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BackgroundFacebook has a comprehensive set of policies intended to inhibit promotion and sales of tobacco products. Their effectiveness has yet to be studied.MethodsLeading tobacco brands (388) were identified via Nielsen and Ranker databases and 108 were found to maintain brand-sponsored Facebook pages. Key indicators of alignment with Facebook policy were evaluated.ResultsPurchase links (eg, ‘shop now’ button) on brand-sponsored pages were found for hookah tobaccos (41%), e-cigarettes (74%), smokeless (50%) and cigars (31%). Sales promotions (eg, discount coupons) were present in hookah tobacco (48%), e-cigarette (76%) and cigar (69%) brand-sponsored pages. While conventional cigarettes did not maintain brand-sponsored pages, they were featured in 80% of online tobacco vendors’ Facebook pages. The requirement for age gating, to exclude those <18 from viewing tobacco promotion, was absent in hookah tobacco (78%), e-cigarette (62%) and cigar (21%) brand-sponsored pages and for 90% of online tobacco stores which promote leading cigarette brands (eg, Marlboro, Camel). Many of the brand-sponsored tobacco product pages had thousands of ‘likes’.ConclusionsIt is laudable that Facebook has policies intended to interdict tobacco promotion throughout its platform. Nevertheless, widespread tobacco promotion and sales were found at variance with the company’s policies governing advertising, commerce, page content and under age access. Vetting could be improved by automated screening in partnership with human reviewers.

Objectives. To assess exposure to marijuana advertising in Oregon after the start of retail marijuana sales in October 2015. Methods. We conducted a repeated cross-sectional online survey of 4001 Oregon adults aged 18 years and older in November 2015 and April–May 2016. We assessed subgroup differences by using the Pearson χ 2 test. Results. More than half of adults (54.8%) statewide reported seeing marijuana advertising in the past month. These adults reported that they most frequently saw storefront (74.5%), streetside (66.5%), and billboard (55.8%) advertising. Exposure did not significantly differ by participant’s age or marijuana use but was higher among those living in counties with retail sales (56.5%) than in counties without (32.5%). Conclusions. Most adults reported exposure to marijuana advertising following the start of retail marijuana sales in Oregon. People who do not use marijuana and those aged 18 to 24 years were as exposed to advertising as other groups. Public Health Implications. Advertising restrictions may be needed to protect youths and young adults from pro-use messages. Commercial free speech afforded by the First Amendment makes advertising restrictions challenging, but public policy experts note that restrictions aimed at protecting youths may be allowed.

Background In Australia, sport is saturated by the promotion of junk food, alcohol and gambling products. This is particularly evident on player jerseys. The effect of this advertising on children, who are exposed to these messages while watching sport, has not been thoroughly investigated. The aim of this research study was to investigate: (1) the extent to which children implicitly recalled shirt sponsors with the correct sporting team; (2) whether children associated some types of sponsors with certain sporting codes more than others; and (3) whether age of the children influenced the correct recall of sponsoring brands and teams. Method This experimental study conducted in New South Wales, Australia used projective techniques to measure the implicit recall of team sponsorship relationships of 85 children aged 5–12 years. Participants were asked to arrange two sets of magnets – one which contained sporting teams and one which contained brand logos – in the manner deemed most appropriate by them. Children were not given any prompts relating to sporting sponsorship relationships. Results Three quarters (77 %) of the children were able to identify at least one correct shirt sponsor. Children associated alcohol and gambling brands more highly with the more popular sporting code, the National Rugby League compared to the Australian Football League sporting code. Results showed that age had an effect on number of shirt sponsors correctly recalled with 9–12 year olds being significantly more likely than 5–8 year olds to correctly identify team sponsors. Conclusions Given children’s ability to implicitly recall shirt sponsors in a sporting context, Australian sporting codes should examine their current sponsorship relationships to reduce the number of unhealthy commodity shirt sponsors. While there is some regulation that protects children from the marketing of unhealthy commodity products, these findings suggest that children are still exposed to and recall these sponsorship relationships. Results suggest that the promotion of unhealthy commodity products during sporting matches is contributing to increased awareness amongst children of unhealthy commodity brands. Further investigation is required to examine the extent and impact of marketing initiatives during televised sporting matches on children.

Objectives. To provide regulators and the US Food and Drug Administration with a description of cessation-themed advertising among electronic cigarette (e-cigarette) brands. Methods. We performed a content analysis of 6 months (January through June 2015) of advertising by e-cigarette brands on their company-sponsored social media channels and blogs as well as user-generated content (testimonials) appearing within brand-sponsored Web sites. An explicit claim of cessation efficacy unambiguously states that e-cigarettes help in quitting smoking, and implicit claims use euphemisms such as “It works.” We selected a cohort of 23 leading e-cigarette brands, either by their rank in advertising spending or their prevalence in Internet searches. Results. Among leading e-cigarette brands, 22 of 23 used cessation-themed advertisements. Overall, 23% of the advertisements contained cessation claims, of which 18% were explicit and 82% were implicit. Conclusions. Among leading e-cigarette advertisers, cessation themes are prevalent with implicit messaging predominating over explicit quit claims. Policy implications. These results can help the Food and Drug Administration clarify whether tobacco products should be regulated as drugs with therapeutic purpose or as recreational products.

We explored how sugar‐sweetened beverages are marketed to Australian young people through sugar‐sweetened beverage brand Facebook pages. We undertook a content analysis of Facebook posts made by six of the most popular sugar‐sweetened beverage Facebook pages in Australia. Data were collected for a six‐month period and were quantitatively analysed for descriptive data and explicit marketing techniques and then thematically analysed for implicit marketing messages. There were almost 1.9 million engagements across the six pages over the six‐month period. Most posts (70%) included one or more calls to action through which followers were encouraged to do something. Content by sports and energy drink brands were heavily dominated by ‘sporting prowess’ and ‘masculinity’ themes while content by Coca‐Cola shared the message of ‘having fun with friends’ and ‘happiness’. All pages used outdoor setting scenes. Sugar‐sweetened beverage brands use Facebook to align their marketing with the socio‐cultural values and practices likely to be regarded as important by young people. Our findings provide challenges and opportunities for those in public health advocacy and policy to consider for future obesity‐reduction strategies.

The existing empirical research exploring the impact of threat appeals on driver behavior has reported inconsistent findings. In an effort to provide an up-to-date synthesis of the experimental findings, meta-analytic techniques were employed to examine the impact of threat-based messages on fear arousal and on lab-based indices of driving behavior. Experimental studies (k = 13, N = 3044), conducted between 1990 and 2011, were included in the analyses. The aims of the current analysis were (a) to examine whether or not the experimental manipulations had a significant impact on evoked fear, (b) to examine the impact of threat appeals on three distinct indices of driving, and (c) to identify moderators and mediators of the relationship between fear and driving outcomes. Large effects emerged for the level of fear evoked, with experimental groups reporting increased fear arousal in comparison to control groups (r = .64, n = 619, p<.01). The effect of threat appeals on driving outcomes, however, was not significant (r = .03, p = .17). This analysis of the experimental literature indicates that threat appeals can lead to increased fear arousal, but do not appear to have the desired impact on driving behavior. We discuss these findings in the context of threat-based road safety campaigns and future directions for experimental research in this area.

BackgroundDespite declines in overall US cigarette consumption, the menthol cigarette market share has increased in recent years. Advertising contributes to menthol initiation and use, but little has been done to characterise menthol cigarette advertising outside of the point of sale.MethodsTwo full-service advertising firms were used to develop a library of menthol cigarette advertisements (ads) over a 9-month period (June 2012–February 2013) in the USA. The volume of ads, media channel (direct mail, print, online, email), estimated spend and households reached was summarised overall and by brand in 2013. Direct mail, email and print ads were coded for content and the target audience of print publications was examined.ResultsOver the study period, 205 menthol cigarette ads were identified with estimated expenditures exceeding US$31 million, with 70% spent on direct mail ads. Over 90% of ads promoted Camel, Marlboro and Newport menthol cigarettes. A majority (87%) of direct mail ads contained coupons or other incentives known to appeal to price-sensitive customers. Only two brands’ print ads appeared during this period: Newport ads focused on themes of sociability and sexuality, and were placed in magazines targeting African-Americans and younger consumers; American Spirit print ads were placed in general interest magazines and predominantly stressed the ‘natural’ aspects of their brand.DiscussionThe tobacco industry continues to spend millions of dollars promoting menthol cigarettes through channels that preferentially target vulnerable subgroups, such as African-Americans and younger consumers. Public health campaigns to educate and combat the influence of menthol advertising are needed.

The aim of the present study is to conduct a social media content analysis of chronic obstructive pulmonary disease (COPD) patient education videos on YouTube. A systematic search protocol was used to locate 223 videos. Two independent coders evaluated each video to determine topics covered, media source(s) of posted videos, information quality as measured by HONcode guidelines for posting trustworthy health information on the Internet, and viewer exposure/engagement metrics. Over half the videos (n = 113, 50.7%) included information on medication management, with far fewer videos on smoking cessation (n = 40, 17.9%). Most videos were posted by a health agency or organization (n = 128, 57.4%), and the majority of videos were rated as high quality (n = 154, 69.1%). HONcode adherence differed by media source (Fisher’s exact test = 20.52, p = 0.01), however with user-generated content receiving the lowest quality scores. Overall level of user engagement as measured by number of “likes,” “favorites,” “dislikes,” and user comments was low (median range = 0–3, interquartile range = 0–16) across all sources of media. Study findings suggest that COPD education via YouTube has the potential to reach and inform patients; however, existing video content and quality varies significantly. Future interventions should help direct individuals with COPD to engage with high-quality patient education videos on YouTube that are posted by reputable health organizations and qualified medical professionals. Patients should be educated to avoid and/or critically view low-quality videos posted by individual YouTube users who are not health professionals.

While young adults have the highest prevalence of cigarette smoking of any adult age group, studies of tobacco and other substance use have reported challenges in recruiting this age group. The Internet may be a useful tool for reaching young adult smokers. The present study compared three Internet-based recruitment methods for young adult smokers to complete a survey about tobacco and other substance use: Craigslist advertisements, other Internet advertisements, and E-mail invitations through a survey sampling service. Recruitment campaigns invited young adults aged 18-25 years who had smoked at least one cigarette in the past 30 days to complete an online survey. Recruitment methods were compared across recruitment numbers, costeffectiveness, and demographic and smoking characteristics of recruited participants. In 6 months, 920 people gave online consent to determine eligibility to complete the survey, of which 336 (36.5%) were eligible, and 201 (59.8%) completed the survey. While Internet advertisements yielded the largest proportion of recruited participants and completed surveys overall, Craigslist and sampling strategies were more successful at targeting young adult smokers who went on to complete the survey and were more costeffective. Participants differed in demographic and substance use characteristics across the three recruitment mechanisms. We identified success at reaching young adults who have smoked cigarettes recently through the Internet, though costs, participant eligibility, proportion of completed surveys, and respondent characteristics differed among the three methods. A multipronged approach to Internet recruitment is most likely to generate a broad diverse sample of young adult smokers.

Unhealthful food-and-beverage advertising often targets vulnerable groups. The extent of such advertising in subway stations has not been reported and it is not clear how ad placement may relate to subway ridership or community demographics, or what the implications might be for diets and diet-related health in surrounding communities. Riding all subway lines ( n =  7) in the Bronx, NY, USA, investigators systematically assessed all print ads ( n =  1586) in all stations ( n =  68) in 2012. Data about subway ridership came from the Metropolitan Transportation Authority. Demographic data on surrounding residential areas came from the U.S. Census Bureau. Data on dietary intake and diet-related conditions came from a city health-department survey. There were no ads promoting “more-healthful” food-or-beverage items (i.e., fruits, vegetables, whole grains, nuts, water or milk). There were many ads for “less-healthful” items (e.g., candies, chips, sugary cereals, frozen pizzas, “energy” drinks, coffee confections, hard alcohol, and beer). Ad placement did not relate to the number of riders entering at stations. Instead, exposure to food-or-beverage ads generally, and to “less-healthful” ads particularly (specifically ads in Spanish, directed at youth, and/or featuring minorities), was directly correlated with poverty, lower high-school graduation rates, higher percentages of Hispanics, and/or higher percentages of children in surrounding residential areas. Correlations were robust to sensitivity analyses. Additional analyses suggested correlations between ad exposures and sugary-drink consumption, fruit-and-vegetable intake, and diabetes, hypertension, and high-cholesterol rates. Subway-station ads for “less-healthful” items were located disproportionately in areas home to vulnerable populations facing diet and diet-related-health challenges. The fact that uneven ad placement did not relate to total rider counts suggests ads were not directed at the largest possible audiences but rather targeted to specific groups.