A Brief Review of Plain Packaging Research for Tobacco Products

In September 2009 the Public Health Research Consortium was approached by the Department of Health to conduct a rapid review of the literature on plain packaging for tobacco products. Time was very constrained, but every effort has been made to track down and assimilate as much as possible of the published and unpublished research in the area. This report presents the findings

Six conseils pour l’intégration du croisement des savoirs traditionnels autochtones et de la biomédecine dans l’enseignement aux étudiants en médecine dans le cadre d'un programme culturellement sécuritaire sur la santé des Autochtones

As Indigenous knowledges and biomedicine come together in healthcare today, to improve health outcomes and strengthen cultural identity among Indigenous Peoples, it is vital for physicians to learn about this convergence during their training. This narrative review article aims to provide practical advice for educators when implementing teaching regarding this topic, using examples from the research literature, and pedagogical and practice-based methods used at the University of Toronto (UofT). The methodology on obtaining the research literature included a search of a computer database called Medline. Moreover, the medical school curriculum information specific to UofT, was obtained through the formal curriculum map and UofT’s Office of Indigenous Medical Education. The following six recommendations provide a way to successfully implement the teachings on Indigenous knowledges and biomedicine, within a culturally-safe Indigenous health curriculum.Alors que les savoirs autochtones et la biomédecine se rejoignent dans les soins de santé aujourd’hui, il est essentiel d’intégrer cette rencontre dans la formation des médecins afin d’améliorer les issues de santé et de renforcer l'identité culturelle des peuples autochtones. À l’aide d’exemples tirés de la littérature et des méthodes pédagogiques et pratiques employées à l'Université de Toronto, la présente revue narrative vise à offrir aux éducateurs des conseils pratiques sur l’intégration de ce sujet dans leur programme. La méthodologie utilisée pour la recherche de littérature scientifique comprenait une consultation de la base de données informatique Medline. Quant aux informations sur le programme d'études de la Faculté de médecine de l’Université de Toronto, elles ont été obtenues par le biais du schéma tutoriel officiel et du Bureau de la formation médicale autochtone de l’université. Nous présentons six recommandations pour un enseignement réussi du croisement des savoirs autochtones et de la biomédecine dans le cadre d'un programme culturellement sécuritaire sur la santé des Autochtones. &nbsp

Young women smokers' response to using plain cigarette packaging: Qualitative findings from a naturalistic study

Background: The aim of this study was to explore in-depth the response of young women smokers (18-35 years) to using dark brown ‘plain' cigarette packs in naturalistic settings. Methods: Participants were recruited in six towns and cities in Scotland to take part in a naturalistic study, where they used plain cigarette packs for a week. Participants completed a number of questionnaires during the study period (reported elsewhere), and a sub-sample participated in post-study telephone interviews to explore their experiences of using the plain packs. Of the 187 participants who completed the study, 23 were randomly selected to participate in the post-study interviews. Within the interviews a semi-structured topic guide was used to assess perceptions of the plain pack, feelings created by the pack, feelings about smoking, and avoidant and smoking behaviour. Results: The brown (plain) packs were perceived negatively due to the colour, the  undesirable image the pack conveyed, and the reaction from others. The plain packs were  also associated with negative feelings, such as embarrassment, discomfort and guilt. Some participants also commented that they felt differently about the product, considered to be less enjoyable or more harmful, when using the plain packs, and were less interested in, or felt more negatively about, smoking. A number of participants said that they had engaged in avoidant behavior with the plain packs, such as hiding it, due to their negative thoughts about the packs and the reaction of others. Some participants also mentioned cessation-related behaviours when using the plain packs, such as forgoing cigarettes, stubbing cigarettes out early and thinking about quitting, largely due to the decreased enjoyment of smoking. Conclusions: The experience of using cigarettes in plain packs prompted a range of negative responses from young women smokers, who are a crucial target group for tobacco control interventions

How adolescents perceive cigarette packaging and possible benefits of plain packaging

Surveys in secondary schools in Scotland show 3% of 13 year olds to be regular smokers, i.e. smoke one or more cigarettes a week, with this number rising to 13% for 15 year olds (Black et al., 2011). While smoking prevalence is in long-term decline in Scotland, and indeed most of Europe, these figures are concerning given that trying a single cigarette increases the risk that an adolescent will become a later smoker, even after a gap of not smoking for up to three years (Fidler et al., 2006). Furthermore, the earlier that adolescents start smoking regularly, the greater the risk of developing tobaccorelated cancers and other diseases (International Agency for Research on Cancer, 2004; Muller, 2007). For smoking prevention to be effective a coordinated approach is required. This may include policy measures such as increasing taxation on tobacco products to keep prices high, and non-policy measures such as providing health advice to parents and carers, as well as promoting smoke-free domestic environments and encouraging smoking cessation (Muller, 2007). School-based interventions can also play a key role in helping prevention efforts (NICE, 2010)

Adolescent girls and young adult women's perceptions of superslims cigarette packaging: a qualitative study

Objectives: To explore perceptions of superslims packaging, including compact ‘lipstick’ packs, in line with 3 potential impacts identified within the impact assessment of the European Union (EU) Tobacco Products Directive: appeal, harm perceptions and the seriousness of warning of health risks.  Design: Qualitative focus group study. SettingInformal community venues in Scotland, UK.  Participants: 75 female non-smokers and occasional smokers (age range 12–24).  Results: Compact ‘lipstick’-type superslims packs were perceived most positively and rated as most appealing. They were also viewed as less harmful than more standard sized cigarette packs because of their smaller size and likeness to cosmetics. Additionally, ‘lipstick’ packs were rated as less serious in terms of warning about the health risks associated with smoking, either because the small font size of the warnings was difficult to read or because the small pack size prevented the text on the warnings from being displayed properly. Bright pack colours and floral designs were also thought to detract from the health warning.  Conclusions: As superslims packs were found to increase appeal, mislead with respect to level of harm, and undermine the on-pack health warnings, this provides support for the decision to ban ‘lipstick’-style cigarette packs in the EU and has implications for policy elsewhere

THE RELATIONSHIP BETWEEN MUSCULOSKELETAL STRENGTH, PHYSIOLOGICAL CHARACTERISTICS, AND KNEE KINESTHESIA FOLLOWING FATIGUING EXERCISE

Fatiguing exercise may result in impaired functional joint stability and increased risk of unintentional injury. While there are several musculoskeletal and physiological characteristics related to fatigue onset, their relationship with proprioceptive changes following fatigue has not been examined. The purpose of this study was to establish the relationship between musculoskeletal and physiological characteristics and changes in proprioception, measured by threshold to detect passive motion (TTDPM), following fatiguing exercise. Twenty, physically active females participated (age: 28.65 ± 5.6 years, height: 165.6 ± 4.3 cm, weight: 61.8 ± 8.0 kg, BMI: 22.5± 2.3 kg/m2, BF: 23.3 ± 5.4%). During Visit 1, subjects completed an exercise history and 24-hour dietary questionnaire, and body composition, TTDPM familiarization, isokinetic knee strength, and maximal oxygen uptake/lactate threshold assessments. During Visit 2, subjects completed TTDPM and isometric knee strength testing prior to and following a fatiguing exercise protocol. Wilcoxon signed rank tests determined TTDPM and isometric knee strength changes from pre- to post- fatigue. Spearman’s rho correlation coefficients determined the relationship between strength and physiological variables with pre- to post-fatigue changes in TTDPM and with pre-fatigue and post-fatigue TTDPM in extension and flexion (α=0.05). No significant differences were demonstrated from pre-fatigue to post-fatigue TTDPM despite a significant decrease in isometric knee flexion strength (P<0.01) and flexion/extension ratio (P<0.05) following fatigue. No significant correlations were observed between strength or physiological variables and changes in TTDPM from pre- to post-fatigue in extension or flexion. Flexion/extension ratio was significantly correlated with pre-fatigue TTDPM in extension (r=-0.231, P<0.05). Peak oxygen uptake was significantly correlated with pre-fatigue (r=-0.500, P<0.01) and post-fatigue (r=-0.520, P<0.05) TTDPM in extension. No significant relationships were demonstrated between musculoskeletal and physiological characteristics and changes in TTDPM following fatigue. The results suggest that highly trained individuals may have better proprioception, and that the high fitness level of subjects in this investigation may have contributed to absence of TTDPM deficits following fatigue despite reaching a high level of perceptual and physiological fatigue. Future studies should consider various subject populations, other musculoskeletal strength characteristics, and different modalities of proprioception to determine the most important contributions to proprioceptive changes following fatigue

Changes in Fat Mass, Fat Free Mass, Cardiorespiratory Fitness and Grip Strength Across a College Population

Research has shown that traditional college students are more physically fit at the beginning of their freshman year compared to their senior year. PURPOSE: The purpose of this data analysis is to examine how fat mass (FM), fat free mass (FFM), handgrip strength and VO2max change in a college-aged population. METHODS: A five-year cross-sectional design was used to assess a sample of college students (n=3,379; Males=55.4%; BMI: 25.2±5.7; Age:19.4±1.5) in an introductory wellness class. The range in age was 18-25 which were divided into four groups: 1=18-19yrs, 2=20-21yrs, 3=22-23yrs and 4=24-25yrs. Subjects were taken through the following screenings: height, weight, body fat percentage, grip strength, and estimated VO2Max. Body Fat was analyzed using a Tanita. Grip strength was assessed using a handgrip dynamometer. Estimated VO2max and heart rate recovery were assessed using the Tecumseh sub-maximal step test. One-way ANOVAs were conducted to examine changes in the estimated VO2max, FFM, FM and handgrip strength. RESULTS: Comparing the whole population across age groups, there was no significant change in FM and estimated VO2max. However, hand­grip strength (F(3,3103)=11.53,P\u3c0.001) and FFM (F(3,1357)=7.58,P\u3c0.001) did change across age groups. Students had a significant increase in handgrip strength from ages 18-19 (38.13 kg) to ages 24-25 (42.89 kg), re­spectively. Students also had an increase in FFM from ages 18-19 (57.10 kg) to ages 22-23 (61.82kg), respective­ly. CONCLUSION: The results demonstrated that college-aged students have both and increase and decrease in measures of fitness and body composition

Agreement Study Between the ParvoMedics TrueOne 2400 and Vacu-Med Vista MINI-CPX Metabolic Measurement System

Aerobic capacity (VO2 MAX) predicts both athletic performance and health status. Many tools are available to assess VO2 MAX ranging in both cost and accuracy. Understanding limitations of less expensive tools, likely found in settings such as health clinics or sports performance facilities, will help practitioners in developing accurate exercise prescriptions for their respective populations. To evaluate agreement lower cost VO2 MAX assessment tool (Vacu-Med Vista MINI-CPX) to the industry “gold standard” (ParvoMedics TrueOne 2400). Thirty-one participants (22.5 ± 3.5 years; BMI 24.9 ± 2.3; 51% female) completed two sessions of maximal VO2 MAX assessment using the Bruce Protocol graded treadmill exercise test. The first session of assessment utilized the “gold-standard” unit (TrueOne 2400, ParvoMedics, Inc., Murray, UT). 24-48 hours later the second unit (Vista Mini-CPX, Vacu-Med, Inc., Ventura, CA) was used to assess VO2 MAX again. A Bland-Altman analyses was used to evaluate both potential bias and agreement for between the two assessment tools. The CPX unit sig­nificantly overestimated VO2 MAX compared to the TrueOne (Bias = 10.67 ± 5.87 ml/kg/min, LoA = -0.83, 22.18; t = 1.96, p \u3c .001). However, the CPX unit demonstrates good reliability as 93.5% (29/31 participants) of values fell within the 95% LoA. Further, values above 46.5 ml/kg/min tend to be greater than the mean bias while those below tend to be lower than the mean bias (r = .605, F = 16.80, p \u3c .001). The CPX unit demon­strates good reliability yet a significant overestimation of aerobic capacity

Cigarette pack design and adolescent smoking susceptibility: A cross-sectional survey

Objectives: To compare adolescents' responses to three different styles of cigarette packaging: novelty (branded packs designed with a distinctive shape, opening style or bright colour), regular (branded pack with no special design features) and plain (brown pack with a standard shape and opening and all branding removed, aside from brand name). Design: Cross-sectional in-home survey. Setting: UK. Participants: Random location quota sample of 1025 never smokers aged 11-16 years. Main outcome measures: Susceptibility to smoking and composite measures of pack appraisal and pack receptivity derived from 11 survey items. Results: Mean responses to the three pack types were negative for all survey items. However, &lsquo;novelty' packs were rated significantly less negatively than the &lsquo;regular' pack on most items, and the novelty and regular packs were rated less negatively than the &lsquo;plain' pack. For the novelty packs, logistic regressions, controlling for factors known to influence youth smoking, showed that susceptibility was associated with positive appraisal and also receptivity. For example, those receptive to the innovative Silk Cut Superslims pack were more than four times as likely to be susceptible to smoking than those not receptive to this pack (AOR=4.42, 95% CI 2.50 to 7.81, p&lt;0.001). For the regular pack, an association was found between positive appraisal and susceptibility but not with receptivity and susceptibility. There was no association with pack appraisal or receptivity for the plain pack. Conclusions: Pack structure (shape and opening style) and colour are independently associated, not just with appreciation of and receptivity to the pack, but also with susceptibility to smoke. In other words, those who think most highly of novelty cigarette packaging are also the ones who indicate that they are most likely to go on to smoke. Plain packaging, in contrast, was found to directly reduce the appeal of smoking to adolescents