The Brief Addiction Science Information Source (BASIS)

The DRAM Vol. 4(1) - Alcohol Use and HIV Risk in South Africa

Residents of sub-Saharan Africa comprise 60% of the 41 million people in the world with acquired immune deficiency syndrome (AIDS; World Health Organization and UNAIDS, 2004); about 18.8% of South African adults have human immunodeficiency virus (HIV; World Health Organization, 2006).  Changing behaviors that increase the risk of HIV exposure, such as risky consumption of alcohol, might improve the public health in this region.  This week’s DRAM reviews a study examining the relationships among alcohol-sex outcome expectancies, alcohol use in sexual contexts, sensation seeking, and HIV risk behaviors within a population of South African sexually transmitted infection (STI) clinic patients (Kalichman, Simbayi, Jooste, Cain, & Cherry, 2006)

The men (292) and women (219) receiving STI services from a clinic in Cape Town anonymously reported demographic information, drug use history, and responses to the Alcohol Use Disorder Identification Test (AUDIT; Saunders, Aasland, Barbot, de la Fuente, & Grant, 1993).  In addition, these respondents completed culturally-adapted versions of The Sensation Seeking Scale (Kalichman et al., 1994) and an alcohol-sex outcome expectancy scale (Kalichman & Simbayi, 2003).  The participants also reported HIV risk-related behaviors, such as unprotected sex, number of sex partners, and injection drug use.  The authors created a composite index of these behaviors.  The authors tested correlations among these measures.

Table 1. Correlations among sensation seeking, alcohol-sex outcome expectancies, alcohol use in sexual contexts, and HIV risk index scores

The sample was 98% indigenous African, 90% were unmarried, 87% had a high school education or less, 58% were unemployed, and 45% were under 25 years of age.  About 64% of men and 23% of women met criteria for problem drinking according to their AUDIT scores.  Controlling for marital status and gender, those with drinking problems scored higher than those without such problems on sensation seeking, alcohol-sex expectancy, and more HIV risk factors.  Problem drinkers were not more likely to have HIV, but only half had ever been tested.  Table 1 shows that HIV risk was associated positively with all three variables, and sensation seeking was significantly related to alcohol use within the context of sex, which was related to HIV risk.

Three factors limited the study methodologically.  The study used retrospective self-report.  Participants might have reported inaccurately past information about sex and substance use.  Second, correlations prohibit determining which variable causes another.  Finally, the authors only sampled one public health clinic within one geographic area, so these results might not generalize to other locations or to other populations.

A number of variables surrounding alcohol consumption reflect HIV risk behaviors.  Although we cannot assume causality from the data, providing education about the dangers of drinking in sexual contexts might lower alcohol-sex outcome expectancies and the risk of HIV, especially for sensation seekers.  Effective efforts to reduce incidence of HIV in South Africa can expand past targeting just safer sex practices, to targeting behaviors, personalities, and contexts that can compromise these practices.

What do you think?  Comments can be addressed to Leslie Bosworth.

References

Kalichman, S. C., Johnson, J. R., Adair, V., Rompa, D., Multhauf, K., & Kelly, J. A. (1994). Sexual sensations seeking: Scale development and predicting AIDS-risk behavior among homosexually active men. Journal of Personality and Assessment, 62, 385-397.

Kalichman, S. C., & Simbayi, L. C. (2003). HIV testing attitudes, AIDS stigmas, and voluntary HIV counseling and testing in the Western Cape, South Africa. Sexually Transmitted Infections, 79, 442-447.

Kalichman, S. C., Simbayi, L. C., Jooste, S., Cain, D., & Cherry, C. (2006). Sensation seeking, alcohol use and sexual behaviors among sexually transmitted infection clinic patients in Cape Town, South Africa. Psychology of Addictive Behaviors, 20(3), 298-304.

Saunders, B. J., Aasland, O. G., Barbot, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption: II. Addiction, 88, 791-804.

World Health Organization. (2006). Epidemiological Fact Sheets on HIV and Sexually Transmitted Infections: South Africa. Geneva, Switzerland: World Health Organization.

World Health Organization and UNAIDS. (2004). AIDS epidemic update. Geneva, Switzerland: World Health Organization.

The WAGER Vol. 13(1): When Your Heart Beats for Gambling

The excitement of gambling is often described as an increased arousal, where gamblers experience an almost euphoric state. This euphoria is believed to be an important factor in the reinforcement of gambling. Moodie & Finnigan (2005) investigated elevated arousal in frequent and infrequent fruit machine players, as well as non-gamblers. Each group consisted of 21 individuals (three females in each group). Frequent gamblers were identified as people who gambled more than three times a week. Infrequent gamblers in this sample gambled an average of two times a month and non-gamblers had no history of gambling. The study gave participants £6 with which to gamble and measured their heart rate at baseline, before and after each of 20 plays on a fruit machine located inside a real gambling arcade, and one minute after the gambling session ended.

As demonstrated in Figure 1, results of a one-way repeated-measures ANOVA showed an interaction between group and time on arousal. Though non-gamblers had the highest baseline heart rate, frequent gamblers showed a significantly higher increase in heart rate than both infrequent and non-gamblers. Unlike infrequent and non-gamblers, their heart rates continued to rise after the gambling session. Researchers also measured heart rate changes in response to wins, nudges, bonuses and special game features. These machine characteristics were all associated with elevated arousal, which was further exacerbated in frequent gamblers. Significant differences were found between non-gamblers and frequent gamblers for wins and nudges, and between all three groups for features.

Figure 1. Arousal among Frequent, Infrequent, and Non Gamblers in Reponse to a Gambling Task

One major limitation of the study was that the baseline heart rates of the non-gamblers were extremely high relative to both the frequent and infrequent gamblers.  This might be due to the novelty of the gambling surroundings and the research task, and suggests that the higher increase in arousal found in frequent gamblers might potentially be an artifact since the non-gamblers were already aroused. More participants and a longer duration of the gambling session would benefit the study and allow for other observations such as adaptation over time. Nevertheless, it is an important finding that frequent gamblers show increased arousal during gambling, and that not only wins but also the interactive features of the game influence arousal.

What do you think? Comments should be addressed to Line Gebauer.

References

Moodie, C., & Finnigan, F. (2005). A comparison of the autonomic arousal of frequent, infrequent and non-gamblers while playing fruit machines. Addiction, 100(1), 51-59.

STASH Vol. 4 (1) – Running with the (Red) Bulls: Is energy drink consumption fueling caffeine dependence among college students?

Approximately 70% of college students report not getting enough sleep (Engle-Friedman et al., 2003), and many students resort to caffeine consumption to remedy sleep deprivation. Since the late 1990’s, energy drinks like Red Bull have been supplementing coffee and soda as sources of caffeine (Ellis, 2006). According to the Mayo Clinic, many popular energy drinks contain as much or more caffeine as a cup of coffee (Mayo Clinic, 2007).  The increasing popularity of energy drinks with high caffeine levels among college students might lead to an increased number who suffer from the side effects of caffeine consumption (e.g., dehydration, increased blood pressure, irritability, nervousness, and the potential for substance dependence) (SAMHSA, 2007).  In this weeks’ STASH, we examine the prevalence of energy drink consumption among college students, reasons for use of these beverages, and some of the common side effects that result from such use (Malinauskas, Aeby, Overton, Carpenter-Aeby, & Barber-Heidal, 2007).

Malinauskas et al. (2007) recruited 496 college students to participate in a 19 question anonymous self-report survey about energy drink consumption. The respondents volunteered from a state university in the Central Atlantic region of the United States with an undergraduate population of approximately 18,000 students. Researchers varied the time of day and day of the week that they recruited students; they also stationed themselves at various public locations across the campus to diversify the sample. Investigators provided a self-administered survey, which asked for participant age and gender, the average number of energy drinks per month during the current semester, reasons for energy drink consumption, and side effects of energy drink consumption.      

This study does not report the number of students who refused to take part in the survey, consequently, it is not possible to calculate a participation rate.  However, among the 496 college students that did participate, 51% (N = 253) reported drinking more than one energy drink per month during the current semester.  Female college students (53%) were more likely than their male counterparts (42%) to report drinking more than one energy drink per month, χ² (1, N = 496) = 6.46, p = 0.01.  As Figure 1 shows, reasons for consuming energy drinks included: insufficient sleep (67%), to increase energy (65%), and to drink with alcohol (54%).  The most common side effects reported included jolt and crash episodes1 (29% of users), headaches (22%), and heart palpitations (19%).

Figure 1: College students’ reasons for consuming energy drinks according to the average number of drinks per month (Adapted from Malinauskas et al. 2007)

This study has several issues that limit the reliability and validity of the findings.  The survey instrument relied on participants’ retrospective self-report.  Recall makes it difficult for participants to accurately represent the frequency of energy drink consumption or the occurrence of side effects during a semester.   In addition, self-report responses on consumption of energy drinks without an independent confirmation make it impossible to determine the accuracy of the survey.  The survey did not measure other caffeine sources (e.g. soda, coffee, or caffeine pills), which might increase participants’ risk for experiencing side effects or developing tolerance for caffeine which might decrease their risk for side effects.  Researchers asked about participant’s frequency of consuming energy drinks for each of the six reasons listed, treating each as independent of the others; making it impossible to determine exactly how many drinks each participant was consuming per month.  Lastly, there is no mention of response rates, making it impossible to determine how representative the study sample is to all college students.

Despite these important limitations, the results of this study suggest that energy drinks are popular among college students.  Future research could examine daily caffeine consumption, the modes by which students consume caffeine (e.g. coffee, soda, energy drinks, food) and whether gender or grade point average (GPA) impact consumption of energy drinks.  Future research addressing these issues needs to obtain a representative sample.  In addition, survey instruments and methods should be more thorough in examining energy drink consumption, caffeine-related disorders (American Psychiatric Association, 1994), and the side effects of caffeine consumption. 

What do you think? Comments can be addressed to John H. Kleschinsky.

Notes
1. The feeling of increased alertness and energy (the jolt) followed by a sudden drop in energy (the crash) that occurs in response to using energy drinks.

References
American Psychiatric Association. (1994). DSM-IV: Diagnostic and statistical manual of mental disorders (Fourth ed.). Washington, D.C.: American Psychiatric Association.

Ellis, S. (2006). Energy drinks bubble up. The Christian Science Monitor   Retrieved January 03, 2007, from http://www.csmonitor.com/2006/0607/p13s01-lifo.html

Engle-Friedman, M., Riela, S., Golan, R., Ventuneac, A. M., Davis, C. M., Jefferson, A. D., et al. (2003). The effect of sleep loss on next day effort. Journal of Sleep Research, 12(2), 113-124.

Malinauskas, B. M., Aeby, V. G., Overton, R. F., Carpenter-Aeby, T., & Barber-Heidal, K. (2007). A survey of energy drink consumption patterns among college students. Nutrition Journal, 6(1), 35.

Mayo Clinic. (2007). How much caffeine is in your daily habit? Food and Nutrition   Retrieved January 03, 2008, from http://www.mayoclinic.com/health/caffeine/AN01211

SAMHSA. (2007). Energy Drinks: Power Boosts or Empty Boasts? A Family Guide To Keeping Youth Mentally Healthy & Drug Free   Retrieved January 03, 2007, from http://www.family.samhsa.gov/monitor/energydrinks.aspx

Op-Ed/Editorials: Private Interest vs. Public Interest: Science Caught in the Crossfire

Leslie Bosworth, B.A.
Debi LaPlante, Ph.D.
Richard LaBrie, Ed.D.
Howard Shaffer, Ph.D, C.A.S.

As public policy makers and scientists address modern public health problems such as obesity, they acknowledge the negative impact the tobacco industry had on public health policy discussions of the past (Danynard, 2003).  For the past few decades, the tobacco industry introduced industry favoring scientific evidence to public policy discussion, slowing legislation addressing health issues such as second hand smoke.  This harmful effect coupled with allegations of biased research has sparked debate among the research community as to the moral integrity of accepting private funding, especially from industries producing negative health consequences (e.g., tobacco, fast food; Adams, 2007).  This debate also strengthened the belief that government funded research is inherently more invested in the public interest than privately funded research (Moskalewicz, 2007), and therefore is more genuine.  This editorial argues that discrediting all privately funded research as vulnerable to bias is just as much of an oversimplification as viewing all government funded research as trustworthy.  All sources of funding have the power to create a conflict of interest among scientists. To illustrate this issue, this editorial contrasts two poor scientific activities of “the worst of the worst” in private funding (i.e., Big Tobacco) with recent scientific activity of a respected US federal government agency.

Tobacco Industry Funded Research

Censorship
Censoring data is one symptom of a conflict of interest.  The tobacco industry funded research in response to the growing body of scientific evidence showing the ill health effects of second hand smoke, but prohibited publication of unfavorable results.  For example, an editor of Psychopharmacology requested revisions of a 1983 article entitled “Nicotine as a positive reinforcer in rats,” submitted by three authors employed by the Phillip Morris Research Center.  In their reply to the editor’s request, the authors withdrew the manuscript, and later stated Phillip Morris issued an injunction against publishing the article (Barry, 2006).  Not releasing information with important health consequences is a form of censorship that the tobacco industry achieved by creating a conflict of interest among the authors.

Approving Flawed Findings
Before academic journals publish scientific evidence, a panel of the journal’s scientists typically reviews the evidence to verify methodological and presentational integrity, an approval process that adds credibility to published scientific data.  A second effect of the conflict of interest, however, is scientists’ approval of flawed findings.  Therefore some findings from tobacco-related research disrupted this peer review process.  For example, the tobacco industry was able to publish research with faulty methods and incorrectly attributed results in Inhalation Toxicology, a peer reviewed journal.  One of the editors of this journal is Dr. David Doolittle, Director of Biological Research at RJ Reynolds, a cigarette company (Inhalation Toxicology Homepage, 2007; Tong & Glantz, 2007).  The journal’s uncharacteristic permissiveness points to a conflict of interest. 

The Reason
The tobacco industry created a conflict of interest among scientists to manipulate scientific evidence and the reason is clear: evidence demonstrating ill health effects could influence legislation and public opinion and, as a result, limit cigarette sales. 

White House Funded Research

Before government officials present findings to Congress, the White House Office of Management and Budget (OMB) reviews all testimonies to ensure the testimonies are consistent with the President’s budget and policies.  Last October, the director of the Centers for Disease Control and Prevention (CDC), Dr. Julie Gerberding, submitted testimony to the OMB on climate change’s ill effects on health before speaking to the Senate Committee on Environment. 

Censorship
According to an anonymous CDC official, the OMB “eviscerated” her testimony: editing out key scientific evidence and informed health recommendations, including the CDC’s position that “climate change [is] a serious public health concern” (Associated Press, October 24, 2007).  Four pages remained after editing the original 14-page manuscript (Associated Press, October 24, 2007).  This apparent censorship mirrors censored reports produced by tobacco funded scientists, as neither released important health information inconsistent with the goals or policies of the funding sources.

Approving Flawed Findings
Just as Inhalation Toxicology published flawed findings due to a conflict of interest on the peer review panel, Dr. Gerberding also denied flaws in her presentation, reporting she “[i]s absolutely happy with my testimony” (Associated Press, October 24, 2007).  Dr. Gerberding’s opinion contrasts with Senator Barbara Boxer’s, the chairman of the committee to which Dr. Gerberding presented, who declared “this is not a country that should be censoring science” (Reuters, October 25, 2007).

This incident provides evidence for a conflict of interest because data were censored, and because a scientist endorsed this flawed presentation of censored information.  Indeed, Dr. Gerberding’s cooperation with the OMB coincides with a recent bonus issued by the Bush administration (Harris, September 17, 2006). 

The Reason
The Committee on Oversight and Government Reform released a report last month that quoted internal documents from the American Petroleum Institute (API); these documents provide the Institute’s rationale for manipulating scientific evidence on climate change.  According to the API, “climate is at the center of industry’s business interests.  Policies limiting carbon emissions reduce petroleum product use” (Committee on Oversight and Government Reform, December 12, 2007).  Both President Bush and Vice President Cheney are former executives of oil companies and have an interest in the stability of that industry.  According to the Center for Public Integrity, the oil industry gave $67 million in campaign contributions from 1998-2004, of which George W. Bush received over $1.7 million (Pilhofer & Williams, July 15, 2004).  A separate internal API document described the API’s communication plan: “Victory will be achieved when… average citizens ‘understand’ uncertainties in climate science.”  The congressional committee’s report responded that “the Bush administration has acted as if the oil industry’s communication plan were its mission statement” by censoring science, media access to scientists, and congressional testimonies (Committee on Oversight and Government Reform, December 12, 2007). The reason for manipulating scientific evidence, according to the congressional committee’s data, is because it could change legislation and public opinion towards improving the environment by limiting demand for oil.

Concluding Thoughts
The tobacco industry served as a litmus test for understanding the ethics of researchers and private funding sources, and recent problems with government funded research expand the scope of this understanding.  The potential risks of close partnerships between scientists and any type of funding source calls into question our ability to evaluate the quality of research and our persistence in accessing censored research.  If even the White House biases research findings, disclosing the source of funding for research is a poor shortcut by which consumers can measure its credibility. 

These problems with private industry and scientists accepting private funding are not, however, monolithic.  These industries and these scientists do not represent all funding sources, all scientists, and do not represent these scientists throughout their entire careers.  The integrity of science relies on the continued responsibility of individuals: scientists; those directing the funding sources; and vigilant audience members with sophisticated means of evaluating possible research biases in every study.

Any funding from a private company “invariably contains the seeds of direct or indirect profit motives” (Batra, 2007); these problems are common to any field accepting money from private sources, such as politicians seeking financing for campaigns.  As the United States increasingly relies on private funding, so does science, but the empirical degree to which this funding biases research is largely unknown (Etter, Burri, & Stapleton, 2007; Moskalewicz, 2007).

References

Adams, P. J. (2007). Assessing whether to receive funding support from tobacco, alcohol, gambling and other dangerous consumption industries. Addiction, 102, 1027-1033.

Associated Press. (October 24, 2007). Sources: White House cut testimony. CNN.Com   Retrieved October 24, 2007, from http://www.cnn.com/2007/HEALTH/10/24/global.warming.ap/index.html

Barry, H. (2006). Censorship by a tobacco company. Psychopharmacology, 184(3-4), 273.

Batra, A. (2007). Funding support - cui bono? Addiction, 102, 1034-1040.

Committee on Oversight and Government Reform. (December 12, 2007). Committee report: White House engaged in systematic effort to manipulate climate change science.   Retrieved December 18, 2007, from http://oversight.house.gov/documents/20071210101633.pdf; http://www.bespacific.com/index.html

Danynard, R. A. (2003). Commentary: Lessons from Tobacco Control for the Obesity Control Movement. Journal of Public Health Policy, 24(3-4), 291-295.

Etter, J.-F., Burri, M., & Stapleton, J. (2007). The impact of pharmaceutical company funding on results of randomized trials of nicotine replacement therapy for smoking cessation: a meta-analysis. Addiction, 102, 815-822.

Harris, G. (September 17, 2006). Gush of bonuses awarded to top CDC administrators.  Generous perks part of Bush push to revamp agency. SFGate.com   Retrieved October 25, 2007, from http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/09/17/MNGFIL779F1.DTL&hw=CDC+julie&sn=002&sc=339

Inhalation Toxicology Homepage. (2007). Editorial Board of Inhalation Toxicology.   Retrieved October 20, 2007, from http://www.tandf.co.uk/journals/journal.asp?issn=0895-8378&linktype=5

Moskalewicz, J. (2007). Commentaries on Adams: Moral jeopardy or research integrity. Addiction, 102, 1034-1040.

Pilhofer, A., & Williams, B. (July 15, 2004). Big oil protects its interests: Industry spends hundreds of millions on lobbying, elections. The Center for Public Integrity: Investigative Journalism in the Public Interest.   Retrieved November 13, 2007, from http://www.publicintegrity.org/oil/report.aspx?aid=345

Reuters. (October 25, 2007). Democrats press Bush on climate change testimony. New York Times   Retrieved October 26, 2007, from http://www.nytimes.com/reuters/washington/politics-climate-cdc-congress.html

Tong, E. K., & Glantz, S. A. (2007). Tobacco industry efforts undermining evidence linking secondhand smoke with cardiovascular disease. Circulation, 116, 1845-1854.

Addiction & the Humanities Vol. 4(1) - Frank "Superfly" Lucas: American Gangster

In the last Humanities, we discussed the role of Khun Sa, "The Golden Triangle King", in international drug trafficking. Based out of Myanmar (formerly Burma) Khun Sa had enormous success in growing and trafficking opium. Continuing with the theme of drug trafficking, this week's HUMANITIES reviews the newly released Denzel Washington movie, American Gangster. The movie is similar to other Hollywood movies depicting gangsters and drug dealers (e.g., The Godfather I, II, and III, Scarface, Goodfellas, Hustle and Flow), but American Gangster's storyline is inspired by a real drug dealer: Frank "Superfly" Lucas.

The title American Gangster is the first clue to the movie's importance in American Culture. The movie explains the dry, meticulous business of successful drug trafficking in America, giving it an almost legitimate feel. Further, and more importantly, the movie also provides its viewers with an inside view to the world of successful drug dealers, giving considerable insight into what that world says about drugs and addiction in the United States.

In a move that focuses attention on the US's national drug market, the movie contains only 3 international links: Lucas's wife is of Puerto Rican descent, (although Puerto Rico is a US Territory its culture is distinct from US Culture), the Vietnam War serves as a historical backdrop, and Lucas's product supplier farms his opium in Asia. Although these international links are important, they do not detract from the fact that cutting, shipping, distribution and, most importantly, profit all happen within the US and to benefit US citizens. Even members of the US military participated in the illegal activities. Having been contracted by Lucas, some military personnel turned a blind eye to, and guided the illegal cargo across international lines. This imagery conveys the message to the American public that the leaders of successful drug trafficking operations (people similar to Khun Sa,) are not always based outside of the country. Furthermore, those in the US are often more successful due to the demand for high quality opioid in the West and the reduced price at which people like Frank Lucas could and did purchase purer drugs from the East.

Picture:
(left) Frank Lucas and his wife Julie Lucas
(right) Actors Denzel Washington & Lynmari Nadal as Frank and Eva Lucas.

Further substantiating the significance of the American drug dealer, with minimal glamorization, the movie American Gangster shows the cycle that perpetuates within successful American drug trafficking. This cycle is the same supply and demands cycle that influences international drug trafficking, as well as a lifestyle that rejects the use of addictive substances. However, the cycle has the added elements of familial hierarchy and business. In the movie, Frank Lucas "inherits" his drug business after the death of his former employer, for whom he was the driver. He subsequently expands it by using the services of his closest relatives: his brothers. Furthermore, Frank Lucas's character never uses any of the products that he sells. He doesn't drink excessively, smoke or gamble excessively or engage with any other addictive activities. In fact, various scenes in the movie (e.g., a party at his home in which he is infuriated by a "high"guest) show his disdain for those that use drugs and lack the self-control required to stay away from them. Frank's only addictive behavior pattern, and the reason for his steady success, is his penchant for working constantly.

American Gangster's geographical setting, Harlem, provides the viewing public with a familiar locale within which to place and understand one aspect of American drug trafficking. Because of its rich history -- the Harlem Renaissance, significant cultural diversity before the Great Depression, the 1968 riot following Martin Luther King's assassination, and David N. Dinkins 1989 election as mayor -- Harlem is familiar to most movie-goers. Even for movie-goers that will not recognize Harlem, the presentation of a poorer neighborhood with unsafe apartment complexes filled with illegal drugs is a well-known image with which viewers can easily identify. Movies, television, books, and news outlets repeatedly present these images as a common setting for drug abuse.

The American Gangster movie formula is not a new one: information about a drug dealer's pre-drug business life, his rise to power and notoriety, and his downfall. However, American Gangster is interesting and worth seeing. Both leads, Denzel Washington and Russell Crowe play their parts well, and the imagery in the movie is evocative. The movie's plot becomes even more interesting when viewers take the time to research the real Frank Lucas. In two New York Magazine interviews, from 2000 and 2007, images and quotes from the real Frank Lucas (Jacobson, 2000; Jacobson, 2007) immediately bring the reader back to specific scenes in the movie. Although the movie is not biographical, the attention to details and facts from Frank Lucas' life is captivating. For example, the left side of the above photo is not of Denzel Washington, but of the real Frank Lucas and his wife; movie-goers will remember that the same fur coat ultimately brings about Lucas' downfall in the movie.

What do you think? Comments can be addressed to Ingrid Maurice.

 

References

Grazer, B. (Producer), & Scott R. (Director). (2007). American Gangster [Motino Picture]. United States: Universal Pictures

Jacobson, M. (2000). The Return of Superfly. Retrieved on December 23, 2007 from http://nymag.com/nymetro/news/people/features/3649/

Jacobson, M. (2007). The Lords of Dopetown. Retrieved on December 23, 2007 from http://nymag.com/guides/money/2007/39948/

ASHES Vol. 4(1) - Is Honesty Always the Best Policy? How the TRUTH and “Think. Don’t Smoke.” Anti-Smoking Campaigns Influence Adolescent Perceived Smoking Prevalence

Research has shown that some adolescents tend to overestimate smoking among their peers (Sherman, Presson, Chassin, Corty, & Olshavsky, 1983; Tyas & Pederson, 1998). Longitudinal and cross-sectional studies show that such overestimation predicts smoking in the future (Miller & McFarland, 1987; Prentice & Miller, 1996).  Anti-smoking campaigns have worked to correct adolescents’ inaccurate perceptions about smoking prevalence; however, there is a paucity of research assessing the effect of these programs.  This week’s ASHES reviews a comparison of the TRUTH and the “Think. Don’t Smoke.” (TDS) campaigns’ influence on adolescents’ perceived smoking prevalence.

To evaluate the influence of two anti-smoking public health campaigns, TRUTH and TDS, on youth smoking rates, Davis, Nonnemaker, and Farrelly (2007) analyzed data from eight cross-sectional waves of the Legacy Media Tracking Survey (LMTS), which were conducted between winter 1999 and fall 2003 (response rates = 52.5%, 52.3%, 60.4%, 46.7%, 51.7%, 53.1%, 42.5%, 30.1%, respectively).  The TRUTH campaign featured adolescents stating facts about the tobacco industry and the TDS campaign featured adolescents declaring their personal reasons for not smoking. LMTS assessed the extent of adolescents’ (n=35,074; ages 12-7 years) exposure to both antismoking campaigns by confirming (1) exposure to at least one television advertisement, (2) prompted recall of a specific campaign slogan, or (3) unprompted recall of a specific campaign slogan. The survey also asked participants to estimate the prevalence of smoking among their peers, and to report their own smoking behavior. 

Linear trend tests indicated a significant decrease in the perception about peer smoking prevalence among adolescents between the first and last LMTS wave (45.4% to 37.5%, p<.05).   Figure 1 shows that this decline in perceived smoking prevalence was similar to a significant decrease in actual smoking prevalence among participants during the same period (12.7% to 7.6%, p<.05). Regression analyses indicated that participants who confirmed exposure to the TRUTH campaign in measures (1), (2), or (3) all estimated the smoking prevalence among adolescents to be significantly lower (campaign awareness regression coefficients were 1.4, 1.6, and 1.7 percentage points lower, respectively) than those who were unaware of the campaign (p <.02, p<.03, p<.04, respectively).  However, there were no significant differences in the estimation of smoking prevalence between participants who confirmed exposure to the TDS campaign and those who did not.

Figure 1: Smoking Prevalence Among 12 to 17 Year-Olds

This study is not without its limitations.  The study found statistically significant but clinically small differences due to exposure to the TRUTH campaign, and only for the comparison between first and last wave estimates. This difference might be confounded by the large decline in the response rate at these observation points (i.e., 52.5% to 30.1%). 

The results of this investigation indicate that adolescents find actual information about the tobacco industry more compelling than their peers’ personal beliefs.  Future research should focus on the components of the TRUTH campaign that have led to the program’s success; developing successful marketing methods to correct adolescents’ magnified perception of smoking prevalence indirectly might help to reduce future smoking behavior.

What do you think? Comments can be addressed to Sara Kaplan.

References

Davis, K. C., Nonnemaker, J. M., & Farrelly, M. C. (2007). Association between national smoking prevention campaigns and perceived smoking prevalence among youth in the United States. Journal of Adolescent Health, 41, 430-436.

Miller, D. T., & McFarland, C. (1987). Pluralistic ignorance:  When similarity is interpreted as dissimilarity. Journal of Personality and Social Psychology, 53, 298-305.

Prentice, D. A., & Miller, D. T. (1996). Pluralistic ignorance and the perpetuation of social norms by unwitting actors. Advances in Experimental Social Psychology 28, 161-209.

Sherman, S. J., Presson, C. C., Chassin, L., Corty, E., & Olshavsky, R. (1983). The false consensus effect in estimates of smoking prevalence:  Underlying mechanisms. Personality and Social Psychology Bulletin, 9, 197-207.

Tyas, S. L., & Pederson, L. L. (1998). Psychosocial factors related to adolescent smoking:  A critical review of the literature. Tobacco Control, 7, 409-420.