a community-based study of cancer survivors, was conducted from June 2015 through December 2016 via in-person community fairs, advertisements in periodicals, and direct postal mailings. In addition, "Right Column" banner ads were purchased from Facebook to direct participants to the Survivorship Promotion In Reducing IGF-1 Trial website. Response rates, costs of traditional and online advertisements, and demographic data were determined and compared across different online and traditional recruitment strategies. Micro-trials optimizing features of online advertisements were also explored., Results: Of the 406 respondents to our overall outreach efforts, 6% (24 of 406) were referred from online advertising. Facebook advertisements were shown over 3 million times (impressions) to 124,476 people, which resulted in 4401 clicks on our advertisement. Of these, 24 people ultimately contacted study staff, 6 underwent prescreening, and 4 enrolled in the study. The cost of online advertising per enrollee was $794 when targeting a general population versus $1426 when accounting for strategies that specifically targeted African Americans or men. By contrast, community fairs, direct mail, or periodicals cost $917, $799, or $436 per enrollee, respectively. Utilization of micro-trials to assess online ads identified subtleties (e.g. use of an advertisement title) that substantially impacted viewer interest in our trial., Conclusion: Online advertisements effectively directed a relevant population to our website, which resulted in new enrollees in the Survivorship Promotion In Reducing IGF-1 Trial at a cost comparable to traditional methods. Costs were substantially greater with online recruitment when targeting under-represented populations, however. Additional research using online micro-trial tools is needed to evaluate means of more precise recruitment to improve yields in under-represented groups. Potential gains from faster recruitment speed remain to be determined.

Objective: Exposure to advertisements cannot fully explain the associations between young children's dietary intake and the time they spend in front of the television. It is therefore of importance to study television content other than advertisements in this aspect. The present study aimed to examine the nature and extent of verbal and visual appearances of foods and beverages in children's television programmes on Icelandic public service television., Design: A total of 27 h of children's programmes (domestic and internationally produced) were watched. All verbal and visual appearances of foods and beverages were coded, as well as the context in which the foods/beverages were discussed or appeared., Setting: Children's programmes on Icelandic public service television., Subjects: Two food groups were of special interest for their importance from a public health perspective: high-calorie and low-nutrient (HCLN) foods and fruits and vegetables (F&V). The χ 2 test and logistic regression were performed to analyse if the occurrence of the two groups was associated with the context where foods/beverages appeared., Results: Of the 125 different programmes, a food or beverage appeared in 86 %. Of the total food appearances (n 599), HCLN foods accounted for 26 % and F&V for 23 %. HCLN foods were presented as desirable by appearing more frequently with child characters (P<0·01) than F&V., Conclusions: Public service television has the potential to improve the way food and eating is presented in children's programmes, as young childhood is a critical period for founding healthy habits for later life.

In ∼100 years, marketing to children went from a severely frowned upon practice to an integral part of growing up as companies came to realize that investing in marketing to children and adolescents provides excellent immediate and future dividends. Each year, enormous sums of money are spent to reach this valuable audience because children and adolescents spend billions on their own purchases, influence family decisions about what to buy, and promise a potential lifetime of brand loyalty. The channels to reach youth have grown, and marketers are increasingly using them, often blurring the distinction between entertainment and advertising. Because advertising to children and adolescents has become ubiquitous, researchers who study its influence raise significant concerns about the practice, especially as it relates to dietary behavior, family conflict, marketer tactics, and children's potential vulnerability as an audience. In this review by the Workgroup on Marketing and Advertising, we highlight the state of the research in this area and suggest that more research needs to be conducted on understanding the following: the effects of advertising exposure, how psychological development affects children's responses to marketing, the problems associated with advertising in newer media, and how researchers, parents, and practitioners might be able to mitigate the most deleterious advertising effects. We then present avenues of future research along with recommendations for key stakeholders., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

Background: The question of whether underage youth are disproportionately exposed to alcohol advertising lies at the heart of the public health debate about whether restrictions on alcohol advertising are warranted. The aim of this study was to determine whether alcohol brands popular among underage (ages 12 to 20 years) drinkers ("underage brands") are more likely than others ("other brands") to advertise in magazines with high underage readerships., Methods: We analyze the advertising of 680 alcohol brands in 49 magazines between 2006 and 2011. Using a random effects probit model, we examine the relationship between a magazine's underage readership and the probability of an underage or other brand advertising in a magazine, controlling for young adult (ages 21 to 29 years) and total readerships, advertising costs and expenditures, and readership demographics., Results: We find that underage brands are more likely than other brands to advertise in magazines with a higher percentage of underage readers. Holding all other variables constant at their sample means, the probability of an "other" brand advertising in a magazine remains essentially constant over the range of underage readership from 0.010 (95% confidence interval [CI], 0.007 to 0.013) at 5% to 0.012 (95% CI, 0.008 to 0.016) at 35%. In contrast, the probability of an underage brand advertising nearly quadruples, ranging from 0.025 (95% CI, 0.015 to 0.035) to 0.096 (95% CI, 0.057 to 0.135), where underage brands are 7.90 (95% CI, 3.89 to 11.90) times more likely than other brands to advertise., Conclusions: Alcohol brands popular among underage drinkers are more likely than other brands to advertise in magazines with high underage readerships, resulting in the disproportionate exposure of underage youth. Current voluntary advertising industry guidelines are not adequate to protect underage youth from high and disproportionate exposure to alcohol advertising in magazines. To limit advertising exposure among underage youth, policy makers may want to consider regulation of alcohol advertising in magazines., (Copyright © 2017 by the Research Society on Alcoholism.)

Background: Recruitment in clinical research is a common challenge and source of study failure. The reporting of recruitment methods and costs in hypertension trials is limited especially for smaller, single-site trials, online intervention trials, and trials using newer online recruitment strategies., Objective: The aims of this study are to describe and examine the feasibility of newer online-e-mail recruitment strategies and traditional recruitment strategies used to enroll participants with insomnia and high blood pressure into an online behavioral sleep intervention study (Sleeping for Heart Health)., Methods: The 16 online-e-mail-based and traditional recruitment strategies used are described. Recruitment strategy feasibility was examined by study interest and enrollee yields, conversion rates, and costs (direct, remuneration, labor, and cost per enrollee)., Results: From August 2014 to October 2015, 183 people were screened and 58 (31.7%) enrolled in the study (51.1 ± 12.9 years, 63.8% female, 72.4% African American, 136 ± 12/88 ± 7 mm Hg, 87.9% self-reported hypertension, 67.2% self-reported antihypertensive medication use). The recruitment strategies yielding the highest enrollees were the university hospital phone waiting message system (25.4%), Craigslist (22.4%), and flyers (20.3%) at a per enrollee cost of $42.84, $98.90, and $128.27, respectively. The university hospital phone waiting message system (55.6%) and flyers (54.5%) had the highest interested participant to enrolled participant conversion rate of all recruitment strategies., Conclusion: Approximately 70% of all enrolled participants were recruited from the university hospital phone waiting message system, Craigslist, or flyers. Given the recruitment challenges that most researchers face, we encourage the documenting, assessing, and reporting of detailed recruitment strategies and associated recruitment costs so that other researchers may benefit.

Objective: To test whether hospital advertising expenditures predict HCAHPS global ratings., Data Sources/study Setting: We examined media advertising expenditures by 2,142 acute care hospitals in 209 markets in the United States. Data on hospital characteristics, location, and revenue came from CMS reports; system ownership was obtained from the American Hospital Association. Advertising data came from Kantar Media. HCAHPS data were obtained from HospitalCompare., Study Design: Regression models examined whether hospitals' advertising spending predicts HCAHPS global measures and whether market concentration moderated this association., Data Collection/extraction Methods: Hospital advertising spending was calculated by adding each individual hospital's expenditures to the amount spent by its parent health system, proportionally allocated by hospital revenue. Health system market share was used to estimate market concentration. These data were compared to hospitals' HCAHPS measures., Principal Findings: In competitive markets (HHI below 1,000), hospital advertising predicted HCAHPS global measures. A 1-percent increase in advertising was associated with a 1.173-percent increase in patients rating the hospital a "9" or "10" on the HCAHPS survey and a 1.540-percent increase in patients who "definitely" would recommend the hospital. In concentrated markets, this association was not significant., Conclusions: In competitive markets, hospitals that spend more on advertising earn higher HCAHPS ratings on global measures., (© Health Research and Educational Trust.)

The declining cost of DNA sequencing has been accompanied by a proliferation of companies selling 'direct-to-consumer genetic testing' (DTC-GT) services. Many of these are marketed online as tools for enabling citizens to make more informed decisions about their health, wellness and lifestyle. We assessed the 'information for consumers' provided by these companies at the prepurchase stage, which could influence initial decisions to part with money, data or tissue samples. A scoping exercise revealed 65 DTC-GT companies advertising their services online to consumers in the United Kingdom, of which 15 met our inclusion criteria. We benchmarked their consumer information against the good practice principles developed by the UK Human Genetics Commission (HGC). No provider complied with all the HGC principles and overall levels of compliance varied considerably. Although consent for testing was discussed by all but one company, information about data reuse for research or other purposes was often sparse and consent options limited or unclear. Most did not provide supplementary support services to help users better understand or cope with the implications of test results. We provide recommendations for updating the preconsumer transparency aspects of the HGC guidelines to ensure their fitness-for-purpose in this rapidly changing market. We also recommend improving coordination between relevant governance bodies to ensure minimum standards of transparency, quality and accountability. Although DTC-GT has many potential benefits, close partnership between consumers, industry and government, along with interdisciplinary science input, are essential to ensure that these innovations are used ethically and responsibly.

Objectives: Delivery of interventions via smartphone is a relatively new initiative in public health, and limited evidence exists regarding optimal strategies for recruitment. We describe the effectiveness of approaches used to recruit participants to a smartphone-enabled nutrition intervention trial., Methods: Internet and social media advertising, mainstream media advertising and research team networks were used to recruit New Zealand adults to a fully automated smartphone-delivered nutrition labelling trial (no face-to-face visits were required). Recruitment of Māori and Pacific participants was a key focus and ethically relevant recruitment materials and approaches were used where possible. The effectiveness of recruitment strategies was evaluated using Google Analytics, monitoring of study website registrations and randomisations, and self-reported participant data. The cost of the various strategies and associations with participant demographics were assessed., Results: Over a period of 13 months, there were 2448 registrations on the study website, and 1357 eligible individuals were randomised into the study (55%). Facebook campaigns were the most successful recruitment strategy overall (43% of all randomised participants) and for all ethnic groups (Māori 44%, Pacific 44% and other 43%). Significant associations were observed between recruitment strategy and age (p<0.001), household size (p<0.001), ethnicity (p<0.001), gender (p=0.005) and interest in healthy eating (p=0.022). Facebook campaigns resulted in the highest absolute numbers of study registrations and randomisations (966 and 584, respectively). Network strategies and Facebook campaigns cost least per randomised participant (NZ$4 and NZ$5, respectively), whereas radio advertising costs most (NZ$179 per participant)., Conclusion: Internet and social media advertising were the most effective and least costly approaches to recruiting participants to a smartphone-delivered trial. These approaches also reached diverse ethnic groups. However, more culturally appropriate recruitment strategies are likely to be necessary in studies where large numbers of participants from specific ethnic groups are sought., Trial Registration: ACTRN12614000644662; Post-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)