Elder mistreatment: priorities for consideration by the white house conference on aging

Elder mistreatment is recognized internationally as a prevalent and growing problem, meriting the attention of policymakers, practitioners, and the general public. Studies have demonstrated that elder mistreatment is sufficiently widespread to be a major public health concern and that it leads to a range of negative physical, psychological, and financial outcomes. This article provides an overview of key issues related to the prevention and treatment of elder mistreatment, focusing on initiatives that can be addressed by the White House Conference on Aging. We review research on the extent of mistreatment and its consequences. We then propose 3 challenges in preventing and treating elder mistreatment that relate to improving research knowledge, creating a comprehensive service system, and developing effective policy. Under each challenge, examples are provided of promising initiatives that can be taken to eliminate mistreatment. To inform the recommendations, we employed recent data from the Elder Justice Roadmap Project, in which 750 stakeholders in the field of elder mistreatment were surveyed regarding research and policy priorities.

Adolescents' response to pictorial warnings on the reverse panel of cigarette packs: a repeat cross-sectional study

BACKGROUND

The UK (UK) became the third country in the European Union to require pictorial warnings on the back of cigarette packs, in October 2008.

METHODS

A repeat cross-sectional survey was conducted with 11-16-year-olds in the UK between August and September 2008 (N=1401) and August and September 2011 (N=1373). At both waves the same text warnings appeared on the front and back of packs, with the only difference being the inclusion of images on the back of packs to support the text warnings in 2011. Warning related measures assessed were salience (noticing, looking closely at warnings), depth of processing (thinking about warnings, discussing them with others), comprehension and credibility (warning comprehensibility, believability and truthfulness), unaided recall, persuasiveness (warnings as a deterrent to smoking), avoidance techniques (eg, hiding packs) and a behavioural indicator (forgoing cigarettes due to warnings).

RESULTS

For never smokers, warning persuasiveness and thinking about what warnings are telling them when the pack is in sight significantly increased from 2008 to 2011, but warning comprehensibility significantly decreased. For experimental smokers, there was a significant increase from 2008 to 2011 for warning persuasiveness, believing warnings and considering them truthful. For regular smokers, there were no significant changes from 2008 to 2011, except for an increase in hiding packs to avoid warnings and a decrease in warning salience.

CONCLUSIONS

Including pictorial images on the back of cigarette packaging improved warning persuasiveness for never and experimental smokers, but had a negligible impact on regular smokers. The findings have implications for warning design.

The tobacco endgame in Hong Kong: public support for a total ban on tobacco sales

BACKGROUND

Tobacco endgame policies are increasingly advocated to end tobacco use. This study investigated public support for a total ban on tobacco sales, use and possession in Hong Kong.

METHODS

A telephone survey was conducted among 1537 randomly selected residents in 2012 to assess their support for a total ban on tobacco sales, usage and possession. Information on sociodemographic characteristics, smoking, and second hand smoke exposure were collected. Logistic regression was used to investigate factors associated with support for a total ban.

RESULTS

Most of the never smokers (75.3%), ex-smokers (63.9%), and nearly half of current smokers (48.9%) backed some form of a total ban on tobacco. A total ban on tobacco sales was the most popular option among the three groups, with over half (64.8%) of all respondents supporting a ban within 10 years. Current smoking and higher educational attainment were associated with less support for a total ban on tobacco sales. Among current smokers, having quit intentions and attempts to quit were associated with support for a total ban.

CONCLUSIONS

A total ban on tobacco sales was supported by most respondents. Ex-smokers and current smokers also voiced substantial support, although less than never smokers. A total ban on tobacco sales before 2022 should be the goal as it is supported by most of the respondents. Interim tobacco control measures, such as tax increases, expansion of smoking cessation services and plain packaging should be implemented to help current smokers quit and reduce smoking initiation before implementation of the ban.

Theoretical impacts of a range of major tobacco retail outlet reduction interventions: modelling results in a country with a smoke-free nation goal

OBJECTIVE

To inform endgame strategies in tobacco control, this study aimed to estimate the impact of interventions that markedly reduced availability of tobacco retail outlets. The setting was New Zealand, a developed nation where the government has a smoke-free nation goal in 2025.

METHODS

Various legally mandated reductions in outlets that were phased in over 10 years were modelled. Geographic analyses using the road network were used to estimate the distance and time travelled from centres of small areas to the reduced number of tobacco outlets, and from there to calculate increased travel costs for each intervention. Age-specific price elasticities of demand were used to estimate future smoking prevalence.

RESULTS

With a law that required a 95% reduction in outlets, the cost of a pack of 20 cigarettes (including travel costs) increased by 20% in rural areas and 10% elsewhere and yielded a smoking prevalence of 9.6% by 2025 (compared with 9.9% with no intervention). The intervention that permitted tobacco sales at only 50% of liquor stores resulted in the largest cost increase (∼$60/pack in rural areas) and the lowest prevalence (9.1%) by 2025. Elimination of outlets within 2 km of schools produced a smoking prevalence of 9.3%.

CONCLUSIONS

This modelling merges geographic, economic and epidemiological methodologies in a novel way, but the results should be interpreted cautiously and further research is desirable. Nevertheless, the results still suggest that tobacco outlet reduction interventions could modestly contribute to an endgame goal.

Social networking sites: a clinical dilemma?

Social networking sites (SNS) are having an increasing influence on patients' lives and doctors are far from certain about how to deal with this new challenge. In our literature search, we could find no research on how doctors could engage positively with SNS to improve patient outcomes or create more patient-led care. We need to acknowledge the fact that a review of a patient's SNS page has the potential to enhance assessment and management, particularly where a corroborant history is hard to attain. As doctors, we need to think clearly about how to adapt our practice in light of this new form of communication; in particular, whether there is a case for engaging with SNS to improve patient care.

Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation

INTRODUCTION

E-cigarettes are largely unregulated and internet sales are substantial. This study examines how the online market for e-cigarettes has changed over time: in product design and in marketing messages appearing on websites.

METHODS

Comprehensive internet searches of English-language websites from May-August 2012 and December 2013-January 2014 identified brands, models, flavours, nicotine strengths, ingredients and product claims. Brands were divided into older and newer groups (by the two searches) for comparison.

RESULTS

By January 2014 there were 466 brands (each with its own website) and 7764 unique flavours. In the 17 months between the searches, there was a net increase of 10.5 brands and 242 new flavours per month. Older brands were more likely than newer brands to offer cigalikes (86.9% vs. 52.1%, p<0.01), and newer brands more likely to offer the more versatile eGos and mods (75.3% vs. 57.8%, p<0.01). Older brands were significantly more likely to claim that they were healthier and cheaper than cigarettes, were good substitutes where smoking was banned and were effective smoking cessation aids. Newer brands offered more flavours per brand (49 vs. 32, p<0.01) and were less likely to compare themselves with conventional cigarettes.

CONCLUSIONS

The number of e-cigarette brands is large and has been increasing. Older brands tend to highlight their advantages over conventional cigarettes while newer brands emphasise consumer choice in multiple flavours and product versatility. These results can serve as a benchmark for future research on the impact of upcoming regulations on product design and advertising messages of e-cigarettes.

Good medical ethics, justice and provincial globalism

The summer 2014 Ebola virus outbreak in Western Africa illustrates global health's striking inequalities. Globalisation has also increased pandemics, and disparate health system conditions mean that where one falls ill or is injured in the world can mean the difference between quality care, substandard care or no care at all, between full recovery, permanent ill effects and death. Yet attention to the normative underpinnings of global health justice and distribution remains, despite some important exceptions, inadequate in medical ethics, bioethics and political philosophy. We need a theoretical foundation on which to build a more just world. Provincial globalism (PG), grounded in capability theory, offers a foundation; it provides the components of a global health justice framework that can guide implementation. Under PG, all persons possess certain health entitlements. Global health justice requires progressively securing this health capabilities threshold for every person.

A bioethics for all seasons

The last four decades have seen the emergence and flourishing of the field of bioethics and its incorporation into wide-ranging aspects of society, from the clinic or laboratory through to public policy and the media. Yet considerable debate still exists over what bioethics is and how it should be done. In this paper I consider the question of what makes good bioethics. Drawing on historical and contemporary examples, I suggest that bioethics encompasses multiple modes of responding to moral disagreement, and that an awareness of which mode is operational in a given context is essential to doing good bioethics.

Ebola: what it tells us about medical ethics

Good medical ethics needs to look more to the resources of public health ethics and use more societal, population or community values and perspectives, rather than defaulting to the individualistic values that currently dominate discussion. In this paper I argue that we can use the recent response to Ebola as an example of a major failure of the global community in three ways. First, the focus has been on the treatment of individuals rather than seeing that the priority ought to be public health measures. Second, the advisory committee on experimental interventions set up by the WHO has focused on ethical issues related to individuals and their guidance has been unclear. Third, the Ebola issue can be seen as a symptom of a massive failure of the global community to take sufficient notice of global injustice.

Preimplantation genetic diagnosis and rational choice under risk or uncertainty

In this paper I present an argument in favour of a parental duty to use preimplantation genetic diagnosis (PGD). I argue that if embryos created in vitro were able to decide for themselves in a rational manner, they would sometimes choose PGD as a method of selection. Couples, therefore, should respect their hypothetical choices on a principle similar to that of patient autonomy. My thesis shows that no matter which moral doctrine couples subscribe to, they ought to conduct the PGD procedure in the situations when it is impossible to implant all of the created embryos and if there is a significant risk for giving birth to a child with a serious condition.

Global and domestic legal preparedness and response: 2014 Ebola outbreak

The global rise of Ebola viral diseases in 2014 necessitates legal responses that promote effective public health responses and respect for the health and human rights of populations. Compulsory public health interventions, approval and administration of experimental drugs or vaccines, and allocation of finite resources require difficult choices in law and policy. Crafting legal decisions in real-time emergencies is neither easy nor predictable, but it is essential to controlling epidemics and saving lives.

Inequities in the freedom to lead a flourishing and healthy life: issues for healthy public policy

There are many reasons for the health inequities that we see around the world today. Public policy and the way society organises its affairs affects the economic, social and physical factors that influence the conditions in which people are born, grow, live, work and age - the social determinants of health. Tackling health inequities is a political issue that requires leadership, political courage, progressive public policy, social struggle and action, and a sound evidence base.

Quantifying the influence of the tobacco industry on EU governance: automated content analysis of the EU Tobacco Products Directive

Objective

The tobacco industry spends large sums lobbying the European Union (EU) institutions, yet whether such lobbying significantly affects tobacco policy is not well understood. We used novel quantitative text mining techniques to evaluate the impact of industry pressure on the contested EU Tobacco Products Directive revision.

Design

Policy positions of 18 stakeholders including the tobacco industry, health NGOs and tobacco retailers were evaluated using their text submissions to EU consultations and impact assessments. Using Wordscores to calculate word frequencies, we developed a scale ranging from 0–tobacco industry to 1–public health organisations, which was then used to track changes in the policy position of the European Commission's 2010 consultation document, its 2012 final proposal and the European Parliament and Council's approved legislation in March 2014.

Results

Several stakeholders’ positions were closer to the tobacco industry than that of health NGOs, including retailers (ω=0.35), trade unions (ω=0.34) and publishers (ω=0.33 and ω=0.40). Over time the European Commission's position shifted towards the tobacco industry from ω=0.52 (95% CI 0.50 to 0.54) to ω=0.40 (95% CI 0.39 to 0.42). This transition reflected an increasing use of words pertaining to business and the economy in the Commission's document. Our findings were robust to alternative methods of scoring policy positions in EU documents.

Conclusions

Using quantitative text mining techniques, we observed that tobacco industry lobbying activity at the EU was associated with significant policy shifts in the EU Tobacco Products Directive legislation towards the tobacco industry's submissions. In the light of the Framework Convention on Tobacco Control, additional governance strategies are needed to prevent undue influence of the tobacco industry on EU policy making.

Support for laws to prohibit weight discrimination in the United States: public attitudes from 2011 to 2013

OBJECTIVE

Public attitudes about three proposed laws prohibiting weight discrimination in the US, from 2011 to 2013 were examined.

METHODS

An online survey using a diverse national sample of US adults to assess their level of support for three specific laws against weight discrimination was conducted. Data collection occurred between June and July in 2011 (n = 1,098), 2012 (n = 1,202), and 2013 (n = 1,202).

RESULTS

Between 2011 and 2013, support for laws prohibiting weight discrimination remained consistent, and in some cases became increasingly supportive, primarily in 2012-2013. At least 75% of participants consistently favored laws prohibiting weight discrimination in the workplace. Individuals became increasingly supportive of extending disability protections for individuals with obesity (62% in 2011 to 69% in 2013) and adding body weight as a protected class in Civil Rights statutes (70% in 2011 to 76% in 2013). Analyses highlight specific predictors of support (gender, race, education, and political affiliation).

CONCLUSIONS

There is strong, consistent support for policies prohibiting weight discrimination. These findings have important implications for developing specific antidiscrimination legislation to protect Americans with obesity and improve their quality of life.

A baseline understanding of state laws governing e-cigarettes

BACKGROUND

Electronic cigarettes (e-cigarettes) have been available for purchase in the USA since 2007, and have grown rapidly in popularity. Currently, there are no federal restrictions on e-cigarettes; therefore, any regulations are under the purview of state and/or local governments. This study examines state laws governing e-cigarettes through youth access restrictions, smoke-free air requirements and/or excise taxation.

METHODS

Codified statutory and administrative laws, attorney general opinions, executive orders, and revenue notices and rulings effective as of 15 November 2013 for all 50 states and the District of Columbia, were compiled using Boolean searches in Lexis-Nexis and Westlaw. All laws were analysed by two study authors to determine the presence and components of relevant provisions. Two categories of laws were identified; (1) explicit e-cigarette laws and (2) laws focused on tobacco-derived and/or nicotine-containing products.

RESULTS

Thirty-four states' laws address e-cigarettes either explicitly or as part of language applying to tobacco-derived or nicotine-containing products. Laws explicitly addressing e-cigarettes primarily focus on youth access (22 states) or smoke-free air (12 states); only Minnesota imposes an excise tax on e-cigarettes. Similarly, tobacco-derived or nicotine-containing products are primarily regulated through youth access restrictions (6 states), smoke-free air laws (5 states), or excise taxation (2 states).

CONCLUSIONS

In the current absence of federal law governing e-cigarettes, more than one-half of the states have taken the initiative to regulate these products. The opportunity exists for the remaining states to incorporate e-cigarette-related restrictions into their pre-existing tobacco control laws.

Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation

INTRODUCTION

E-cigarettes are largely unregulated and internet sales are substantial. This study examines how the online market for e-cigarettes has changed over time: in product design and in marketing messages appearing on websites.

METHODS

Comprehensive internet searches of English-language websites from May-August 2012 and December 2013-January 2014 identified brands, models, flavours, nicotine strengths, ingredients and product claims. Brands were divided into older and newer groups (by the two searches) for comparison.

RESULTS

By January 2014 there were 466 brands (each with its own website) and 7764 unique flavours. In the 17 months between the searches, there was a net increase of 10.5 brands and 242 new flavours per month. Older brands were more likely than newer brands to offer cigalikes (86.9% vs. 52.1%, p<0.01), and newer brands more likely to offer the more versatile eGos and mods (75.3% vs. 57.8%, p<0.01). Older brands were significantly more likely to claim that they were healthier and cheaper than cigarettes, were good substitutes where smoking was banned and were effective smoking cessation aids. Newer brands offered more flavours per brand (49 vs. 32, p<0.01) and were less likely to compare themselves with conventional cigarettes.

CONCLUSIONS

The number of e-cigarette brands is large and has been increasing. Older brands tend to highlight their advantages over conventional cigarettes while newer brands emphasise consumer choice in multiple flavours and product versatility. These results can serve as a benchmark for future research on the impact of upcoming regulations on product design and advertising messages of e-cigarettes.

Why participating in (certain) scientific research is a moral duty

Our starting point in this article is the debate between John Harris and Iain Brassington on whether or not there is a duty to take part in scientific research. We consider the arguments that have been put forward based on fairness and a duty to rescue, and suggest an alternative justification grounded in a hypothetical agreement: that is, because effective healthcare cannot be taken for granted, but requires continuous medical research, and nobody knows what kind of healthcare they will need, participating in research should be viewed from the perspective of a social contract, based on our mutual need for medical advances.

Is it acceptable to use animals to model obese humans? A critical discussion of two arguments against the use of animals in obesity research

Animal use in medical research is widely accepted on the basis that it may help to save human lives and improve their quality of life. Recently, however, objections have been made specifically to the use of animals in scientific investigation of human obesity. This paper discusses two arguments for the view that this form of animal use, unlike some other forms of animal-based medical research, cannot be defended. The first argument leans heavily on the notion that people themselves are responsible for developing obesity and so-called 'lifestyle' diseases; the second involves the claim that animal studies of obesity's causes and therapies distract attention from preventive efforts. Drawing on both empirical data and moral reasoning, we argue that the relevant attributions of responsibility and claims about distraction are not plausible, and that, therefore, there is no reason to single out the use of animals in obesity research as especially problematic.

Tobacco imagery on prime time UK television

BACKGROUND

Smoking in films is a common and well documented cause of youth smoking experimentation and uptake and hence a significant health hazard. The extent of exposure of young people to tobacco imagery in television programming has to date been far less investigated. We have therefore measured the extent to which tobacco content occurs in prime time UK television, and estimated exposure of UK youth.

METHODS

The occurrence of tobacco, categorised as actual tobacco use, implied tobacco use, tobacco paraphernalia, other reference to tobacco, tobacco brand appearances or any of these, occurring in all prime time broadcasting on the five most popularly viewed UK television stations during 3 separate weeks in 2010 were measured by 1-minute interval coding. Youth exposure to tobacco content in the UK was estimated using media viewing figures.

FINDINGS

Actual tobacco use, predominantly cigarette smoking, occurred in 73 of 613 (12%) programmes, particularly in feature films and reality TV. Brand appearances were rare, occurring in only 18 programmes, of which 12 were news or other factual genres, and 6 were episodes of the same British soap opera. Tobacco occurred with similar frequency before as after 21:00, the UK watershed for programmes suitable for youth. The estimated number of incidences of exposure of the audience aged less than 18 years for any tobacco, actual tobacco use and tobacco branding were 59 million, 16 million and 3 million, respectively on average per week.

CONCLUSIONS

Television programming is a source of significant exposure of youth to tobacco imagery, before and after the watershed. Tobacco branding is particularly common in Coronation Street, a soap opera popular among youth audiences. More stringent controls on tobacco in prime time television therefore have the potential to reduce the uptake of youth smoking in the UK.