Standardised packs and larger health warnings: visual attention and perceptions among Colombian smokers and non-smokers.

Aims To measure how cigarette packaging (standardised packaging and branded packaging) and health warning size affect visual attention and pack preferences among Colombian smokers and non-smokers. Design To explore visual attention, we used an eye-tracking experiment where non-smokers, weekly smokers and daily smokers were shown cigarette packs varying in warning size (30%-pictorial on top of the text, 30%-pictorial and text side-by-side, 50%, 70%) and packaging (standardised packaging, branded packaging). We used a discrete choice experiment (DCE) to examine the impact of warning size, packaging and brand name on preferences to try, taste perceptions and perceptions of harm. Setting Eye-tracking laboratory, Universidad Nacional de Colombia, Bogotá, Colombia. Participants Participants (n=175) were 18 to 40 years old. Measurements For the eye-tracking experiment, our primary outcome measure was the number of fixations toward the health warning compared with the branding. For the DCE, outcome measures were preferences to try, taste perceptions and harm perceptions. Findings We observed greater visual attention to warning labels on standardised versus branded packages (F[3,167]=22.87, P<0.001) and when warnings were larger (F[9,161]=147.17, P<0.001); as warning size increased, the difference in visual attention to warnings between standardised and branded packaging decreased (F[9,161]=4.44, P<0.001). Non-smokers visually attended toward the warnings more than smokers, but as warning size increased these differences decreased (F[6,334]=2.92, P=0.009). For the DCE, conditional trials showed that increasing the warning size from 30% to 70% reduced preferences to try (odds ratio [OR]=0.48, 95% CI = [0.42,0.54], P<0.001), taste perceptions (OR=0.61, 95% CI = [0.54,0.68], P<0.001); and increased harm perceptions (OR=0.78, 95% CI = [0.76,0.80], P<0.001). Compared with branded packaging, standardised packaging reduced our DCE outcome measures with ORs ranging from OR=0.25 (95% CI = [0.17,0.38], P<0.001) to OR=0.79 (95% CI = [0.67,0.93], P<0.001) across two brands. These effects were more pronounced among non-smokers, males and younger participants. Unconditional trials showed similar results. Conclusions Standardised cigarette packaging and larger health warnings appear to decrease positive pack perceptions and have the potential to reduce the demand for cigarette products in Colombia

Investigating the DNA methylation profile of e-cigarette use

BACKGROUND: Little evidence exists on the health effects of e-cigarette use. DNA methylation may serve as a biomarker for exposure and could be predictive of future health risk. We aimed to investigate the DNA methylation profile of e-cigarette use. RESULTS: Among 117 smokers, 117 non-smokers and 116 non-smoking vapers, we evaluated associations between e-cigarette use and epigenome-wide methylation from saliva. DNA methylation at 7 cytosine-phosphate-guanine sites (CpGs) was associated with e-cigarette use at p < 1 × 10(–5) and none at p < 5.91 × 10(–8). 13 CpGs were associated with smoking at p < 1 × 10(–5) and one at p < 5.91 × 10(–8). CpGs associated with e-cigarette use were largely distinct from those associated with smoking. There was strong enrichment of known smoking-related CpGs in the smokers but not the vapers. We also tested associations between e-cigarette use and methylation scores known to predict smoking and biological ageing. Methylation scores for smoking and biological ageing were similar between vapers and non-smokers. Higher levels of all smoking scores and a biological ageing score (GrimAge) were observed in smokers. A methylation score for e-cigarette use showed poor prediction internally (AUC 0.55, 0.41–0.69) and externally (AUC 0.57, 0.36–0.74) compared with a smoking score (AUCs 0.80) and was less able to discriminate lung squamous cell carcinoma from adjacent normal tissue (AUC 0.64, 0.52–0.76 versus AUC 0.73, 0.61–0.85). CONCLUSIONS: The DNA methylation profile for e-cigarette use is largely distinct from that of cigarette smoking, did not replicate in independent samples, and was unable to discriminate lung cancer from normal tissue. The extent to which methylation related to long-term e-cigarette use translates into chronic effects requires further investigation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13148-021-01174-7

Evaluating a pre-surgical health optimisation programme: a feasibility study

BACKGROUND: Health optimisation programmes are increasingly popular and aim to support patients to lose weight or stop smoking ahead of surgery, yet there is little published evidence about their impact. This study aimed to assess the feasibility of evaluating a programme introduced by a National Health Service (NHS) clinical commissioning group offering support to smokers/obese patients in an extra 3 months prior to the elective hip/knee surgery pathway. METHODS: Feasibility study mapping routinely collected data sources, availability and completeness for 502 patients referred to the hip/knee pathway in February–July 2018. RESULTS: Data collation across seven sources was complex. Data completeness for smoking and ethnicity was poor. While 37% (184) of patients were eligible for health optimisation, only 28% of this comparatively deprived patient group accepted referral to the support offered. Patients who accepted referral to support and completed the programme had a larger median reduction in BMI than those who did not accept referral (− 1.8 BMI points vs. − 0.5). Forty-nine per cent of patients who accepted support were subsequently referred to surgery, compared to 61% who did not accept referral to support. CONCLUSIONS: Use of routinely collected data to evaluate health optimisation programmes is feasible though demanding. Indications of the positive effects of health optimisation interventions from this study and existing literature suggest that the challenge of programme evaluation should be prioritised; longer-term evaluation of costs and outcomes is warranted to inform health optimisation policy development. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13741-022-00255-2

Health Economic Models for Estimating the Benefits of Obesity Reduction and Weight Loss: a Scoping Review

Policymakers need to invest in interventions to reduce obesity in the face of increasing obesity-related health and social care resource demands. The variation in economic modelling suggests that there is no consensus about the most appropriate approach to take, which may undermine confidence in current estimates of intervention cost-effectiveness and the development of future interventions. The aim of this study is to identify and critically appraise the economic models used recently to evaluate the long-term cost-effectiveness of policies or interventions to prevent or reduce overweight and obesity. This study will provide an evidence base for making recommendations for improving economic modelling

Alcohol health warning messages: the impact of self-affirmation, message content and message severity

The objective is to understand how self-affirmation, health warning severity and health warning content influence defensive and positive reactions to alcohol health warnings. 64 self-affirmed participants and 64 non-self-affirmed participants (control group) will watch several alcohol containers with moderate and severe health warnings about different drinking alcohol health risks

Cigarette pack design: visual attention and perceptions among Colombian smokers and non-smokers

In the present study we want to examine the impact of cigarettes pack attributes of branding (branded vs. standardised packaging) and health warning size (30%, 50% vs. 70%) on visual attention and on preferences to try and judgements of taste and of harm among Colombian smokers and non-smoker