Alcohol and tobacco content in UK video games and their association with alcohol and tobacco use among young people

Aims: To determine the extent to which video games include alcohol and tobacco content and assess the association between playing them and alcohol and smoking behaviours in adolescent players. Design: Assessment of substance in the 32 UK bestselling video games of 2012/2013; online survey of adolescent playing of 17 games with substance content; content analysis of the five most popular games. Setting: Great Britain Participants: 1,094 adolescents aged 11-17 years. Measurements: Reported presence of substance content in the 32 games; estimated numbers of adolescents who had played games; self-reported substance use; semi-quantitative measures of substance content by interval coding of video game cut scenes. Findings: Non-official sources reported substance content in 17 (44%) games but none were reported by the official Pan European Game Information (PEGI) system. Adolescents who had played at least one game were significantly more likely ever to have tried smoking (adjusted OR 2.70, 95% CI 1.75 to 4.17) or consumed alcohol (adjusted OR 2.35, 95% CI 1.70 to 3.23). In the five most popular game episodes of alcohol actual use, implied use and paraphernalia occurred in 31 (14%), 81 (37%) and 41 (19%) intervals, respectively. Tobacco actual use, implied use and paraphernalia occurred in 32 (15%), 27 (12 %) and 53 (24%) intervals, respectively. Conclusions: Alcohol and tobacco content is common in the most popular video games but not reported by the official PEGI system. Content analysis identified substantial substance content in a sample of those games. Adolescents who play these video games are more likely to have experimented with tobacco and alcohol

Adolescents' exposure to tobacco and alcohol content in YouTube music videos

AIMS: To quantify tobacco and alcohol content, including branding, in popular contemporary YouTube music videos; and measure adolescent exposure to such content. DESIGN: Ten-second interval content analysis of alcohol, tobacco or electronic cigarette imagery in all UK Top 40 YouTube music videos during a 12-week period in 2013/14; on-line national survey of adolescent viewing of the 32 most popular high-content videos. SETTING: Great Britain. PARTICIPANTS: A total of 2068 adolescents aged 11–18 years who completed an on-line survey. MEASUREMENTS: Occurrence of alcohol, tobacco and electronic cigarette use, implied use, paraphernalia or branding in music videos and proportions and estimated numbers of adolescents who had watched sampled videos. FINDINGS: Alcohol imagery appeared in 45% [95% confidence interval (CI) = 33–51%] of all videos, tobacco in 22% (95% CI = 13–27%) and electronic cigarettes in 2% (95% CI = 0–4%). Alcohol branding appeared in 7% (95% CI = 2–11%) of videos, tobacco branding in 4% (95% CI = 0–7%) and electronic cigarettes in 1% (95% CI = 0–3%). The most frequently observed alcohol, tobacco and electronic cigarette brands were, respectively, Absolut Tune, Marlboro and E-Lites. At least one of the 32 most popular music videos containing alcohol or tobacco content had been seen by 81% (95% CI = 79%, 83%) of adolescents surveyed, and of these 87% (95% CI = 85%, 89%) had re-watched at least one video. The average number of videos seen was 7.1 (95% CI = 6.8, 7.4). Girls were more likely to watch and also re-watch the videos than boys, P < 0.001. CONCLUSIONS: Popular YouTube music videos watched by a large number of British adolescents, particularly girls, include significant tobacco and alcohol content, including branding

Portrayal of tobacco smoking in popular women's magazines: a content analysis

Background: Whilst many countries have introduced legislation prohibiting tobacco advertising and sponsorship, references to tobacco continue to appear in the media. This study quantified and characterized tobacco smoking content in popular women's magazines. Methods: The 10 top weekly and 5 monthly women's magazines most popular among 15–34 year olds in Britain published over a 3-month period were included. A content analysis was conducted for both written and visual content. Results: In 146 magazines, there were 310 instances of tobacco content, the majority of which were positive towards smoking. Instances of celebrities smoking were most common (171, 55%), often in holiday or party settings that could be perceived to be luxurious, glamorous or fun. In all, 55 (18%) tobacco references related to fashion, which generally created an impression of smoking as a norm within the industry; and 34 (11%) text and image references to tobacco in TV and film. There were 50 (16%) reader-initiated mentions of smoking, typically in real-life stories or readers writing in to seek advice about smoking. Anti-smoking references including the hazards of smoking were infrequent (49; 16%). Conclusions: Although tobacco advertising is prohibited in Britain, women's magazines still appear to be promoting positive messages about tobacco and smoking

Alcohol content in the 'Hyper-Reality' MTV show 'Geordie Shore'

Aim: To quantify the occurrence of alcohol content, including alcohol branding, in the popular primetime television UK Reality TV show 'Geordie Shore' Series 11. Methods: A 1-min interval coding content analysis of alcohol content in the entire DVD Series 11 of 'Geordie Shore' (10 episodes). Occurrence of alcohol use, implied use, other alcohol reference/paraphernalia or branding was recorded. Results: All categories of alcohol were present in all episodes. 'Any alcohol' content occurred in 78%, 'actual alcohol use' in 30%, 'inferred alcohol use' in 72%, and all 'other' alcohol references occurred in 59% of all coding intervals (ACIs), respectively. Brand appearances occurred in 23% of ACIs. The most frequently observed alcohol brand was Smirnoff which appeared in 43% of all brand appearances. Episodes categorized as suitable for viewing by adolescents below the legal drinking age of 18 years comprised of 61% of all brand appearances. Conclusions: Alcohol content, including branding, is highly prevalent in the UK Reality TV show 'Geordie Shore' Series 11. Two-thirds of all alcohol branding occurred in episodes age-rated by the British Board of Film Classification (BBFC) as suitable for viewers aged 15 years. The organizations OfCom, Advertising Standards Authority (ASA) and the Portman Group should implement more effective policies to reduce adolescent exposure to on-screen drinking. The drinks industry should consider demanding the withdrawal of their brands from the show. Short Summary: Alcohol content, including branding, is highly prevalent in the MTV reality TV show 'Geordie Shore' Series 11. Current alcohol regulation is failing to protect young viewers from exposure to such content

Adult and adolescent exposure to tobacco and alcohol content in contemporary YouTube music videos in Great Britain: a population estimate

Background: We estimate exposure of British adults and adolescents to tobacco and alcohol content from a sample of popular YouTube music videos. Methods: British viewing figures were generated from 2 representative online national surveys of adult and adolescent viewing of the 32 most popular videos containing content. 2068 adolescents aged 11–18 years (1010 boys, 1058 girls), and 2232 adults aged 19+years (1052 male, 1180 female) completed the surveys. We used the number of 10 s intervals in the 32 most popular videos containing content to estimate the number of impressions. We extrapolated gross and per capita impressions for the British population from census data and estimated numbers of adults and adolescents who had ever watched the sampled videos. Results: From video release to the point of survey, the videos delivered an estimated 1006 million gross impressions of alcohol (95% CI 748 to 1264 million), and 203 million of tobacco (95% CI 151 to 255 million), to the British population. Per capita exposure was around 5 times higher for alcohol than for tobacco, and nearly 4 times higher in adolescents, who were exposed to an average of 52.1 (95% CI 43.4 to 60.9) and 10.5 (95% CI 8.8 to 12.3) alcohol and tobacco impressions, respectively, than in adults (14.1 (95% CI 10.2 to 18.1) and 2.9 (95% CI 2.1 to 3.6)). Exposure rates were higher in girls than in boys. Conclusions: YouTube music videos deliver millions of gross impressions of alcohol and tobacco content. Adolescents are exposed much more than adults. Music videos are a major global medium of exposure to such content

Patients' attitudes towards cost feedback to doctors to prevent unnecessary testing: a qualitative focus group study

© 2020 The Authors Objectives: There is a need to improve efficiency in healthcare delivery without compromising quality of care. One approach is the development and evaluation of behavioural strategies to reduce unnecessary use of common tests. However, there is an absence of evidence on patient attitudes to the use of such approaches in the delivery of care. Our objective was to explore patient acceptability of a nudge-type intervention that aimed to modify blood test requests by hospital doctors. Study design: Single-centre qualitative study. Methods: The financial costs of common blood tests were presented to hospital doctors on results reports for 1 year at a hospital. Focus group discussions were conducted with recent inpatients at the hospital using a semi-structured question schedule. Discussions were transcribed and analysed using qualitative content analysis to identify and prioritise common themes explaining attitudes to the intervention approach. Results: Three focus groups involving 17 participants were conducted. Patients were generally apprehensive about the provision of blood test cost feedback to doctors. Attitudes were organised around themes representing beliefs about blood tests, the impact on doctors and their autonomy, and beliefs about unnecessary testing. Patients thought that blood tests were important, powerful and inexpensive, and cost information could place doctors under additional pressure. Conclusion: The findings identify predominantly positive beliefs about testing and negative attitudes to the use of financial costs in the decision-making of hospital doctors. Public discussion and education about the possible overuse of common tests may allow more resources to be allocated to evidence-based healthcare, by reducing the perception that such strategies to improve healthcare efficiency negatively impact on quality of care

Hospital doctors’ attitudes to brief educational messages that aim to modify diagnostic test requests: a qualitative study

Background: Avoidable use of diagnostic tests can both harm patients and increase the cost of healthcare. Nudge-type educational interventions have potential to modify clinician behaviour while respecting clinical autonomy and responsibility, but there is little evidence how this approach may be best used in a healthcare setting. This study aims to explore attitudes of hospital doctors to two nudge-type messages: one concerning potential future cancer risk after receiving a CT scan, another about the financial costs of blood tests. Methods: We added two brief educational messages to diagnostic test results in a UK hospital for one year. One message on the associated long-term potential cancer risk from ionising radiation imaging to CT scan reports, and a second on the financial costs incurred to common blood test results. We conducted a qualitative study involving telephone interviews with doctors working at the hospital to identify themes explaining their response to the intervention. Results: Twenty eight doctors were interviewed. Themes showed doctors found the intervention to be highly acceptable, as the group had a high awareness of the need to prevent harm and optimise use of finite resources, and most found the nudge-type approach to be inoffensive and harmless. However, the messages were not seen as personally relevant because doctors felt they were already relatively conservative in their use of tests. Cancer risk was important in decision-making but was not considered to represent new knowledge to doctors. Conversely, financial costs were considered to be novel information that was unimportant in decision-making. Defensive medicine was commonly cited as a barrier to individual behaviour change. The educational cancer risk message on CT scan reports increased doctors’ confidence to challenge decisions and explain risks to patients and there were some modifications in clinical practice prompted by the financial cost message. Conclusion: The nudge-type approach to target avoidable use of tests was acceptable to hospital doctors but there were barriers to behaviour change. There was evidence doctors perceived this cheap and light-touch method can contribute to culture change and form a foundation for more comprehensive educational efforts to modify behaviour in a healthcare environment

Quantifying audio visual alcohol imagery in popular Indian films: A content analysis

Objectives Though exposure to alcohol imagery in films is a significant determinant of uptake and severity of alcohol consumption among young people, there is poor evidence regarding the content of alcohol imagery in films in low-income and middle-income countries. We have measured alcohol imagery content and branding in popular Indian films, in total and in relation to language and age rating. Design In this observational study we measured alcohol imagery semiquantitatively using 5-minute interval coding. We coded each interval according to whether it contained alcohol imagery or brand appearances. Setting India. Participants None. Content analysis of a total of 30 national box office hit films over a period of 3 years from 2015 to 2017. Primary and secondary outcome measures To assess alcohol imagery in Indian films and its distribution in relation to age and language rating has been determined. Results The 30 films included 22 (73%) Hindi films and 8 (27%) in regional languages. Seven (23%) were rated suitable for viewing by all ages (U), and 23 (77%) rated as suitable for viewing by children subject to parental guidance for those aged under 12 (UA). Any alcohol imagery was seen in 97% of the films, with 195 of a total of 923 5-minute intervals, and actual alcohol use in 25 (83%) films, in 90 (10%) intervals. The occurrence of these and other categories of alcohol imagery was similar in U-rated and UA-rated films, and in Hindi and local language films. Episodes of alcohol branding occurred in 10 intervals in five films. Conclusion Almost all films popular in India contain alcohol imagery, irrespective of age rating and language. Measures need to be undertaken to limit alcohol imagery in Indian films to protect the health of young people, and to monitor alcohol imagery in other social media platforms in future

Evaluation of the impact of a brief educational message on clinicians’ awareness of risks of ionising-radiation exposure in imaging investigations:a pilot pre-post intervention study

Background:In the context of increasing availability of computed tomography (CT) scans, judicious use of ionising radiation is a priority to minimise the risk of future health problems. Hence, education of clinicians on the risks and benefits of CT scans in the management of patients is important. Methods:An educational message about the associated lifetime cancer risk of a CT scan was added to all CT scan reports at a busy acute teaching hospital in the UK. An online multiple choice survey was completed by doctors before and after the intervention, assessing education and knowledge of the risks involved with exposure to ionising radiation.Results:Of 546 doctors contacted at baseline, 170 (31%) responded. Over a third (35%) of respondents had received no formal education on the risks of exposure to ionising radiation. Over a quarter (27%) underestimated (selected 1 in 30 000 or negligible lifetime cancer risk) the risk associated with a chest, abdomen and pelvis CT scan for a 20 year old female. Following exposure to the intervention for one year there was a statistically significant improvement in plausibleestimates of risk from 68.3% to 82.2% of respondents (p < 0.001). There was no change in the proportion of doctors correctly identifying imaging modalities that do or do not involve ionising radiation.Conclusions:Training on the longterm risks associated with diagnostic radiation exposure is inadequate among hospital doctors.Exposure to a simple non-directional educational message for one year improved doctors’ awareness of risks associated with CT scans. This demonstrates the potential of the approach to improve knowledge that could improve clinical practice. This approach is easily deliverable and may have applications in other areas of clinical medicine. The wider and longer term impact on radiation awareness is unknown, however, and there may be a need for regular mandatory training in the risks of radiation exposure

Does cost feedback modify demand for common blood tests in secondary care? A prospective controlled intervention study

Background: Behavioural insights or ‘nudge’ theory suggests that non-directional interventions may be used to modify human behaviour. We have tested the hypothesis that the provision of the cost of common blood tests with their results may modify subsequent demand for blood assays.Methods: The study design was a prospective controlled intervention study. The individual and annual institutional cost of full blood count (FBC), urea and electrolytes (U&E) and liver function test (LFT) blood assays were added to the electronic results system for inpatients at the intervention teaching hospital, but not the control hospital.Results: In the 12 months after the intervention was implemented, demand for FBC dropped by 3% (95% confidence intervals [CI]: 1 to 5, p less than 0.001), U&E by 2% (95%CI: 0 to 4, p=0.054) and there was no change in demand for LFT compared to the control institution.Conclusions: Providing cost feedback to clinicians for commonly used blood tests is a viable intervention that is associated with small reductions in demand for some, but not all blood assays. As this is an easily scalable approach, this has potential to enable efficient health care delivery, while also minimising the morbidity experienced by the patient