Archive for June, 2012

Graphic warning labels improve smokers’ recall of warning

In a first of its kind study in the U.S., researchers at the Perelman School of Medicine at the University of Pennsylvania have shown that the addition of graphic warning labels on cigarette packaging can improve smokers’ recall of the warning and health risks associated with smoking. The new findings are published online-first in the American Journal of Preventive Medicine.

In past studies in Europe and Canada, graphic warning labels have proven to be effective in eliciting negative responses to smoking, increasing reported intention to quit smoking in smokers, and modifying beliefs about smoking dangers. However, these previous research results have generally been conducted using large, population-based studies that could be confounded by concurrent tax increases or anti-smoking media campaigns that coincide with the introduction of new warning labels.

Graphic Warning Labels

“An important first step in evaluating the true efficacy of the warning labels is to demonstrate if smokers can correctly recall its content or message,” said Andrew A. Strasser, PhD, associate professor, Department of Psychiatry at Penn and lead author of the new study. “Based on this new research, we now have a better understanding of two important questions about how U.S. smokers view graphic warning labels: do smokers get the message and how do they get the message.”

In the study, 200 current smokers were randomized to view either a text-only warning label advertisement, which was unaltered and utilized the Surgeon General’s warning and Federal Trade Commission (FTC) testing information that has appeared on cigarette advertisements since 1985; or a graphic warning label version that contained a graphic image (depicting a hospitalized patient on a ventilator) and a health warning with larger text, similar to what has been proposed by the FDA to be adopted in the U.S.

Graphics Make a Difference

In order to gauge how the participants viewed the layout of the advertisements, the research team utilized sophisticated eye-tracking technology. With this equipment, they were able to measure dwell time (total time viewing various parts of the ad, including the text or graphic warning), time to first viewing of portions of the ad to assess how attention is drawn, and fixations or the number of times they viewed each area of the ad (including the text or graphic warning). After reading the ads, each study participant also had to rewrite the warning label text to demonstrate their recall of the information.

Researchers found a significant difference in percentage correct recall of the warning label between those in the text-only versus graphic warning label condition, 50 percent vs. 83 percent. In addition, the quicker a smoker looked at the large text in the graphic warning, and the longer they viewed the graphic image, the more likely they were at recalling the information correctly.

The researchers say that the new data demonstrates that drawing attention to the warning label can improve recall of health relevant information, which may extend to improving risk perception of smoking. Additionally, attracting attention to the warning before viewing the advertisement body may change the framing of the message in the advertisement body, causing viewers to approach it with greater caution. Finally, time to first viewing has practical application to real-world settings where people may allocate only a few seconds to a print advertisement. Further study on the size, font, color, and location of text may identify the most effective way to draw attention.

More Effective Labels

“In addition to showing the value of adding a graphic warning label, this research also provides valuable insight into how the warning labels may be effective, which may serve to create more effective warning labels in the future,” said Dr. Strasser. “We’re hopeful that once the graphic warning labels are implemented, we will be able to make great strides in helping people to be better informed about their risks, and to convince them to quit smoking.”

The 2009 Family Smoking Prevention and Tobacco Control Act mandated the FDA to require graphic warning labels on cigarette packages. Originally mandated to appear on cigarette packages in September 2012, the implementation of these warning labels has been held up in court.

Strasser and colleagues note that the current study was designed to gauge short-term recall of the graphic warning information and that additional research addressing long-term recall and behavior changes are currently underway at Penn.

June 26th, 2012  in Tobacco No Comments »

Risk of alcohol abuse may increase after bariatric surgery

Among patients who underwent bariatric surgery, there was a higher prevalence of alcohol use disorders in the second year after surgery, and specifically after Roux-en-Y gastric bypass, compared with the years immediately before and following surgery, according to a study in the June 20 issue of JAMA. This study is being published early online to coincide with its presentation at the annual meeting of the American Society for Metabolic and Bariatric Surgery.

“As the prevalence of severe obesity increases in the United States, it is becoming increasingly common for health care providers and their patients to consider bariatric surgery, which is the most effective and durable treatment for severe obesity. Although bariatric surgery may reduce long-term mortality, and it carries a low risk of short-term serious adverse outcomes, safety concerns remain. Anecdotal reports suggest that bariatric surgery may increase the risk for alcohol use disorders (AUD; i.e., alcohol abuse and dependence),” according to background information in the article.

Higher Alcohol Level Peak

The authors add that there is evidence that some bariatric surgical procedures (i.e., Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy) alter the pharmacokinetics of alcohol. “Given a standardized quantity of alcohol, patients reach a higher peak alcohol level after surgery compared with case-controls or their preoperative levels.”

Wendy C. King, Ph.D., of the University of Pittsburgh, and colleagues conducted a study to determine whether the prevalence of AUD changed following bariatric surgery, comparing reported AUD in the year prior to surgery with the first and second years after surgery. The prospective study included 2,458 adults who underwent bariatric surgery at 10 U.S. hospitals. Of these participants, 1,945 (78.8 percent female; 87 percent white; median [midpoint] age, 47 years; median body mass index, 45.8) completed preoperative and postoperative (at 1 year and/or 2 years) assessments between 2006 and 2011. The primary outcome measure for the study was past year AUD symptoms determined with the Alcohol Use Disorders Identification Test (AUDIT) (indication of alcohol-related harm, alcohol dependence symptoms, or score 8 or greater).

Increases in 2nd Year

The researchers found that the prevalence of AUD symptoms did not significantly differ from 1 year before to 1 year after bariatric surgery (7.6 percent vs. 7.3 percent), but was significantly higher in the second postoperative year (9.6 percent). Frequency of alcohol consumption and AUD significantly increased in the second postoperative year compared with the year prior to surgery or the first postoperative year.

“More than half (66/106; 62.3 percent) of those reporting AUD at the preoperative assessment continued to have or had recurrent AUD within the first 2 postoperative years,” the authors write. “In contrast, 7.9 percent (101/1,283) of participants not reporting AUD at the preoperative assessment had postoperative AUD. Nonetheless, more than half (101/167; 60.5 percent) of postoperative AUD was reported by those not reporting AUD at the preoperative assessment”

The researchers also found that male sex, younger age, smoking, regular alcohol consumption, AUD, recreational drug use, lower score on a measure of a sense of belonging at the preoperative assessment and undergoing a RYGB were independently related to an increased likelihood of AUD after surgery. RYGB accounted for 70 percent of surgeries and doubled the likelihood of postoperative AUD compared with laparoscopic adjustable gastric banding.

Significant Societal Costs

The authors note that although the 2 percent increase (7.6 percent to 9.6 percent) in prevalence of AUD from prior to surgery to the 2-year postoperative assessment may seem small, the increase potentially represents more than 2,000 additional people with AUD in the United States each year, with accompanying personal, financial, and societal costs.

“This study has important implications for the care of patients who undergo bariatric surgery. Regardless of alcohol history, patients should be educated about the potential effects of bariatric surgery, in particular RYGB, to increase the risk of AUD. In addition, alcohol screening and, if indicated, referral should be offered as part of routine preoperative and postoperative clinical care. Further research should examine the long-term effect of bariatric surgery on AUD, and the relationship of AUD to postoperative weight control.”

June 26th, 2012  in Alcohol 1 Comment »