Exploring adolescents’ perceptions of graphic health warning labels: a cross-cultural qualitative study from the United Kingdom and the State of Qatar

Introduction: Despite the progress in tobacco control efforts, smoking remains the leading reason of preventable morbidity and mortality. Alarmingly, adolescents are the most prone to experiment with smoking and become addicted. As part of deterring and reducing smoking, the Framework Convention on Tobacco Control (FCTC) recommends the implementation of Graphic Health Warnings (GHWs) on cigarette packages. This thesis examines whether GHWs are perceived as an effective approach to reducing smoking among adolescents. It also investigates the under- researched area of whether fear appeal associated with GHWs increases stigma and how adolescents engage with and create meaning from GHWs. As yet, no research has specified the social and cultural dimensions that may be important factors to the effectiveness of GHWs among adolescents. Aim: The study takes a social marketing approach to examine the effectiveness of a public health policy, GHWs. The study follows an audience-centred approach to explore, through the lens of semiotics theory, the factors related to adolescents’ perception of GHWs in a cross-cultural context. This empirical study aims to offer an original contribution to the literature by establishing the communication relationship between context-specific and cross-cultural public health and social marketing communication in tobacco control. The study also explores adolescents’ suggestions for alternative messages and ways that could be more persuasive to change adolescents’ smoking attitudes. Method: The study followed a multi-site qualitative research method of focus groups and interviews among adolescents (13–18 years) in the UK and in Qatar. Twenty-six focus group discussions were conducted with adolescents in Qatar and a total of 9 focus groups and 6 individual interviews were conducted with adolescents in the UK. In total, 141 adolescents from both countries participated in the study. Interviews and focus groups were based on a semi-structured topic guide. The focus groups and interviews entailed an interactive methodological technique which is known as a projective technique. The technique involved three main activities for participants: ranking GHWs on a matrix of least to most persuasive for adolescents; designing their own understanding of a relevant and persuasive health message; and creating a mood board of the messages they perceive as persuasive to adolescents. Findings: The data were thematically analysed drawing on the theory of semiotics. Analysis of the data revealed three main themes and eight sub-themes. The study reveals that fear appeal is not always effective among adolescents and that it might create unintended consequences such as disengagement with the message, ethical considerations and reduced self-efficacy. The data suggest factors that are important message characteristics to account for during the development and evaluation of GHWs. Moreover, the study findings identify certain social and cultural factors that influence perceptions of GHWs. Adolescents in the study suggested alternative ways of communicating GHWs such as incorporating positively framed messages and other novel ways of communicating the anti-smoking message. Discussion: This thesis makes a theoretical contribution by adding concepts to the theory of semiotics, such as proximity and authenticity that can enhance the relevance and effectiveness of health messages. This contribution adds to the understanding of the meaning of signs and the dimensions deemed relevant in meaning creation. The study offers early insights into adolescents’ perceptions of GHWs in the Middle Eastern region and provides a comparative insight to adolescents’ perceptions in the UK. The thesis contributes original insights to the health communication and social marketing field, by raising awareness of the importance of specific message characteristics and social and cultural dimensions in influencing the perceptions of the target group. It also provides informed perspectives on the potential of positively framed messages and other novel approaches that could reduce unintended consequences. Furthermore, the study connects social marketing and health promotion principles to elevate a public health policy. By following an audience centred approach, the study explores the perspective of adolescents on GHWs and for the first time explores their suggestions for alternative messages and ways to communicate the antismoking message. Conclusion: The study highlights concepts and dimensions to be considered in tobacco control policy that could also be transferable to other health products. The study accentuates the importance of targeting and tailoring health communication through contextualised messages that engage the target audience. This perspective suggests a participatory approach of health communication messages

Assessing the effectiveness of a pharmacist-delivered smoking cessation program in the State of Qatar: study protocol for a randomized controlled trial

Background: It had been reported that up to 37% of the adult male population smokes cigarettes in Qatar. The Global Youth Tobacco Survey also stated that 13.4% of male school students aged 13 to 15 years in Qatar smoke cigarettes. Smoking cessation is key to reducing smoking-related diseases and deaths. Healthcare providers are in an ideal position to encourage smoking cessation. Pharmacists are the most accessible healthcare providers and are uniquely situated to initiate behavior change among patients. Many studies have shown that pharmacists can be successful in helping patients quit smoking. Studies demonstrating the effectiveness of pharmacist-delivered smoking cessation programs are lacking in Qatar. This proposal aims to test the effect of a structured smoking cessation program delivered by trained ambulatory pharmacists in Qatar. Methods/Design: A prospective, randomized, controlled trial is conducted at eight ambulatory pharmacies in Qatar. Participants are randomly assigned to receive an at least four-session face-to-face structured patient-specific smoking cessation program conducted by the pharmacist or 5 to 10 min of unstructured brief smoking cessation advice (emulating current practice) given by the pharmacist. Both groups are offered nicotine replacement therapy if feasible. The primary outcome of smoking cessation will be confirmed by an exhaled carbon monoxide test at 12 months. Secondary outcomes constitute quality-of-life adjustment as well as cost analysis of program resources consumed, including per case and patient outcome. Discussion: If proven to be effective, this smoking cessation program will be considered as a model that Qatar and the region can apply to decrease the smoking burden. Trial registration: Clinical Trials NCT02123329.Qatar National Research Fund under its National Priorities Research Program (NPRP)

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

Intercultural Comparison of Social and Cultural Factors Shaping Adolescents’ Perceptions of Graphic Health Warnings on Cigarette Packages: the Case of the United Kingdom and the State of Qatar

The session presents results from a study that explored adolescents’ perception of GHW across differing cultural contexts to establish the communicative relationship between context-specific and crosscultural public health communication in tobacco control. Results also include adolescents’ suggestions for alternative warning label messages

How do UK Adolescents Perceive Graphic Health Warning Labels on Cigarette Packages? A Scoping Study

Background: Graphic health warnings (GHW) are an integral component of the comprehensive package of tobacco control policies laid out in the WHO Framework Convention on Tobacco Control. Current UK GHW use fear appeal to motivate smokers to quit. Yet, the use of fear appeal, and specifically its potential unintended consequences on adolescents, have been a subject of debate among scholars. Several scholars argue that fear appeal might lead to: defensive mechanisms among adolescents such as disengagement with the message as they depict long term health consequences that adolescents may not relate to; negative reactions due to feelings of being paternalised, potentially fuelling desires to rebel against health messages; and feelings of guilt and self-blame that might impede self-efficacy beliefs and stigmatise adolescents. Aim: The aim of this study is twofold: to investigate UK adolescents’ perceptions of GHW on cigarette packages, and to explore the individual, social and cultural factors that may shape their perceptions of risk, harm and relevance of public health messages. Method: The research approach is qualitative: we conduct a series of focus groups and individual interviews with adolescents in the UK (13-18 years old). We report early findings from the UK fieldwork, which commenced in March 2018. Findings: 20 adolescents were interviewed in five focus groups and four individual interviews. Preliminary findings showed that adolescents in the UK mainly show disengagement with the existing messages on GHW labels as well as some unintended consequences. Adolescents seemed to rationalise smoking as addictive and thus find existing GHW labels ineffective. Instead, adolescents suggested alternative messages that they might be more likely to relate to. Conclusion: The results of the study can help to enhance the effectiveness of GHW targeted at adolescents by suggesting improvements to existing GHW labels in the UK and could inform the development of GHW policies targeted at adolescents in the UK and other legislatures

A 1810 skull of Napoleon army’s soldier: a clinical–anatomical correlation of steam gun trauma

International audienceIntroduction: In the following article, we are presenting a clinical observation of Baron Larrey. In 1804, Larrey was the inspector general of health, as well as the chief surgeon of the imperial Napoleonic Guard. He participated in all of Napoleon's campaigns. A paleopathological study was performed on a skull from Dupuytren's Museum (Paris) with a long metal stick in the head. We report here a clinical case as well as the autopsy description of this soldier's skull following his death. We propose a different anatomical analysis of the skull, which allowed us to rectify what we believe to be an anatomical error and to propose varying hypotheses regarding the death of soldier Cros.Materials and methods: The skull was examined, observed and described by standard paleopathology methods. Measurements of the lesion were performed with metric tools and expressed in centimeters. Historical research was made possible through the collaboration with the Museum of Medicine History-Paris Descartes University.Results: Following the above detailed anatomical analysis of the path of the metal rod, we propose various possible lesions in soldier Cros due to the accident. At the inlet, the frontal sinuses could have been damaged. At the level of the second portion of the intracranial path, all of the anatomical elements present in the cavernous sinus could have been injured (cranial nerves III, IV, V1 and V2, VI, internal carotid artery and cavernous sinus). The exit orifice of the foreign body passes through the left condylar fossa of the occipital bone, points to a highly probable lesion of the left hypoglossal nerve (12th cranial nerve).Conclusion: The paleopathological study of human remains, when combined with anatomical and clinical knowledge of the pathologies of the head and neck, can rectify diagnoses of the past

How do UK Adolescents Perceive Graphic Health Warning Labels on Cigarette Packages? A Scoping Study

Background: Graphic health warnings (GHW) are an integral component of the comprehensive package of tobacco control policies laid out in the WHO Framework Convention on Tobacco Control. Current UK GHW use fear appeal to motivate smokers to quit. Yet, the use of fear appeal, and specifically its potential unintended consequences on adolescents, have been a subject of debate among scholars. Several scholars argue that fear appeal might lead to: defensive mechanisms among adolescents such as disengagement with the message as they depict long term health consequences that adolescents may not relate to; negative reactions due to feelings of being paternalised, potentially fuelling desires to rebel against health messages; and feelings of guilt and self-blame that might impede self-efficacy beliefs and stigmatise adolescents. Aim: The aim of this study is twofold: to investigate UK adolescents’ perceptions of GHW on cigarette packages, and to explore the individual, social and cultural factors that may shape their perceptions of risk, harm and relevance of public health messages. Method: The research approach is qualitative: we conduct a series of focus groups and individual interviews with adolescents in the UK (13-18 years old). We report early findings from the UK fieldwork, which commenced in March 2018. Findings: 20 adolescents were interviewed in five focus groups and four individual interviews. Preliminary findings showed that adolescents in the UK mainly show disengagement with the existing messages on GHW labels as well as some unintended consequences. Adolescents seemed to rationalise smoking as addictive and thus find existing GHW labels ineffective. Instead, adolescents suggested alternative messages that they might be more likely to relate to. Conclusion: The results of the study can help to enhance the effectiveness of GHW targeted at adolescents by suggesting improvements to existing GHW labels in the UK and could inform the development of GHW policies targeted at adolescents in the UK and other legislatures

Intercultural Comparison of Social and Cultural Factors Shaping Adolescents’ Perceptions of Graphic Health Warnings on Cigarette Packages: the Case of the United Kingdom and the State of Qatar

The session presents results from a study that explored adolescents’ perception of GHW across differing cultural contexts to establish the communicative relationship between context-specific and crosscultural public health communication in tobacco control. Results also include adolescents’ suggestions for alternative warning label messages

Infantile malignant osteopetrosis (Leontiasis ossea) in a mid-19th c. French skull

International audienceIntroduction: Autosomal recessive osteopetrosis (ARO) is a rare genetic disorder that is also called “malignant osteopetrosis” because it typically manifests within the first few months after birth and later manifests severe complications (blindness, deafness, facial palsy, dental caries, hypocalcemia) and medullary haematopoetic disorders. The aim of this study is to describe lesions and conclude hypothetical clinical symptoms by performing a CT-scan analysis on an early 19th century human skull preserved in the Dupuytren museum collection (Paris). Materials and methods: The dried skull was examined and described using classical methods of paleopathology. We conducted additional research using historical data on the skull and a CT scan was performed. Results: Screening of the archives from the museum allowed us to estimate the skull's origin as somewhere between 1850 and 1900, with an estimated age of six years. Several ducts and foramens of the skull and the facial bones were obstructed as a result of this disease, clinically corresponding to diffuse neurological (and also vascular) deficits. This devastating pathology led to many symptoms stemming from brain tissue damage and cranial nerve deficits, leading to the inevitable death of this child. These symptoms include headache, intracranial hypertension with vomiting, blindness, exophthalmos, deafness, oral breathing, eating disorder (suffocation), facial palsy, balance disorder (excessive weight, vestibulo-cochlear and cerebellar involvement). Conclusion: The study of this specimen from the 19th century confirms that the six-year old patient suffered from malignant osteopetrosis. CT-scan allowed confirmation of the diagnosis, as well as a complete description of the disease, and highlight a possible associated anaemia