New Systematic Review: Effectiveness of Mass Media Campaigns to Reduce Alcohol Consumption and Harm

This systematic review, published in Alcohol and Alcoholism, assessed the effectiveness of mass media messages to reduce alcohol consumption and related harms. Eight databases were searched along with reference lists of eligible studies. Studies of any design in any country were included, provided that they evaluated a mass media intervention targeting alcohol consumption or related behavioural, social cognitive or clinical outcomes. This was the first comprehensive systematic review of evidence of the effectiveness of mass media to reduce alcohol consumption, allowing those who make decisions about whether and how to develop and implement such campaigns to do so informed by a synthesis of the evidence base.
a&a1The search produced 10,212 results and 24 studies were included in the review. Most of the campaigns used TV or radio in combination with other media channels. There was little evidence of reduction in alcohol consumption associated with exposure to campaigns based on 13 studies which measured consumption, although most did not state this as a specific aim of the campaign. There were some increases in treatment seeking and information seeking and mixed evidence of changes in intentions, motivation, beliefs and attitudes about alcohol. Campaigns were associated with increases in knowledge about alcohol consumption, especially where levels had initially been low.The evidence suggests mass media health campaigns about alcohol can be recalled by individuals and can achieve changes in knowledge, attitudes and beliefs about alcohol, based mainly on weak quality studies. Findings of studies that measured alcohol consumption suggest campaigns have not reduced consumption, although most did not state that they directly aim to do so.

The finding that campaigns can be recalled suggests appropriate media channels, targeting strategies, durations and intensities have been utilized to reach target audiences. These campaign characteristics were not always reported by studies so it is not possible to draw a link between types of campaign strategies and levels of recall or exposure. Recall of tobacco mass media campaigns has been shown to be positively associated with smoking cessation (Jepson et al., 2007) so the outcome may be an important first step towards subsequent behaviour change in populations.

Most campaigns that aimed to improve knowledge were shown to be effective. This was particularly evident in areas where knowledge was initially low, for example, knowledge of unit consumption guidelines and of the link between alcohol and cancer. Mass media can yield sustained knowledge, which may lay the groundwork for reductions in consumption that are achieved using other public health measures.

There was evidence of increases in information seeking and treatment seeking. However, alcohol campaigns have not presented the simple call to action of tobacco messages (‘quit’) or provided offers of tangible help such as ‘quitlines’. Furthermore, as alcohol support services have historically been aimed at very heavy drinkers there may be a perception that current services do not cater for those who drink less. Mass media might therefore have limited utility in promoting service uptake.

Most studies found no impact on alcohol consumption, consistent with the conclusion of a previous review that there should be modest expectations of behaviour change from such campaigns (Snyder et al., 2004). Longer term evaluations conducted following sustained and repeated exposure to campaigns might be expected to be better able to detect effects on behaviour. However, the relationship between tobacco mass media campaign duration and effectiveness has been difficult to gauge due to confounding influences and trends over time (Durkin et al., 2012). The context in which alcohol health promotion campaigns operate is particularly challenging because of the ubiquity and power of alcohol marketing (de Bruijn et al., 2016) and pro-alcohol cultural norms (Gordon et al., 2012). This is another key difference to tobacco, where health campaigns in recent years have run in a context where most tobacco marketing has been banned or strictly regulated and social norms have become increasingly anti-smoking. The current review found evidence of impact on short term intermediate outcomes, suggesting mass media can play a supportive role for other actions which are more likely to have an impact on behaviour. These might include price-based measures (Babor et al., 2010), advertising restrictions (Siegfried et al., 2014), limiting availability and access to alcohol (Anderson et al., 2009) with the targeting of high risk groups (Foxcroft et al., 2015).

Alcohol and Alcoholism
Published: 10 January 2018

Congratulations to Suzi Gage for winning the AAAS Early Career Public Engagement Award!

Suzanne Gage, a scientist whose podcast, “Say Why To Drugs,” has received over 264,000 listens, has been chosen by the American Association for the Advancement of Science (AAAS) to receive the 2016 Early Career Award for Public Engagement with Science.

screen-shot-2017-02-09-at-09-32-03Gage recently completed her post-doctoral research in the MRC Integrative Epidemiology Unit at the University of Bristol, and is now a scientist at the University of Liverpool. She also founded “Sifting the Evidence,” a blog on The Guardian’s website in which she examines epidemiology, mental health and substance abuse. She is being honored by AAAS for “her evidence-based approach to public engagement activities and targeting audiences who may not be actively seeking science information.”

Gage is a “highly talented, enthusiastic and energetic young researcher who promises to be a real star of the future,” wrote Marcus Munafò, a professor of biological psychology at the University of Bristol, where Gage was a post-doctoral research associate until December. Through her blog and podcast, Munafò wrote, “Suzi has worked tirelessly to provide information to the general public about the scientific evidence surrounding the effects of recreational drugs.”

Her podcast, which she was inspired to produce after appearing on rapper Scroobius Pip’s podcast, discusses a different recreational drug in each episode. Gage aims to counter misinformation and myths surrounding various substances. Munafò noted that Pip’s involvement in the podcast has helped Gage reach an audience of young adults who might not otherwise receive the information. Pip emphasized that the program is not meant to condone drug use.

“This is not a pro-drugs podcast, this is not anti-drugs podcast,” Pip explained, “this is pro-truth and anti-myth.”

The podcast has topped the Science and Medicine chart in the iTunes store and has received support on Twitter, including from Virgin Group founder Richard Branson. It also won the Skeptic Magazine 2016 Ockham Award for Best Podcast. Munafò wrote that the show has also been used by teachers to introduce their students to evidence-based thinking.

Gage has also traveled across the United Kingdom, speaking at “Skeptics in the Pub,” evening events hosted by local organizations to promote critical thinking. She has spoken at the Royal Institution of Great Britain and music festivals in the UK.

She engaged with younger audiences in 2011 by participating in “I’m a Scientist, Get Me Out of Here,” an online event where students meet and interact with scientists. The scientists compete with one other, answering questions about science and their research that are provided by students, who then vote for their favorite scientist. Gage won in the “Brain Zone” category and used the winnings to start her podcast.

Gage’s work in public engagement was recognized in 2012, when she won the UK Science Blog Prize, and in 2013, when she received the British Association for Psychopharmacology Public Communication Award. She has also written for The Economist, The Telegraph and The Lancet Psychiatry.

Gage’s recent scientific work in studying the relationship between health behaviors and mental health outcomes has included investigating causal associations from observational studies, with particular emphasis on substance use and mental health. She earned a Master of Science degree in cognitive neuropsychology from University College London in 2005 and a Ph.D. in translational epidemiology from the University of Bristol in 2014. Her research also earned her the European College of Neuropsychopharmacology Travel Award in 2012. More recently, she received the Society for Research in Nicotine and Tobacco’s 2015 Basic Science Network Travel Award.

The AAAS Early Career Award for Public Engagement with Science was established in 2010 to recognize “early-career scientists and engineers who demonstrate excellence in their contribution to public engagement with science activities.” The recipient receives a monetary prize of $5,000, a commemorative plaque, complimentary registration to the AAAS Annual Meeting and reimbursement for reasonable travel and hotel expenses to attend the AAAS Annual Meeting to receive the prize.

The award will be bestowed upon Gage during the 183rd AAAS Annual Meeting in Boston, Massachusetts, Feb. 16-20, 2017. The AAAS Awards Ceremony and Reception will be held at 6:30 p.m. on Friday, Feb. 17, in the Republic Ballroom of the Sheraton Boston Hotel.

images-duckduckgo-comSuzanne Gage completed her post-doctoral research at the University of Bristol and is now a scientist at the University of Liverpool. She has written for The GuardianThe Economist, The Telegraph and The Lancet Psychiatry.


Clearing the air around e-cigarettes

Fears that “vaping” is a gateway to tobacco smoking are unfounded, shows a comprehensive review of available evidence on the harms and benefits of electronic or e-cigarettes and vapour devices, released today by University of Victoria’s Centre for Addictions Research of BC (CARBC) in a report called “Clearing the Air.”

Researchers surveyed the rapidly increasing academic literature on e-cigarettes and found evidence that vaping is replacing—rather than encouraging—the smoking of tobacco cigarettes among young people. The CARBC researchers identified 1,622 articles on the topic, of which 170 were relevant to their review. Evidence shows that tobacco use by youth has been declining while use of vapour devices has been increasing.

“Fears of a gateway effect are unjustified and overblown,” says principal investigator Marjorie MacDonald. “From a public health perspective, it’s positive to see youth moving towards a less harmful substitute to tobacco smoking.”

Among their other observations, CARBC researchers found strong evidence that the vapour from e-cigarettes is less toxic than tobacco cigarette smoke. Vapour devices do not release tar, and vapour emissions contain only eighteen of the 79 toxins found in cigarette smoke, including considerably lower levels of certain cancer causing agents and volatile organic compounds (VOCs). Almost all substances tested were substantially lower, or not detected, in vapour devices compared to cigarettes.

In addition, vapour from electronic devices is airborne for less than 30 seconds compared to 18 to 20 minutes for tobacco smoke, substantially reducing the time of second-hand exposure.

Researchers caution, however, that some vapour devices may contain potentially concerning levels of metals and particulate matter, noting that there has been insufficient research regarding some significant carcinogens that may still be present.

Finally, they found encouraging evidence that vapour devices could be at least as effective as other nicotine replacements as aids to help tobacco smokers quit.

“The public has been misled about the risks of e-cigarettes,” concludes Tim Stockwell, CARBC director and co-principal investigator. “Many people think they are as dangerous as smoking tobacco but the evidence shows this is completely false.”

A media kit containing author photos, full report (for media only, not for publication), and an infographic is available on Dropbox. An executive summary is available here.

Click here to read the original story on University of Victoria’s website.

Media contacts:
Tim Stockwell (Director, UVic’s Centre for Addictions Research) at 250-472-5445 or
Marjorie MacDonald (Scientist, UVic’s Centre for Addictions Research/Nursing) at 250-472-4399 or
Suzanne Ahearne (University Communications + Marketing) at 250-721-6139 or

John Britton speaks to RegWatchCanada on #COP7FCTC and the World Health Organization’s view of E-cigarettes

Just as vapers in several countries began to feel like events may finally be turning in favor of e-cigarettes as a harm reduction tool, the harsh realities of the global public health movement shattered any optimism.

The World Health Organization is just wrapping its Conference of the Parties to the Framework Convention on Tobacco Control, known as COP7, in India and according to professor John Britton, Chair of the Tobacco Advisory Group at the Royal College of Physicians in Britain (RCP), the future for vaping looks bleak.

The RCP, Public Health England and the UK Centre for Tobacco and Alcohol Studies have all endorsed e-cigarettes as a vital tool in the battle to end the tobacco epidemic.

Tune in to this special edition of RegWatch and learn why officials from England’s top public health organizations fear that pending WHO regulatory action on e-cigarettes could kill millions of people.


Click here to read the UKCTAS commentary on the WHO report on e-cigarettes. –  Released 26/10/2016


Teenagers who play video games with alcohol & tobacco content are more likely to drink & smoke.

Images and references to alcohol and tobacco in popular video games may be influencing UK teens who play the games and the age restriction system is not working, according to a new study. 

Experts from the UK Centre for Tobacco and Alcohol Studies at The University of Nottingham have carried out the first ever analysis of best-selling video games to find out the extent to which the games include this content and to assess the link between playing the games and drinking and smoking behaviour.

They found that teenagers who play video games featuring alcohol and tobacco references appeared to be directly influenced because they were twice as likely to have tried smoking or drinking themselves.

‘Cut scenes’ on YouTube

The research examined the content of 32 UK best-selling video games of 2012/2013 and carried out a large online survey of adolescents playing games with alcohol and tobacco content. An analysis of ‘cut scenes’ uploaded by gamers to YouTube from the five most popular games was also carried out. All the games studied were from the genres of stealth, action adventure, open world, shooter and survival/horror because they involve avatars that look and act like real people.

The study, published in the journal Cyberpsychology, Behavior and Social Networking, found alcohol and tobacco content in 44% of the most popular video games. They also found this content was not reported by the official regulator, the Pan-European Games Information (PEGI) system which informs the Video Standards Council age ratings that help parents decide whether game content is suitable for their children.

Subliminal messages

The researchers used YouGov survey tools to ask 1,094 UK adolescents aged 11-17 whether they had played any of the most popular video games identified as containing either tobacco or alcohol imagery. They were also asked whether and to what extent they smoked or drank alcohol. The study found that adolescents who had played at least one game with tobacco or alcohol content were twice as likely to have tried smoking or consumed alcohol themselves.

Out of the top five most popular games, Grand Theft Auto V & VI contained the highest level of alcohol and smoking content using fictitious brands only. The other top games containing these references were Call of Duty:Black Ops II, Call of Duty:Modern Warfare 3 and Assassin’s Creed III. There was no electronic cigarette content.

Video and Film
FIG. 1.  Percentage of total coding intervals containing alcohol content by category in the five games.
Video and Film
FIG. 2.  Percentage of total coding intervals containing tobacco content by category in the five games.


Psychologist Dr Joanne Cranwell from the UK Centre for Tobacco and Alcohol Studies, said:

”Although around 54% of UK adolescents play video games online, parental concern over exposure to inappropriate content while playing video games seems to be lower than for other media, like movies for example. While 80% of children aged 10-15 play packaged or online video games with an age rating higher than their age, more than half of British parents are unaware of the harmful content this exposes them to.

Video games are clearly attractive to adolescents regardless of age classification. It appears that official PEGI content descriptors are failing to restrict youth access to age inappropriate content. We think that the PEGI system needs to include both alcohol and tobacco in their content descriptors. Also, game developers could be offered incentives to reduce the amount of smoking and drinking in their games or to at least reference smoking and drinking on their packaging and websites.

As a child protection method it is naïve for both the games industry and the Interactive Software Federation of Europe, who regulate the PEGI system, to rely on age ratings alone. Future research should focus on identifying the levels of exposure in terms of dose that youth gamers are exposed to during actual gameplay and the effects of this on long- term alcohol and smoking behaviour.”

A copy of the full paper is online here: Alcohol and tobacco content in UK video games and their association with alcohol and tobacco use among young people.

News Reports:

Teenagers influenced by video games with alcohol, smoking content – ScienceDaily

Nottingham study finds teenagers ‘are influenced’ by smoking and alcohol in video games – NottsTV

GRAND THEFT WARNING – Teenagers who play video games are ‘TWICE as likely to smoke and drink alcohol’ – TheSUN

Teens who play Grand Theft Auto are ‘twice as likely to smoke or drink alcohol’ – AngleNews

Does YOUR teenager play Grand Theft Auto? They are ‘twice as likely to smoke or drink alcohol’ – DailyMail

Experts say WHO needs better understanding of the evidence on e-cigs to inform its international tobacco control treaty.

A new WHO report fails to properly evaluate the evidence on e-cigarettes and could even undermine international efforts to reduce smoking, says a group of UK based academics.

UK academics are calling for better understanding of the potential benefits of e-cigarettes to reducing the smoking pandemic ahead of an international gathering of countries that have signed the World Health Organisation’s Framework Convention for Tobacco Control.

The 7th session of the Conference of the Parties (COP) of the Framework Convention on Tobacco Control (FCTC), a global public health treaty, will be held in Delhi, India from 7th-12th November 2016. At this meeting, Parties to the treaty (countries and other jurisdictions) will discuss whether similar policy measures recommended to reduce tobacco use should be applied to e-cigarettes.

In advance of the COP the World Health Organisation published a report about Electronic Nicotine Delivery Systems (ENDS) and Electronic Non-Nicotine Delivery Systems (ENDDS), also known as e-cigarettes. This aimed to summarise the evidence about these devices.

Academics from the UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence, have today published a robust critique of the WHO report setting out a series of concerns about the content of the document which, in their view, screen-shot-2016-10-26-at-12-37-14does not fairly represent existing evidence on e-cigarettes. Their critique examines each element of the WHO report and identifies flaws in the way the evidence is presented and problems with how the report could be interpreted, potentially encouraging countries to adopt excessive restrictions on e-cigarettes which could undermine efforts to reduce smoking.

The UKCTAS critique points to evidence set out in the recent Royal College of Physician’s’ report ‘Nicotine without Smoke’ and subsequent research which recognise that e-cigarettes are far less harmful than smoking and that smokers who find it difficult to stop should be encouraged to use them.

The WHO report fails to accurately present what is already known about e-cigarettes. In particular, it: positions e-cigarettes as a threat rather than an opportunity to reduce smoking; fails to accurately quantify any risks of e-cigarettes compared with smoking; misrepresents existing evidence about any harms to bystanders; discounts the fact that e-cigarettes are helping smokers to quit; does not recognise the place of some promotion of e-cigarettes to encourage smokers to switch to these less harmful products; fails to understand that the flavours in e-cigarettes are useful for people trying to stop smoking; mischaracterises the current e-cigarette market screen-shot-2016-10-26-at-12-39-18and appears to support very restrictive policies on e-cigarettes without including any good policy analysis. In addition, the WHO report does not acknowledge that significant restrictions on e-cigarettes could lead to unintended consequences, including increases in smoking.

Finally, the researchers point out that the WHO briefing is based on four unpublished papers which are still undergoing peer review, which does not allow for open, transparent scrutiny of the evidence. This does not, therefore, provide a good basis for policy making and risks undermining rather than promoting the aims of the FCTC, which is a treaty that was designed to help countries reduce smoking rates and save lives.

To read the full report click here.

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