ORCID Profile
0000-0002-4984-1818
Current Organisations
University of Bristol
,
University of Bath
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Publisher: Elsevier BV
Date: 06-2021
Publisher: Wiley
Date: 30-08-2019
DOI: 10.1111/ADD.14770
Abstract: Very few countries regulate maximum cigarette pack size. Larger, non‐standard sizes are increasingly being introduced by the tobacco industry. Larger portion sizes increase food consumption larger cigarette packs may similarly increase tobacco consumption. Here we consider the evidence for legislation to cap cigarette pack size to reduce tobacco‐related harm. We first describe the regulations regarding minimum and maximum pack sizes in the 12 countries that have adopted plain packaging legislation and describe the range of sizes available. We then discuss evidence for two key assumptions that would support capping pack size. First, regarding the causal nature of the relationship between pack size and tobacco consumption, observational evidence suggests that people smoke fewer cigarettes when using smaller packs. Secondly, regarding the causal nature of the relationship between reducing consumption and successful cessation, reductions in number of cigarettes smoked per day are associated with increased cessation attempts and subsequent abstinence. However, more experimental evidence is needed to infer the causal nature of these associations among general populations of smokers. Cigarette pack size is positively associated with consumption and consumption is negatively associated with cessation. Based on limited evidence of the causal nature of these associations, we hypothesize that government regulations to cap cigarette pack sizes would positively contribute to reducing smoking prevalence.
Publisher: Cold Spring Harbor Laboratory
Date: 08-03-2022
DOI: 10.1101/2022.03.04.22271898
Abstract: Increasing the availability of non-alcoholic options is a promising population-level intervention to reduce alcohol consumption, currently unassessed in naturalistic settings. This study in an online retail context aimed to estimate the impact of increasing the proportion of non-alcoholic (relative to alcoholic) drinks, on selection and purchasing of alcohol. Adults (n=737) residing in England and Wales who regularly purchased alcohol online were recruited between March-July 2021. Participants were randomly assigned to one of three groups: ‘25% non-alcoholic/75% alcoholic’ ‘50% non-alcoholic/50% alcoholic’ ‘75% non-alcoholic/25% alcoholic’, then selected drinks in a simulated online supermarket, before purchasing them in an actual online supermarket. The primary outcome was the number of alcohol units selected (with intention to purchase) secondary outcomes included actual purchasing. 607 participants (60% female, mean age = 38 years [range: 18-76]) completed the study and were included in the primary analysis. In the first part of a hurdle model, a greater proportion of participants in the ‘75% non-alcoholic’ group did not select any alcohol (13.1%) compared to the ‘25% non-alcoholic’ group (3.4% 95% confidence interval [CI] - 2.09, -0.63 p 0.001). There was no evidence of a difference between the ‘75% non-alcoholic’ and the ‘50% non-alcoholic’ (7.2%) groups (95% CI 0.10, 1.34 p = 0.022) or between the ‘50% non-alcoholic’ and the ‘25% non-alcoholic’ groups (95% CI -1.44, 0.17 p = 0.121). In the second part of a hurdle model in participants (559/607) selecting any drinks containing alcohol, the ‘75% non-alcoholic’ group selected fewer alcohol units compared to the ‘50% non-alcoholic’ (95% CI -0.44, -0.14 p 0.001) and ‘25% non-alcoholic’ (95% CI - 0.54, -0.24 p 0.001) groups, with no evidence of a difference between the ‘50% non-alcoholic’ and ‘25% non-alcoholic’ groups (95% CI -0.24, 0.05 p = 0.178). Overall, across all participants, 17.46 units (95% CI 15.24, 19.68) were selected in the ‘75% non-alcoholic’ group 25.51 units (95% CI 22.60, 28.43) in the ‘50% non-alcoholic’ group and 29.40 units (95% CI 26.39, 32.42) in the ‘25% non-alcoholic’ group. This corresponds to 8.1 fewer units (a 32% reduction) in the ‘75% non-alcoholic’ compared to the ‘50% non-alcoholic’ group, and 11.9 fewer alcohol units (41% reduction) compared to the ‘25% non-alcoholic’ group 3.9 fewer units (13% reduction) were selected in the ‘50% non-alcoholic’ group than in the ‘25% non-alcoholic’ group. For all other outcomes, alcohol selection and purchasing were consistently lowest in the ‘75% non-alcoholic’ group. Study limitations include the setting not being entirely naturalistic due to using a simulated online supermarket as well as an actual online supermarket, and that there was substantial dropout between selection and purchasing. This study provides evidence that substantially increasing the proportion of non-alcoholic drinks – from 25% to 50% or 75% - meaningfully reduces alcohol selection and purchasing. Further studies are warranted to assess whether these effects are realised in a range of real-world settings. ISRCTN: 11004483 OSF: osf.io/qfupw Excessive alcohol consumption contributes to the global burden of non-communicable diseases, including cancer, heart disease and stroke. Interventions that change physical and economic environments have the potential to reduce alcohol consumption. Interventions targeting physical environments include availability interventions that involve changing the proportion of healthier options that are available, relative to less healthy options. A previous online study found that increasing the availability of non-alcoholic compared to alcoholic drinks reduced the hypothetical selection of alcoholic drinks, but there is an absence of evidence from naturalistic settings. This study evaluated the impact of increasing the proportion of non-alcoholic (relative to alcoholic) drinks, on selection and actual purchasing of alcohol. In a randomised controlled trial, 737 participants were randomly assigned to one of three groups with varying proportions of alcoholic versus non-alcoholic drinks ‘25% non-alcoholic/75% alcoholic’ ‘50% non-alcoholic/50% alcoholic’ ‘75% non-alcoholic/25% alcoholic’). Participants selected drinks from 64 options in a simulated online supermarket which was designed to look and function similarly to an online supermarket. Participants were then required to immediately purchase the same drinks in an actual online supermarket. It was found that increasing the proportion of non-alcoholic drinks – from 25% to 50% or 75% – reduced the amount of alcohol selected and bought, in this online supermarket setting. This study provides evidence that increasing the proportion of non-alcoholic drinks could reduce alcohol selection and purchasing, highlighting the potential for availability interventions to reduce alcohol sales at population level. Further studies are warranted to assess whether these effects are realised in a range of real-world settings
Publisher: Wiley
Date: 25-05-2021
DOI: 10.1111/ADD.15519
Abstract: Health warning labels (HWLs) on tobacco products reduce smoking. There is an absence of evidence concerning the impact of alcohol HWLs on selection or purchasing in naturalistic settings. Using a commercial‐standard naturalistic shopping laboratory, this study aimed to estimate the impact on selection of alcoholic drinks of HWLs describing adverse health consequences of excessive alcohol consumption. A between‐subjects randomised experiment with three groups was conducted: group 1: image‐and‐text HWL group 2: text‐only HWL group 3: no HWL. A commercial‐standard naturalistic shopping laboratory in the United Kingdom. Adults ( n = 399, 55% female) over the age of 18 years, who purchased beer or wine weekly to drink at home. Participants were randomised to one of three groups varying in the HWL displayed on the packaging of the alcoholic drinks: (i) image‐and‐text HWL ( n = 135) (ii) text‐only HWL ( n = 129) (iii) no HWL ( n = 135). Participants completed a shopping task, selecting items from a range of alcoholic and non‐alcoholic drinks, and snacks. The primary outcome was the proportion of alcoholic drinks selected. Secondary outcomes included HWL ratings on negative emotional arousal and label acceptability. There was no clear evidence of a difference in the HWL groups for the percentage of drinks selected that were alcoholic compared to no HWL (44%): image‐and‐text HWL: 46% (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.82, 1.42) text‐only HWL: 41% (OR = 0.87, 95% CI = 0.67, 1.14). Concordant with there being no difference between groups, there was extreme evidence in favour of the null hypothesis (Bayes factor [BF] 0.01). Negative emotional arousal was higher ( P 0.001) and acceptability lower ( P 0.001) in the image‐and‐text HWL group, compared to the text‐only HWL group. In a naturalistic shopping laboratory, there was no evidence that health warning labels describing the adverse health consequences of excessive alcohol consumption changed selection behaviour.
Publisher: BMJ
Date: 13-04-2022
DOI: 10.1136/TOBACCOCONTROL-2021-056980
Abstract: To estimate the impact of electronic cigarette (e-cigarette) retail display exposure on attitudes to smoking and vaping (susceptibility to tobacco smoking and using e-cigarettes, and perceptions of the harms of smoking and e-cigarette use). Between-subjects randomised experiment using a 2 (e-cigarette retail display visibility: high vs low)×2 (proportion of e-cigarette images: 75% vs 25%) factorial design. Online via the Qualtrics survey platform. UK children aged 13–17 years (n=1034), recruited through a research agency. Participants viewed 12 images of retail displays that contained e-cigarette display images or unrelated product images. E-cigarette display images were either high or low visibility, based on a conspicuousness score. Participants were randomised to one of four groups, with e-cigarette display visibility and proportion of e-cigarette images, compared with images of unrelated products, manipulated: (1) 75% e-cigarettes, high visibility (2) 25% e-cigarettes, high visibility (3) 75% e-cigarettes, low visibility (4) 25% e-cigarettes, low visibility. The primary outcome was susceptibility to smoking (among never smokers only). Secondary outcomes were susceptibility to using e-cigarettes (among never vapers only), and perceptions of smoking and e-cigarette harm (all participants). Neither e-cigarette retail display visibility, nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to smoking (visibility: OR=0.84, 95% CI 0.62 to 1.13, p=0.24 proportion: OR=1.34, 95% CI 1.00 to 1.82, p=0.054 (reference: low visibility, not susceptible)). Planned subgroup analyses indicated that exposure to a higher proportion of e-cigarette images increased susceptibility to smoking among children who visited retail stores more regularly (n=524, OR=1.59, 95% CI 1.04 to 2.43, p=0.034), and those who passed the attention check (n=880, OR=1.43, 95% CI 1.03 to 1.98, p=0.031). In addition, neither e-cigarette retail display visibility nor the proportion of e-cigarette images displayed, appeared to influence susceptibility to using e-cigarettes (visibility: OR=1.07, 95% CI 0.80 to 1.43, p=0.65 proportion: OR=1.22, 95% CI 0.91 to 1.64, p=0.18). Greater visibility of e-cigarette retail displays reduced perceived harm of smoking (mean difference (MD)=−0.19, 95% CI −0.34 to −0.04, p=0.016). There was no evidence that the proportion of e-cigarette images displayed had an effect (MD=−0.07, 95% CI −0.22 to 0.09, p=0.40). Perceived harm of e-cigarette use did not appear to be affected by e-cigarette retail display visibility (MD=−0.12, 95% CI −0.28 to 0.05, p=0.16) or by the proportion of e-cigarette images displayed (MD=−0.10, 95% CI −0.26 to 0.07, p=0.24). There is no evidence in the full s le to suggest that children’s susceptibility to smoking is increased by exposure to higher visibility e-cigarette retail displays, or to a higher proportion of e-cigarette images. However, for regular store visitors or those paying more attention, viewing a higher proportion of e-cigarette images increased susceptibility to smoking. In addition, viewing higher visibility e-cigarette images reduced perceived harm of smoking. A review of the current regulatory discrepancy between tobacco and e-cigarette point-of-sale marketing is warranted. ISRCTN18215632 .
Publisher: Wiley
Date: 02-01-2019
DOI: 10.1111/ADD.14976
Publisher: BMJ
Date: 13-09-2021
DOI: 10.1136/TOBACCOCONTROL-2020-056314
Abstract: Tobacco point of sale (POS) retail displays are banned in many countries, including in England, due in part to evidence linking them to greater susceptibility to smoking in children. There is no equivalent ban on displays of electronic cigarettes (e-cigarettes) or smoking paraphernalia (eg, cigarette lighters) in England, which are often positioned alongside covered tobacco storage units. This observational study describes the visibility and placement of e-cigarette and smoking paraphernalia POS displays in major tobacco retailers in two cities in England to inform future research examining their possible links to susceptibility to tobacco smoking, particularly in children. Researchers visited all small- and large-format stores of four supermarket chains and a randomly selected s le of convenience stores, in Bristol and Cambridge. A standardised checklist was used to create a total visibility score for POS displays of (a) e-cigarettes and (b) smoking paraphernalia, plus other measures of visibility and placement. These were described for the total s le and compared between areas of low, medium, and high deprivation using general linear models adjusting for store location and store type. The visibility checklist was completed in 133 of 166 stores (80% completion rate). Both e-cigarette and smoking paraphernalia POS displays were present in 96% of stores. POS displays were highly visible across all stores: mean (SD) total visibility scores, out of 17, were 14.7 (1.8) for e-cigarettes and 12.7 (1.8) for smoking paraphernalia. There was no clear evidence of differences in visibility by area of deprivation. E-cigarette and smoking paraphernalia POS displays are near ubiquitous and highly visible in major tobacco retailers in two cities in England. The impact of these displays on tobacco smoking in children and adults is unknown, meriting urgent research to assess their effect on susceptibility to tobacco smoking in children.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Anna Blackwell.