Impact of plain packaging of tobacco products on smoking in adults and children: an elicitation of international experts' estimates.

BACKGROUND: Governments sometimes face important decisions in the absence of direct evidence. In these cases, expert elicitation methods can be used to quantify uncertainty. We report the results of an expert elicitation study regarding the likely impact on smoking rates in adults and children of plain packaging of tobacco products. METHODS: Thirty-three tobacco control experts were recruited from the UK (n = 14), Australasia (n = 12) and North America (n = 7). Experts' estimates were individually elicited via telephone interviews, and then linearly pooled. Elicited estimates consisted of (1) the most likely, (2) the highest possible, and (3) the lowest possible value for the percentage of (a) adult smokers and (b) children trying smoking, two years after the introduction of plain packaging (all other things being constant) in a target country in the expert's region of residence. RESULTS: The median estimate for the impact on adult smoking prevalence was a 1 percentage point decline (99% range 2.25 to 0), and for the percentage of children trying smoking was a 3 percentage point decline (99% range 6.1 to 0), the latter estimated impact being larger than the former (P < 0.001, sign test). There were no differences in either estimate by region (I2: Adults: 0; Children: 0) but there was considerable variability between experts' estimates within regions (I2: Adults: 0.91; Children: 0.89). CONCLUSIONS: In the absence of direct evidence for the impact of introducing plain packaging on smoking rates in adults and children, this study shows that tobacco control experts felt the most likely outcomes would be a reduction in smoking prevalence in adults, and a greater reduction in the numbers of children trying smoking, although there was substantial variability in the estimated size of these impacts. No experts judged an increase in smoking as a likely outcome.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Impact of bottle size on in-home consumption of sugar-sweetened beverages: protocol for a feasibility and acceptability study.

BACKGROUND: Intake of free sugars in the population exceeds recommendations, with the largest source in the diet being sugar-sweetened beverages (SSBs). SSB consumption is linked to adverse health consequences and contributes to health inequalities, given greater consumption amongst the most deprived. One possible intervention is to reduce the available sizes of SSB packaging but there is an absence of evidence that this would reduce consumption. Based on evidence from studies targeting food consumption that people consume less when exposed to smaller package sizes, we hypothesise that presenting SSBs in smaller containers reduces consumption. We are planning a crossover randomised controlled trial to assess the impact of presenting a fixed volume of SSB in different bottle sizes on consumption at home. To reduce the uncertainties related to this trial, we propose a preliminary study to assess the feasibility and acceptability of the recruitment, allocation, measurement, retention and intervention procedures. METHODS/DESIGN: Households which purchase at least 2 l of regular cola drinks per week and live in Cambridgeshire, UK will have a set amount of a cola SSB (based on their typical weekly purchasing of cola) delivered to their homes each week by the research team. This total amount of cola will be packaged into bottles of one of four sizes: (i) 1500 ml, (ii) 1000 ml, (iii) 500 ml or (iv) 250 ml. A crossover design will be used in which households will each receive all four of the week-long interventions (the four different bottle sizes) over time, randomised in their order of presentation. Approximately 100 eligible households will be approached to assess the proportion interested in actively participating in the study. Of those interested, 16 will be invited to continue participation. DISCUSSION: The findings will inform the procedures for a crossover randomised controlled trial assessing the impact of presenting a fixed volume of SSB in different bottle sizes on consumption at home. The findings from such a trial are expected to provide the best estimate to date of the effect of container size on beverage consumption and inform ongoing scientific and policy discussions about the effectiveness of this intervention at reducing population intake of free sugars in beverages. TRIAL REGISTRATION: ISRCTN14964130.This is the final version of the article. It first appeared from BioMed Central at http://dx.doi.org/10.1186/s40814-015-0037-8

Does wine glass size influence sales for on-site consumption? A multiple treatment reversal design

Abstract Background Wine glass size can influence both perceptions of portion size and the amount poured, but its impact upon purchasing and consumption is unknown. This study aimed to examine the impact of wine glass size on wine sales for on-site consumption, keeping portion size constant. Methods In one establishment (with separate bar and restaurant areas) in Cambridge, England, wine glass size (Standard; Larger; Smaller) was changed over eight fortnightly periods. The bar and restaurant differ in wine sales by the glass vs. by the bottle (93 % vs. 63 % by the glass respectively). Results Daily wine volume purchased was 9.4 % (95 % CI: 1.9, 17.5) higher when sold in larger compared to standard-sized glasses. This effect seemed principally driven by sales in the bar area (bar: 14.4 % [3.3, 26.7]; restaurant: 8.2 % [−2.5, 20.1]). Findings were inconclusive as to whether sales were different with smaller vs. standard-sized glasses. Conclusions The size of glasses in which wine is sold, keeping the portion size constant, can affect consumption, with larger glasses increasing consumption. The hypothesised mechanisms for these differential effects need to be tested in a replication study. If replicated, policy implications could include considering glass size amongst alcohol licensing requirements. Trial registration ISRCTN registry: ISRCTN12018175 . Registered 12th May 2015

Nature of delusion and delusion-like belief

Delusions have been defined as false beliefs different from those that almost everyone believes. However, studies suggest that beliefs (including delusions) comprise a continuum where content does not distinguish psychosis. Despite the explicit characterisation of delusions as (false) beliefs, most research has focused on delusions while neglecting non-clinical beliefs. To address this, the first formal study of key features of belief was conducted. A large public survey (n=1000) confirmed that most regarded beliefs as relatively stable personal convictions, capable of influencing thoughts and/or behaviour. These participants then completed the Cardiff Beliefs Questionnaire (CBQ), a newly developed measure designed to investigate the prevalence of different types of belief (delusion like bizarre and non-bizarre, paranormal, religious, and societal/cultural). Results showed that 38% of participants strongly endorsed one or more delusion-like beliefs) (DLB), with 91% reporting at least one 'weak', 'moderate' or 'strong' DLB. Moreover, 26% strongly endorsed at least one bizarre DLB. Levels of DLB endorsement were not distinguishable from those of paranormal and religious beliefs (P&RB). These findings support a continuum account but present difficulties for existing clinical definitions of delusion. The CBQ also investigates anomalous experiences (AE), given their proposed causal role in delusion formation. AE and anomalous beliefs (DLB and P&RB) were associated in this sample, but the relationship was not found for all individuals, suggesting that having AE is neither necessary nor sufficient for holding anomalous beliefs. Finally, belief consistency and coherence were explored across and within different belief types. DLBs appeared less stable than other belief types, emphasising the importance of functional characteristics in distinguishing clinically relevant beliefs. In addition, while seemingly contradictory beliefs were reported by some, results generally supported coherence between DLB and P&RB. Collectively, these findings complement those of traditional clinical studies, while demonstrating the value of non-clinical investigations in elucidating the nature of delusions.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Obesity under affluence varies by welfare regimes: The effect of fast food, insecurity, and inequality.

Among affluent countries, those with market-liberal welfare regimes (which are also English-speaking) tend to have the highest prevalence of obesity. The impact of cheap, accessible high-energy food is often invoked in explanation. An alternative approach is that overeating is a response to stress, and that competition, uncertainty and inequality make market-liberal societies more stressful. This ecological regression meta-study pools 96 body-weight surveys from 11 countries c. 1994-2004. The fast-food ‘shock’ impact is found to work most strongly in market liberal countries. Economic insecurity, measured in several different ways, was almost twice as powerful, while the impact of inequality was weak, and went in the opposite direction

Nature of delusion and delusion-like belief

Delusions have been defined as false beliefs different from those that almost everyone believes. However, studies suggest that beliefs (including delusions) comprise a continuum where content does not distinguish psychosis. Despite the explicit characterisation of delusions as (false) beliefs, most research has focused on delusions while neglecting non-clinical beliefs. To address this, the first formal study of key features of belief was conducted. A large public survey (n=1000) confirmed that most regarded beliefs as relatively stable personal convictions, capable of influencing thoughts and/or behaviour. These participants then completed the Cardiff Beliefs Questionnaire (CBQ), a newly developed measure designed to investigate the prevalence of different types of belief (delusion like bizarre and non-bizarre, paranormal, religious, and societal/cultural). Results showed that 38% of participants strongly endorsed one or more delusion-like beliefs) (DLB), with 91% reporting at least one 'weak', 'moderate' or 'strong' DLB. Moreover, 26% strongly endorsed at least one bizarre DLB. Levels of DLB endorsement were not distinguishable from those of paranormal and religious beliefs (P&RB). These findings support a continuum account but present difficulties for existing clinical definitions of delusion. The CBQ also investigates anomalous experiences (AE), given their proposed causal role in delusion formation. AE and anomalous beliefs (DLB and P&RB) were associated in this sample, but the relationship was not found for all individuals, suggesting that having AE is neither necessary nor sufficient for holding anomalous beliefs. Finally, belief consistency and coherence were explored across and within different belief types. DLBs appeared less stable than other belief types, emphasising the importance of functional characteristics in distinguishing clinically relevant beliefs. In addition, while seemingly contradictory beliefs were reported by some, results generally supported coherence between DLB and P&RB. Collectively, these findings complement those of traditional clinical studies, while demonstrating the value of non-clinical investigations in elucidating the nature of delusions

Does Glass Size and Shape Influence Judgements of the Volume of Wine?

This is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pone.0144536Background \ud Judgements of volume may influence the rate of consumption of alcohol and, in turn, the amount consumed. The aim of the current study was to examine the impact of the size and shape of wine glasses on perceptions of wine volume. \ud \ud Methods \ud Online experiment: Participants (n = 360; recruited via Mechanical Turk) were asked to match the volume of wine in two wine glasses, specifically: 1. the Reference glass holding a fixed reference volume, and 2. the Comparison glass, for which the volume could be altered until participants perceived it matched the reference volume. One of three comparison glasses was shown in each trial: ?wider? (20% wider but same capacity); ?larger? (same width but 25% greater capacity); or ?wider-and-larger? (20% wider and 25% greater capacity). Reference volumes were 125ml, 175ml and 250ml, in a fully factorial within-subjects design: 3 (comparison glass) x 3 (reference volume). Non-zero differences between the volumes with which participants filled comparison glasses and the corresponding reference volumes were identified using sign-rank tests. \ud \ud Results \ud Participants under-filled the wider glass relative to the reference glass for larger reference volumes, and over-filled the larger glass relative to the reference glass for all reference volumes. Results for the wider-and-larger glass showed a mixed pattern across reference volume. For all comparison glasses, in trials with larger reference volumes participants tended to fill the comparison glass less, relative to trials with smaller reference volumes for the same comparison glass.\ud \ud Conclusions \ud These results are broadly consistent with people using the relative fullness of glasses to judge volume, and suggest both the shape and capacity of wine glasses may influence perceived volume. Perceptions that smaller glasses contain more than larger ones (despite containing the same volume), could slow drinking speed and overall consumption by serving standard portions in smaller glasses. This hypothesis awaits testing.The study was funded by the Department of Health Policy Research Programme (http://prp.dh.gov.uk/) (Policy Research Unit in Behaviour and Health [PR-UN-0409-10109]). ASA and MRM are members of the UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research: Centre of Excellence. Funding from British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. None of the funders had a role in the study design, data collection, analysis, interpretation, or decision to submit for publication. The research was conducted independently of the funders, and the views expressed in this paper are those of the authors and not necessarily those of the funders

Are meat options preferred to comparable vegetarian options? An experimental study.

OBJECTIVE: Reducing meat consumption would have substantial benefits both in terms of health and environmental impact, but meat options may be more attractive to customers than meat-free options. This study tested this by presenting UK adults (n = 540) with a series of pictures showing two meal options and asking them to select which they would prefer to eat right now. They completed this task for every possible pair from a pool of six comparator meat-based options and six target options (66 pairs). Participants all saw identical comparator options, and were randomised to see the same pictures of target options but with descriptions that suggested they were either meat-based or vegetarian. RESULTS: Selections were used to rank the options for each individual from 1 (most-selected) to 12 (least-selected). Vegetarian target options were ranked worse [by 1.23 places (95% CI: 1.02, 1.44)] than meat target options. Higher self-reported consumption of meat predicted worse mean rankings of target options when these were vegetarian, but not when target options were meat-based. This suggests meat options are preferred to equivalent vegetarian options and may be more likely to be selected. This has implications for interventions aiming to reduce meat consumption to make diets healthier and more sustainable

Testing the effect of a dynamic descriptive social norm message on meat-free food selection in worksite cafeterias: a randomized controlled trial

Background: Overconsumption of meat is a threat to planetary health. Meat consumption is socially and culturally patterned, and interventions using social norms could be a promising strategy to encourage meat reduction. Methods: We developed and tested the effectiveness of a dynamic descriptive social norm message displayed in worksite cafeterias (N = 25, intervention = 12, control = 13) to increase meat-free meal selection. The message was developed based on existing evidence and in collaboration with the catering company operating the cafeterias. The message communicated a specific change in target behavior, using a relevant and relatable referent group, grounding the desired behavior change in time and place, and included a clear call to action. The social norm messages were displayed in each intervention cafeteria for 8 weeks on free-standing banners, posters, and floor stickers. We compared the change in weekly percentage of meat-free meal sales (measured as number of meals sold) between intervention and control cafeterias through linear mixed-effects models. We conducted fidelity checks in intervention cafeterias and interviewed customers to assess perceptions of the intervention. Results: There was no evidence that the intervention led to an increase in sales of meat-free meals (− 2.22 percentage point change, 95% CIs [− 7.33, 2.90], p = 0.378). Pre-intervention baseline sales of meat-free meals varied by site, but there was no evidence the intervention was differentially effective for sites with higher vs. lower baselines. There was also no evidence that the intervention changed overall meal sales. The intervention was implemented with high fidelity, though out of 155 customers interviewed, 57% reported that they did not notice the messages, and only 2% correctly recalled the message. Conclusions: There was no evidence that empirically informed and co-created dynamic descriptive social norm messages increased selection of meat-free meals in worksite cafeterias. This could be due to low salience of the intervention in a busy, fast-paced environment, or the strength of existing eating habits in a workplace cafeteria. The findings suggest that norm messaging interventions, when delivered as an isolated intervention, may not be effective to change a complex and socially grounded dietary behavior such as meat consumption. Trial registration: OSF Registries, Registered September 23, 2022, https://osf.io/h7zk

Ethnic differences in meat consumption attitudes, norms and behaviors: a survey of White, South Asian and Black ethnic groups in the UK

A reduction in meat consumption is necessary to mitigate negative impacts of climate change and adverse health outcomes. The UK has an increasingly multi-ethnic population, yet there is little research on meat consumption habits and attitudes among ethnic groups in the UK. We ran a survey (N = 1014) with quota samples for ethnic groups and analyzed attitudes, behaviors and norm perceptions of White, South Asian and Black British respondents. Most respondents believe overconsumption of red and processed meat has negative impacts on health (73.3%) and the environment (64.3%).South Asian respondents were statistically significantly less likely to be meat eaters than White respondents (OR = 0.44, 95% CIs: 0.30-0.65, t = −4.15, p = 0.000), while there was no significant difference between White and Black respondents (OR = 1.06, 95% CIs: 0.63–1.76, t = 0.21, p = 0.834). Both South Asian (OR = 2.76, 95% CIs: 1.89–4.03 t = 5.25, p = 0.000) and Black respondents (OR = 2.09, 95% CIs: 0.1.30–3.35, t = 3.06, p = 0.002) were significantly more likely to express being influenced by friends and family in their food choices than White respondents. South Asian (OR = 3.24,95% CIs: 2.17–4.84, t = 5.74, p = 0.000) and Black (OR = 2.02,95% CIs: 1.21–3.39, t = 2.69, p = 0.007) respondents were also both significantly more likely to report they would want to eat similarly to their friends and family than White respondents. Statistical analyses suggested some gender and socioeconomic differences across and among ethnic groups, which are reported and discussed. The differences in meat consumption behaviors and norm conformity between ethnic groups raises the prospect that interventions that leverage social norms may be more effective in South Asian groups than Black and White groups in the UK