Brain-Computer interface control of stepping from invasive electrocorticography upper-limb motor imagery in a patient with quadriplegia

Introduction: Most spinal cord injuries (SCI) result in lower extremities paralysis, thus diminishing ambulation. Using brain-computer interfaces (BCI), patients may regain leg control using neural signals that actuate assistive devices. Here, we present a case of a subject with cervical SCI with an implanted electrocorticography (ECoG) device and determined whether the system is capable of motor-imagery-initiated walking in an assistive ambulator. Methods: A 24-year-old male subject with cervical SCI (C5 ASIA A) was implanted before the study with an ECoG sensing device over the sensorimotor hand region of the brain. The subject used motor-imagery (MI) to train decoders to classify sensorimotor rhythms. Fifteen sessions of closed-loop trials followed in which the subject ambulated for one hour on a robotic-assisted weight-supported treadmill one to three times per week. We evaluated the stability of the best-performing decoder over time to initiate walking on the treadmill by decoding upper-limb (UL) MI. Results: An online bagged trees classifier performed best with an accuracy of 84.15% averaged across 9 weeks. Decoder accuracy remained stable following throughout closed-loop data collection. Discussion: These results demonstrate that decoding UL MI is a feasible control signal for use in lower-limb motor control. Invasive BCI systems designed for upper-extremity motor control can be extended for controlling systems beyond upper extremity control alone. Importantly, the decoders used were able to use the invasive signal over several weeks to accurately classify MI from the invasive signal. More work is needed to determine the long-term consequence between UL MI and the resulting lower-limb control.

Design-development of an at-home modular brain-computer interface (BCI) platform in a case study of cervical spinal cord injury

OBJECTIVE

The objective of this study was to develop a portable and modular brain-computer interface (BCI) software platform independent of input and output devices. We implemented this platform in a case study of a subject with cervical spinal cord injury (C5 ASIA A).

BACKGROUND

BCIs can restore independence for individuals with paralysis by using brain signals to control prosthetics or trigger functional electrical stimulation. Though several studies have successfully implemented this technology in the laboratory and the home, portability, device configuration, and caregiver setup remain challenges that limit deployment to the home environment. Portability is essential for transitioning BCI from the laboratory to the home.

METHODS

The BCI platform implementation consisted of an Activa PC + S generator with two subdural four-contact electrodes implanted over the dominant left hand-arm region of the sensorimotor cortex, a minicomputer fixed to the back of the subject's wheelchair, a custom mobile phone application, and a mechanical glove as the end effector. To quantify the performance for this at-home implementation of the BCI, we quantified system setup time at home, chronic (14-month) decoding accuracy, hardware and software profiling, and Bluetooth communication latency between the App and the minicomputer. We created a dataset of motor-imagery labeled signals to train a binary motor imagery classifier on a remote computer for online, at-home use.

RESULTS

Average bluetooth data transmission delay between the minicomputer and mobile App was 23 ± 0.014 ms. The average setup time for the subject's caregiver was 5.6 ± 0.83 min. The average times to acquire and decode neural signals and to send those decoded signals to the end-effector were respectively 404.1 ms and 1.02 ms. The 14-month median accuracy of the trained motor imagery classifier was 87.5 ± 4.71% without retraining.

CONCLUSIONS

The study presents the feasibility of an at-home BCI system that subjects can seamlessly operate using a friendly mobile user interface, which does not require daily calibration nor the presence of a technical person for at-home setup. The study also describes the portability of the BCI system and the ability to plug-and-play multiple end effectors, providing the end-user the flexibility to choose the end effector to accomplish specific motor tasks for daily needs. Trial registration ClinicalTrials.gov: NCT02564419. First posted on 9/30/2015.

Implantable brain-computer interface for neuroprosthetic-enabled volitional hand grasp restoration in spinal cord injury

Loss of hand function after cervical spinal cord injury severely impairs functional independence. We describe a method for restoring volitional control of hand grasp in one 21-year-old male subject with complete cervical quadriplegia (C5 American Spinal Injury Association Impairment Scale A) using a portable fully implanted brain-computer interface within the home environment. The brain-computer interface consists of subdural surface electrodes placed over the dominant-hand motor cortex and connects to a transmitter implanted subcutaneously below the clavicle, which allows continuous reading of the electrocorticographic activity. Movement-intent was used to trigger functional electrical stimulation of the dominant hand during an initial 29-weeks laboratory study and subsequently via a mechanical hand orthosis during in-home use. Movement-intent information could be decoded consistently throughout the 29-weeks in-laboratory study with a mean accuracy of 89.0% (range 78-93.3%). Improvements were observed in both the speed and accuracy of various upper extremity tasks, including lifting small objects and transferring objects to specific targets. At-home decoding accuracy during open-loop trials reached an accuracy of 91.3% (range 80-98.95%) and an accuracy of 88.3% (range 77.6-95.5%) during closed-loop trials. Importantly, the temporal stability of both the functional outcomes and decoder metrics were not explored in this study. A fully implanted brain-computer interface can be safely used to reliably decode movement-intent from motor cortex, allowing for accurate volitional control of hand grasp.

Association Between the Tips From Former Smokers Campaign and Smoking Cessation Among Adults, United States, 2012-2018

In 2012, the Centers for Disease Control and Prevention (CDC) launched the national Tips From Former Smokers (Tips) campaign to encourage people who smoke to quit by showing real-life heath consequences of tobacco use and promoting evidence-based resources for quitting. To assess the campaign's impact on quit attempts and sustained-quit estimates (ie, quits lasting ≥6 mos), CDC analyzed data from a nationally representative longitudinal survey of US adults who smoke cigarettes, aged 18 years or older in 2012-2018. The Tips campaign was associated with an estimated 16.4 million quit attempts and 1,005,419 sustained quits. Continued implementation of cessation campaigns, including the Tips campaign, could accelerate progress toward reducing rates of smoking-related diseases and death.

The 2016 Tips From Former Smokers® Campaign: Associations With Quit Intentions and Quit Attempts Among Smokers With and Without Mental Health Conditions

INTRODUCTION

People living with mental health conditions (MH+) are more likely to smoke cigarettes than people without mental health conditions (MH-) and to experience tobacco-related disparities. The Tips From Former Smokers® (Tips®) campaign is a proven population-level strategy for motivating smokers to quit. In 2016, Tips included ads featuring Rebecca, a former smoker with depression. We evaluated self-reported frequency of exposure to the Rebecca and other Tips ads in association with quit intentions and quit attempts among MH+ and MH- smokers.

METHODS

Intentions to quit and past 6-month quit attempts lasting at least 24 hours were reported from a two-wave longitudinal online survey conducted before and after the 2016 Tips campaign with a nationally representative sample of US adult cigarette smokers with (MH+, N = 777) and without (MH-, N = 1806) lifetime mental health conditions.

RESULTS

In 2016, among MH+ respondents, greater exposure to the Rebecca ads was significantly associated with increased odds of intending to quit in the next 30 days (adjusted odds ratio [AOR] = 1.40, p < .05) and with reporting a quit attempt in the past 6 months (AOR = 1.25, p < .05). Among MH- respondents, greater exposure to the other Tips ads was associated with increased odds of making a quit attempt (AOR = 1.19, p < .05).

CONCLUSIONS

Exposure to the Rebecca ads was associated with a greater likelihood of intentions to quit and quit attempts among MH+ smokers; whereas, exposure to the other (non-mental-health-related) Tips ads was associated with a greater likelihood of quit attempts among MH- smokers.

IMPLICATIONS

National media campaigns are an important population-level strategy for reaching specific population groups who are experiencing tobacco-related disparities. The findings support the inclusion of ads featuring people living with mental health conditions in national tobacco education media campaigns, such as Tips.

Behavioral Alterations in Mice Carrying Homozygous HDAC4 A778T Missense Mutation Associated With Eating Disorder

Eating disorders (EDs) are serious mental illnesses thought to arise from the complex gene-environment interactions. DNA methylation patterns in histone deacetylase 4 (HDAC4) locus have been associated with EDs and we have previously identified a missense mutation in the HDAC4 gene (HDAC4^A786T) that increases the risk of developing an ED. In order to evaluate the biological consequences of this variant and establish a useful mouse model of EDs, here we performed behavioral characterization of mice homozygous for Hdac4^A778T (corresponding to human HDAC4^A786T) that were further backcrossed onto C57BL/6 background. When fed high-fat diet, male, but not female, homozygous mice showed a trend toward decreased weight gain compared to their wild-type littermates. Behaviorally, male, but not female, homozygous mice spent less time in eating and exhibited reduced motivation to work for palatable food and light phase-specific decrease in locomotor activity. Additionally, homozygous Hdac4^A778T female, but not male, mice display social subordination when subjected to a tube dominance test. Collectively, these results reveal a complex sex- and circadian-dependent role of ED-associated Hdac4^A778T mutation in affecting mouse behaviors. Homozygous Hdac4^A778T mice could therefore be a useful animal model to gain insight into the neurobiological basis of EDs.

Evidence of the Impact of the Tips From Former Smokers Campaign: Results From the Behavioral Risk Factor Surveillance System

The Tips From Former Smokers campaign (Tips) has demonstrated significant impact as a population-based intervention for smoking cessation in the United States. Since 2012, evaluations of Tips have relied on web-panel data to attribute the campaign to smoking cessation outcomes. We re-examined the relationship between market-level doses of the campaign and quit attempts by using Behavioral Risk Factor Surveillance System (BRFSS) data to triangulate prior findings. We found that Tips was associated with increased quit attempts among smokers, which validates prior evaluation research on the impact of Tips. These results suggest that continued investments in Tips may help sustain its impact on cessation-related outcomes.

Celastrol Reduces Obesity in MC4R Deficiency and Stimulates Sympathetic Nerve Activity Affecting Metabolic and Cardiovascular Functions

Leptin resistance is a hallmark of obesity with unclear etiology. Celastrol, a compound found in the roots of the Tripterygium wilfordii and known to reduce endoplasmic reticulum (ER) stress, has recently emerged as a promising candidate to treat obesity by improving leptin sensitivity. However, the underlying neural mechanisms by which celastrol reduces obesity remain unclear. Using three different mouse models of obesity-diet-induced obesity (DIO), leptin receptor (LepR)-null, and melanocortin 4 receptor (MC4R)-null mice-in this study, we show that systemic celastrol administration substantially reduces food intake and body weight in MC4R-null comparable to DIO, proving the MC4R-independent antiobesity effect of celastrol. Body weight reduction was due to decreases in both fat and lean mass, and modest but significant body weight reduction was also observed in nonobese wild-type and LepR-null mice. Unexpectedly, celastrol upregulated proinflammatory cytokines without affecting genes involved in ER stress. Importantly, celastrol steadily increased sympathetic nerve activity to the brown fat and kidney with concordant increases of resting metabolic rate and arterial pressure. Our results suggest a previously unappreciated mechanism of action of celastrol in the regulation of energy homeostasis and highlight the need for careful consideration of its development as a safe antiobesity medication.

Control of redundant pointing movements involving the wrist and forearm

The musculoskeletal system can move in more ways than are strictly necessary, allowing many tasks to be accomplished with a variety of limb configurations. Why some configurations are preferred has been a focus of motor control research, but most studies have focused on shoulder-elbow or whole arm movements. This study focuses on movements involving forearm pronation-supination (PS), wrist flexion-extension (FE), and wrist radial-ulnar deviation (RUD) and elucidates how these three degrees of freedom (DOF) combine to perform the common task of pointing, which only requires two DOF. Although pointing is more sensitive to FE and RUD than to PS and could be easily accomplished with FE and RUD alone, subjects tend to involve a small amount of PS. However, why we choose this behavior has been unknown and is the focus of this paper. With the use of a second-order model with lumped parameters, we tested a number of plausible control strategies involving minimization of work, potential energy, torque, and path length. None of these control schemes robustly predicted the observed behavior. However, an alternative control scheme, hypothesized to control the DOF that were most important to the task (FE and RUD) and ignore the less important DOF (PS), matched the observed behavior well. In particular, the behavior observed in PS appears to be a mechanical side effect caused by unopposed interaction torques. We conclude that moderately sized pointing movements involving the wrist and forearm are controlled by ignoring forearm rotation even though this strategy does not robustly minimize work, potential energy, torque, or path length. NEW & NOTEWORTHY Many activities require us to point our hands in a given direction using wrist and forearm rotations. Although there are infinitely many ways to do this, we tend to follow a stereotyped pattern. Why we choose this pattern has been unknown and is the focus of this paper. After testing a variety of hypotheses, we conclude that the pattern results from a simplifying strategy in which we focus on wrist rotations and ignore forearm rotation.

Abstract 086: Neuroanatomical Basis of PVN MC4R-Expressing Neurons for Sympathetic Cardiovascular Control

It is well established that the central melanocortin system is critical for autonomic functions and energy homeostasis mainly via signaling at melanocortin-4 receptor (MC4R). Importantly, while obesity is commonly associated with elevated sympathetic tone and blood pressure, severely obese humans and rodents due to genetic MC4R deficiency exhibit normal to low sympathetic tone and blood pressure, suggesting a significant role of MC4R pathway in mediating obesity-associated sympathoexcitation and hypertension. MC4R is widely expressed in the brain including hypothalamic paraventricular nucleus (PVN) which regulates feeding and sympathetic traffic. However, the neuroanatomical basis of PVN MC4R neurons for sympathetic regulation is unclear. The goal of current study is to map the PVN MC4R neural circuits affecting sympathetic tone in mice. To this end, we injected Cre-dependent AAV driving eYFP-fused channel rhodopsin-2 expression into the PVN of MC4R-t2a-Cre knock-in mice, which allow targeted anterograde tract-tracing of PVN MC4R neurons throughout the brain. In addition to known brain region for feeding behavior (i.e. parabrachial nucleus), we found broad innervations of PVN MC4R neurons to various brain regions important for autonomic-cardiovascular control, including, but not limited to, nucleus of solitary tractus, dorsomotor nucleus of vagus, and ventrolateral medulla. Considerable innervation was also evident in spinal cord, which is further confirmed by Fluoro-gold (FG)-mediated retrograde tracing in the spinal cord (thoracic T6-10) of MC4R-GFP transgenic mouse. Double immunofluorescence labeling of GFP and FG revealed that ~50% (58 out of 116) MC4R neurons in the posterior parvocellular subdivision of PVN project to thoracic spinal cord. Furthermore, microinjection of synthetic MC4R agonist (MTII) into the PVN evokes ~42% increase (from baseline) in renal sympathetic nerve activity in anesthetized mice. These results provide important insights into understanding the divergent neural circuits by which PVN MC4R signaling differentially regulates metabolic and cardiovascular functions. Functional dissection of these diverging neural pathways using optogenetic/chemogenetic approaches is ongoing.

Abstract P177: The Roles of Estrogen-Related Receptor Alpha in Cardiometabolic Control

The estrogen-related receptor alpha (Esrra) is an orphan nuclear receptor with strong homology to estrogen receptor alpha (ERα), whereas it exhibits estrogen-independent constitutive transcriptional activity to regulate a number of genes involving in cellular energy metabolism. Esrra is broadly expressed throughout the body including those metabolically active tissues such as skeletal muscles, heart, brown adipose tissues, kidney, and brain. While previous reports showed that Esrra knockout (KO) mice were hypotensive and resistant to high fat diet-induced obesity (DIO), systemic understanding of the roles of Esrra in cardiometabolic control is limited. We therefore performed a variety of metabolic and cardiovascular measures to evaluate the cardiometabolic consequences of mice lacking Esrra globally. Our results revealed that Esrra KO mice were hypoactive and were resistant to DIO mainly due to decreased food intake. Despite of lower body weight and plasma leptin level, female Esrra KO mice tend to have elevated blood glucose level (p=0.08) without notable changes of insulin and glucagon levels. Non-invasive blood pressure measurement by tail-cuff sphygmomanometer showed that male Esrra KO mice had significantly lower blood pressure when the measurement was performed during light period (WT vs. KO: 99.8±1.4 vs. 93.9±1.8 mmHg, p<0.05). On the other hand, the blood pressure measured during dark period was significantly lower in female, but not male, Esrra KO mice compared to their WT littermates (106.1±1.8 vs. 98.8±1.5 mmHg, p<0.05). Pulse wave velocity test showed that vascular stiffness was comparable between genotypes in both genders. Echocardiographic measurements revealed that the ejection fraction of male, but not female, KO mice was significantly higher than that of WT littermates (WT vs. KO: 75.2±0.02% vs. 85.4±0.01%, P<0.01), while female KO mice did not show any significant changes. These results indicate a multifaceted role of Esrra in the regulation of metabolic and cardiovascular functions likely in a gender- and circadian cycle-dependent manner. Future studies with conditional deletion approach are necessary to tease apart complex roles of Esrra in distinct cardiometabolic processes.

Impact of the Tips From Former Smokers Campaign on Population-Level Smoking Cessation, 2012-2015

This study provides estimates of the long-term cumulative impact of the Centers for Disease Control and Prevention’s national tobacco education campaign, Tips From Former Smokers (Tips), on population-level smoking cessation. We used recently published estimates of the association between increased Tips campaign media doses and quit attempts to calculate campaign-attributable population sustained (6-month) quits during 2012–2015. Tips led to approximately 522,000 sustained quits during 2012–2015. These findings indicate that the Tips campaign’s comprehensive approach to combining evidence-based messages with the promotion of cessation resources was successful in achieving substantial long-term cigarette cessation at the population level over multiple years.

Evaluation of a federally funded mass media campaign and smoking cessation in pregnant women: a population-based study in three states

OBJECTIVES

In 2012, theCenters for Disease Control and Prevention initiated a national anti-smoking campaign, Tips from Former Smokers (Tips). As a result of the campaign, quit attempts among smokers increased in the general population by 3.7 percentage points. In the current study, we assessed the effects of Tips on smoking cessation in pregnant women.

METHODS

We used 2009-2013 certificates of live births in three US states: Indiana, Kentucky and Ohio. Smoking cessation by the third trimester of pregnancy was examined among women who smoked in the 3 months prepregnancy. Campaign exposure was defined as overlap between the airing of Tips 2012 (March 19-June 10) and the prepregnancy and pregnancy periods. Women who delivered before Tips 2012 were not exposed. Adjusted logistic regression was used to determine whether exposure to Tips was independently associated with smoking cessation.

RESULTS

Cessation rates were stable during 2009-2011 but increased at the time Tips 2012 aired and remained elevated. Overall, 32.9% of unexposed and 34.7% of exposed smokers quit by the third trimester (p<0.001). Exposure to Tips 2012 was associated with increased cessation (adjusted OR: 1.07, 95% CI 1.05 to 1.10).

CONCLUSIONS

Exposure to a national anti-smoking campaign for a general audience was associated with smoking cessation in pregnant women.

Perceived Effectiveness of Antismoking Ads and Association with Quit Attempts Among Smokers: Evidence from the Tips From Former Smokers Campaign

BACKGROUND

Measures of perceived effectiveness (PE) of ads have been validated to predict changes in cognitive precursors of quit attempts, but a relationship between PE and actual quit attempts has not been shown in population-based studies. We analyzed smokers' PE ratings of ads from the national Tips From Former Smokers (Tips) campaign to (1) establish the validity of PE in predicting quit attempts in a large, nationally representative sample of smokers; (2) identify behavioral and demographic correlates of PE among respondents; and (3) examine whether PE is influenced by matching the race/ethnicity of ad participants with that of the ad viewer.

METHODS

We used survey data from two waves (baseline and follow-up) of a longitudinal online cohort of adult U.S. cigarette smokers. Respondents were shown one or more of 14 Tips campaign ads and were asked to assess each ad in terms of PE. We used multivariate models to estimate the association between baseline PE and prospective quit attempts; cross-sectional associations between PE and various respondent characteristics, including race/ethnicity, desire to quit, and health conditions; and the association between race/ethnicity of respondents and Tips ad participants.

RESULTS

Higher PE at baseline was associated with increased odds of a quit attempt at follow-up. Higher PE scores were associated with non-Hispanic black race, Hispanic ethnicity, higher desire to quit, presence of a chronic health condition, and presence of a mental health condition. There was no relationship between PE scores and matched race/ethnicity of the respondent and Tips ad participants.

CONCLUSIONS

This is the first study to demonstrate an association between PE scores for antismoking ads and prospective quit attempts in a large, nationally representative sample of smokers. Our findings also provide strong evidence that racial/ethnic minority subpopulations, including non-Hispanic blacks and Hispanics, react more favorably to Tips campaign ads irrespective of race/ethnicity of the ad participant. This suggests that message characteristics (e.g., graphic visuals and emotional content) may play a more important role in PE than race/ethnicity of ad participants.

New product trial, use of edibles, and unexpected highs among marijuana and hashish users in Colorado

OBJECTIVE

This study examines the relationships between trial of new marijuana or hashish products and unexpected highs, and use of edible products and unexpected highs.

METHODS

We conducted an online survey of 634 adult, past-year marijuana users in Colorado. We used logistic regression models to examine the relationship between new product trial or edible use and unexpected highs.

RESULTS

In the first year that recreational marijuana was legal in Colorado, 71.4% of respondents tried a new marijuana or hashish product, and 53.6% used an edible product. Trial of new products was associated with greater odds of experiencing an unexpected high after controlling for age, gender, education, mental health status, current marijuana or hashish use, and mean amount of marijuana or hashish consumed in the past month (OR=2.13, p<0.001). Individuals who reported having used edibles had greater odds of experiencing an unexpected high, after controlling for the same set of variables (OR=1.56, p<0.05).

CONCLUSION

People who try new marijuana or hashish products, or use edible marijuana or hashish products, are at greater risk for an unexpected high. It is possible that some negative outcomes associated with marijuana use and unexpected highs may be averted through a better understanding of how to use product packaging to communicate with consumers.

Association Between Media Doses of the Tips From Former Smokers Campaign and Cessation Behaviors and Intentions to Quit Among Cigarette Smokers, 2012-2015

BACKGROUND

Since 2012, the Centers for Disease Control and Prevention (CDC) has implemented Tips From Former Smokers ( Tips), the first federally funded tobacco education campaign in the United States. To date, there are no evaluations of its long-term impact.

AIMS

To assess the impact of varied doses of the Tips campaign from 2012 through 2015 on cessation-related behaviors and intentions among U.S. smokers.

METHOD

We used a national probability-based online survey of cigarette smokers ( n = 22,189) and recent quitters ( n = 776) to examine associations between doses of Tips advertising, measured by gross rating points (GRPs), and intentions to quit smoking in the next 30 days and quit attempts within the past 3 months. A curvilinear (i.e., square root) functional form of GRPs was used to capture patterns of diminishing effects at higher GRP levels.

RESULTS

An increase of 1,000 quarterly Tips GRPs at the media market level was associated with increased odds of making a quit attempt in the past 3 months (adjusted odds ratio = 1.23, p < .001) and increased odds of intending to quit in the next 30 days (adjusted odds ratio = 1.17, p = .030).

DISCUSSION

Results suggest that CDC-recommended media buys of 800 to 1,000 GRPs per quarter are sufficient to generate statistically significant increases in the likelihood of quit attempts in the past quarter.

CONCLUSIONS

The Tips campaign has had a substantial impact on cessation behaviors among U.S. adult smokers over time. These data support the continued use of graphic and/or emotional media campaigns that encourage smokers to quit to further reduce tobacco use in the United States.

The Eating-Disorder Associated HDAC4A778T Mutation Alters Feeding Behaviors in Female Mice

BACKGROUND

While eating disorders (EDs) are thought to result from a combination of environmental and psychological stressors superimposed on genetic vulnerability, the neurobiological basis of EDs remains incompletely understood. We recently reported that a rare missense mutation in the gene for the transcriptional repressor histone deacetylase 4 (HDAC4) is associated with the risk of developing an ED in humans.

METHODS

To understand the biological consequences of this missense mutation, we created transgenic mice carrying this mutation by introducing the alanine to threonine mutation at position 778 of mouse Hdac4 (corresponding to position 786 of the human protein). Bioinformatic analysis to identify Hdac4-regulated genes was performed using available databases.

RESULTS

Male mice heterozygous for HDAC4^A778T did not show any metabolic or behavioral differences. In contrast, female mice heterozygous for HDAC4^A778T display several ED-related feeding and behavioral deficits depending on housing condition. Individually housed HDAC4^A778T female mice exhibit reduced effortful responding for high-fat diet and compulsive grooming, whereas group-housed female mice display increased weight gain on high-fat diet, reduced behavioral despair, and increased anxiety-like behaviors. Bioinformatic analysis identifies mitochondrial biogenesis including synthesis of glutamate/gamma-aminobutyric acid as a potential transcriptional target of HDAC4^A778T activity relevant to the behavioral deficits identified in this new mouse model of disordered eating.

CONCLUSIONS

The HDAC4^A778T mouse line is a novel model of ED-related behaviors and identifies mitochondrial biogenesis as a potential molecular pathway contributing to behavioral deficits.

Quit Methods Used by US Adult Cigarette Smokers, 2014-2016

To quantify the prevalence of 10 quit methods commonly used by adult cigarette smokers, we used data from a nationally representative longitudinal (2014–2016) online survey of US adult cigarette smokers (n = 15,943). Overall, 74.7% of adult current cigarette smokers used multiple quit methods during their most recent quit attempt. Giving up cigarettes all at once (65.3%) and reducing the number of cigarettes smoked (62.0%) were the most prevalent methods. Substituting some cigarettes with e-cigarettes was used by a greater percentage of smokers than the nicotine patch, nicotine gum, or other cessation aids approved by the US Food and Drug Administration. Further research into the effectiveness of e-cigarettes as a cessation aid is warranted.

Reasons for current E-cigarette use among U.S. adults

E-cigarette use has increased rapidly among U.S. adults. However, reasons for use among adults are unclear. We assessed reasons for e-cigarette use among a national sample of U.S. adults. Data were collected via online surveys among U.S. adults aged 18 or older from April through June 2014. Descriptive and multivariate regression analyses were conducted to assess reasons for e-cigarette use among 2448 current e-cigarette users, by sociodemographic characteristics and product type. Assessed reasons included cessation/health, consideration of others, convenience, cost, curiosity, flavoring, and simulation of conventional cigarettes. Among current e-cigarette users, 93% were also current cigarette smokers. The most common reasons for e-cigarette use were cessation/health (84.5%), consideration of others (71.5%), and convenience (56.7%). The prevalence of citing convenience (adjusted prevalence ratio [aPR]=1.49) and curiosity (aPR=1.54) as reasons for e-cigarette use were greater among current cigarette smokers than nonsmokers (P<0.05). The prevalence of citing flavoring as a reason for use was greater among adults aged 18 to 24 (aPR=2.02) than 55 or older (P<0.05). Tank use was associated with greater prevalence of citing every assessed reason except convenience and curiosity. Cessation- and health-related factors are primary reasons cited for e-cigarette use among adults, and flavorings are more commonly cited by younger adults. Efforts are warranted to provide consumers with accurate information on the health effects of e-cigarettes and to ensure that flavoring and other unregulated features do not promote nicotine addiction, particularly among young adults.

Does Digital Video Advertising Increase Population-Level Reach of Multimedia Campaigns? Evidence From the 2013 Tips From Former Smokers Campaign

Background

Federal and state public health agencies in the United States are increasingly using digital advertising and social media to promote messages from broader multimedia campaigns. However, little evidence exists on population-level campaign awareness and relative cost efficiencies of digital advertising in the context of a comprehensive public health education campaign.

Objective

Our objective was to compare the impact of increased doses of digital video and television advertising from the 2013 Tips From Former Smokers (Tips) campaign on overall campaign awareness at the population level. We also compared the relative cost efficiencies across these media platforms.

Methods

We used data from a large national online survey of approximately 15,000 US smokers conducted in 2013 immediately after the conclusion of the 2013 Tips campaign. These data were used to compare the effects of variation in media dose of digital video and television advertising on population-level awareness of the Tips campaign. We implemented higher doses of digital video among selected media markets and randomly selected other markets to receive similar higher doses of television ads. Multivariate logistic regressions estimated the odds of overall campaign awareness via digital or television format as a function of higher-dose media in each market area. All statistical tests used the .05 threshold for statistical significance and the .10 level for marginal nonsignificance. We used adjusted advertising costs for the additional doses of digital and television advertising to compare the cost efficiencies of digital and television advertising on the basis of costs per percentage point of population awareness generated.

Results

Higher-dose digital video advertising was associated with 94% increased odds of awareness of any ad online relative to standard-dose markets (P<.001). Higher-dose digital advertising was associated with a marginally nonsignificant increase (46%) in overall campaign awareness regardless of media format (P=.09). Higher-dose television advertising was associated with 81% increased odds of overall ad awareness regardless of media format (P<.001). Increased doses of television advertising were also associated with significantly higher odds of awareness of any ad on television (P<.001) and online (P=.04). The adjusted cost of each additional percentage point of population-level reach generated by higher doses of advertising was approximately US $440,000 for digital advertising and US $1 million for television advertising.

Conclusions

Television advertising generated relatively higher levels of overall campaign awareness. However, digital video was relatively more cost efficient for generating awareness. These results suggest that digital video may be used as a cost-efficient complement to traditional advertising modes (eg, television), but digital video should not replace television given the relatively smaller audience size of digital video viewers.

Abstract P150: Lateral Hypothalamic Leptin and Melanocortin Signaling in the Regulation of Sympathetic Nerve Activity and Blood Pressure

Obesity is associated with increased sympathetic nerve activity (SNA), which contributes to the development of hypertension. Hypothalamus plays a fundamental role in both body weight homeostasis and sympathetic outflow, but the underlying neural basis of this association remains incompletely understood. Leptin and melanocortin systems in the brain are important regulators of body weight homeostasis, SNA and blood pressure. However, the neural circuits by which leptin and melanocortin regulate SNA and blood pressure remain unclear. We have previously shown that both leptin receptor (LepR) and melanocortin 4 receptor (MC4R) are co-expressed in a unique subset of GABAergic neurons in the lateral hypothalamic area (LHA). Because the LHA is a well-known site for SNA and cardiovascular function, we hypothesized that LepR and MC4R signaling in the LHA may play an important role in SNA and blood pressure. Here we show that direct microinfusion of leptin into the LHA increases renal SNA in dose-dependent manner (% changes from baseline at 4 th hour: Vehicle -25.03 ± 7.09 %, 0.05 ug leptin 26.01 ± 9.5 %, 0.5 ug leptin 100.23 ± 26.94 %, n=5-7/group, p<0.001). Additionally, in vivo Cre/loxP system-mediated re-expression of endogenous MC4Rs in the LHA restores the blunted response of MTII-induced increase in renal SNA (Wild-type 66.67 ± 16.53 %, MC4R-null 17.65 ± 10.3 %, MC4R reactivation 48.77 ± 9.36 %, n=7-9/group, p<0.01) and elevates blood pressure in obese, but normotensive MC4R-TB mice in inactive light cycle (Wild-type 111.62 ± 4.07, MC4R-TB 115.75 ± 1.27, MC4R re-expression 125.29 ± 3014 mmHg, n=3-4/group, p<0.05) without significantly affecting body weight. Finally, optogenetic stimulation of LHA LepR-positive neurons decease blood pressure and renal SNA in conscious mice. In conclusion, our findings identify a novel brain circuit by which leptin and melanocortin signaling regulate renal SNA and blood pressure.

Analysis of Group Process in Marathon Group Therapy with Users of Illicit Drugs

The Hill Interaction Matrix was used to measure the content and quality of interactions in a 12-hour therapy group of drug addicts. The group included six black and six white male clients and three therapists. The level of therapeutic work was measured by using four categories: conventional, assertive, speculative, and confrontive. The content of interactions was also measured by using four categories: topic, group, personal, and relationship. The group was characterized as highly confrontive, and the most therapeutic interactions occurred during the middle six hours of group time.

Association between self-reports of being high and perceptions about the safety of drugged and drunk driving

This study examines the relationship between self-reports of being high on marijuana and perceptions about driving high or drunk. Data were collected in 2014 from an online convenience sample of adult, past 30-day marijuana and hashish users in Colorado and Washington (n = 865). Respondents were asked, "Were you high or feeling the effects of marijuana or hashish when you took this survey?" Logistic regression was used to assess the relationship between being high and beliefs about driving high, controlling for demographics and marijuana use. Respondents who reported being high at the time of survey administration had higher odds of agreeing with the statements, "I can safely drive under the influence of marijuana" (OR = 3.13, P < 0.001) and "I can safely drive under the influence of alcohol" (OR = 3.71, P < 0.001) compared with respondents who did not report being high. Respondents who were high also had higher odds of being open to driving high under certain circumstances. Being high may influence perceptions about the safety of drugged and drunk driving. The effectiveness of public health messages to prevent drugged and drunk driving may depend in part on how persuasive they are among individuals who are high.

Association Between Media Dose, Ad Tagging, and Changes in Web Traffic for a National Tobacco Education Campaign: A Market-Level Longitudinal Study

BACKGROUND

In 2012, the US Centers for Disease Control and Prevention (CDC) launched Tips From Former Smokers (Tips), the first federally funded national tobacco education campaign. In 2013, a follow-up Tips campaign aired on national cable television networks, radio, and other channels, with supporting digital advertising to drive traffic to the Tips campaign website.

OBJECTIVE

The objective of this study was to use geographic and temporal variability in 2013 Tips campaign television media doses and ad tagging to evaluate changes in traffic to the campaign website in response to specific doses of campaign media.

METHODS

Linear regression models were used to estimate the dose-response relationship between weekly market-level television gross rating points (GRPs) and weekly Web traffic to the Tips campaign website. This relationship was measured using unique visitors, total visits, and page views as outcomes. Ad GRP effects were estimated separately for ads tagged with the Tips campaign website URL and 1-800-QUIT-NOW.

RESULTS

In the average media market, an increase of 100 television GRPs per week for ads tagged with the Tips campaign website URL was associated with an increase of 650 unique visitors (P<.001), 769 total visits (P<.001), and 1255 total page views (P<.001) per week. The associations between GRPs for ads tagged with 1-800-QUIT-NOW and each Web traffic measure were also statistically significant (P<.001), but smaller in magnitude.

CONCLUSIONS

Based on these findings, we estimate that the 16-week 2013 Tips television campaign generated approximately 660,000 unique visitors, 900,000 total visits, and 1,390,000 page views for the Tips campaign website. These findings can help campaign planners forecast the likely impact of targeted advertising efforts on consumers' use of campaign-specific websites.

Increasing the dose of television advertising in a national antismoking media campaign: results from a randomised field trial

Background

While antismoking media campaigns have demonstrated effectiveness, less is known about the country-level effects of increased media dosing. The 2012 US Tips From Former Smokers (Tips) campaign generated approximately 1.6 million quit attempts overall; however, the specific dose–response from the campaign was only assessed by self-report.

Objective

Assess the impact of higher ad exposure during the 2013 Tips campaign on quit-related behaviours and intentions, campaign awareness, communication about campaign, and disease knowledge.

Methods

A 3-month national media buy was supplemented within 67 (of 190) randomly selected local media markets. Higher-dose markets received media buys 3 times that of standard-dose markets. We compared outcomes of interest using data collected via web-based surveys from nationally representative, address-based probability samples of 5733 cigarette smokers and 2843 non-smokers.

Results

In higher-dose markets, 87.2% of smokers and 83.9% of non-smokers recalled television campaign exposure versus 75.0% of smokers and 73.9% of non-smokers in standard-dose markets. Among smokers overall, the relative quit attempt rate was 11% higher in higher-dose markets (38.8% vs 34.9%; p<0.04). The higher-dose increase was larger in African-Americans (50.9% vs 31.8%; p<0.01). Smokers in higher-dose markets without a mental health condition, with a chronic health condition, or with only some college education made quit attempts at a higher rate than those in standard-dose markets. Non-smokers in higher-dose markets were more likely to talk with family or friends about smoking dangers (43.1% vs 35.7%; p<0.01) and had greater knowledge of smoking-related diseases.

Conclusions

The US 2013 Tips antismoking media campaign compared standard and higher doses by randomisation of local media markets. Results demonstrate the effectiveness of a higher dose for engaging non-smokers and further increasing quit attempts among smokers, especially African-Americans.

The Dose-Response Relationship Between Tobacco Education Advertising and Calls to Quitlines in the United States, March-June, 2012

Introduction

We estimated changes in call volume in the United States in response to increases in advertising doses of the Tips From Former Smokers (Tips) campaign, the first federal national tobacco education campaign, which aired for 12 weeks from March 19 to June 10, 2012. We also measured the effectiveness of ad taglines that promoted calls directly with a quitline number (1-800-QUIT-NOW) and indirectly with a cessation help website (Smokefree.gov).

Methods

Multivariate regressions estimated the weekly number of calls to 1–800-QUIT-NOW by area code as a function of weekly market-level gross rating points (GRPs) from CDC’s Tips campaign in 2012. The number of quitline calls attributable solely to Tips was predicted.

Results

For quitline-tagged ads, an additional 100 television GRPs per week was associated with an increase of 89 calls per week in a typical area code in the United States (P < .001). The same unit increase in advertising GRPs for ads tagged with Smokefree.gov was associated with an increase of 29 calls per week in any given area code (P < .001). We estimated that the Tips campaign was responsible for more than 170,000 additional calls to 1–800-QUIT-NOW during the campaign and that it would have generated approximately 140,000 additional calls if all ads were tagged with 1–800-QUIT-NOW.

Conclusion

For campaign planners, these results make it possible to estimate 1) the likely impact of tobacco prevention media buys and 2) the additional quitline capacity needed at the national level should future campaigns of similar scale use 1–800-QUIT-NOW taglines exclusively.

Using Mass Media Campaigns to Reduce Youth Tobacco Use: A Review

Objective.

This review synthesizes the published literature on using mass media campaigns to reduce youth tobacco use, with particular focus on effects within population subgroups and the relative effectiveness of campaign characteristics.

Data Source.

A search of PubMed and PsycINFO conducted in March of 2014 yielded 397 studies with 34 suitable for inclusion.

Study Inclusion and Exclusion Criteria.

Included were quantitative studies that evaluate an antitobacco media campaign intended to influence youth cognitions or behavior or explore the relative effectiveness of campaign characteristics among youth.

Data Extraction.

An automated search and assessment of suitability for inclusion was done.

Data Synthesis.

Study outcomes were compared and synthesized.

Results.

Antitobacco media campaigns can be effective across racial/ethnic populations, although the size of the campaign effect may differ by race/ethnicity. Evidence is insufficient to determine whether campaign outcomes differ by socioeconomic status (SES) and population density. Youth are more likely to recall and think about advertising that includes personal testimonials; a surprising narrative; and intense images, sound, and editing. Evidence in support of using a health consequences message theme is mixed; an industry manipulation theme may be effective in combination with a health consequences message. Research is insufficient to determine whether advertising with a secondhand smoke or social norms theme influences youth tobacco use.

Conclusion.

Our recommendation is to develop antitobacco campaigns designed to reach all at-risk youth, which can be effective across racial/ethnic populations. Research priorities include assessing campaign influence among lower SES and rural youth, disentangling the effects of message characteristics, and assessing the degree to which this body of evidence may have changed as a result of changes in youth culture and communication technology.

Impact of a U.S. antismoking national media campaign on beliefs, cognitions and quit intentions

In 2012, the Centers for Disease Control and Prevention launched a national tobacco education campaign, Tips From Former Smokers, that consisted of graphic, emotionally evocative, testimonial-style advertisements. This longitudinal study examines changes in beliefs, tobacco-related cognitions and intentions to quit smoking among U.S. adult smokers after a 12-week airing of the campaign (n = 4040 adult smokers pre- and post-campaign). Exposure to the campaign was associated with greater odds of intending to quit within the next 30 days [odds ratio (OR) = 1.28, P < 0.01] and within the next 6 months (OR = 1.12, P < 0.05), and quit intentions were stronger among respondents with greater campaign exposure (OR = 1.12, P < 0.01). Campaign exposure was also associated with significant changes in beliefs about smoking-related risks (ORs = 1.15-2.40) and increased worries about health (b = 0.30, P < 0.001). Based on study change rates applied to U.S. census data, an estimated 566 000 additional U.S. smokers reported their intention to quit smoking within the next 6 months as a result of viewing campaign advertisements. Campaign effects were consistent with the theory of reasoned action and an expanding body of research demonstrating that graphic, emotional advertisements are highly effective for prompting positive cessation-related cognitions and behavioral intentions.

A cost-effectiveness analysis of the first federally funded antismoking campaign

BACKGROUND

In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts.

PURPOSE

Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency's perspective.

METHODS

Estimates of sustained cessations; premature deaths averted; undiscounted life years (LYs) saved; and quality-adjusted life years (QALYs) gained by Tips were estimated.

RESULTS

Tips saved about 179,099 QALYs and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained.

CONCLUSIONS

Tips was not only successful at reducing smoking-attributable morbidity and mortality but also was a highly cost-effective mass media intervention.

Reactions to graphic health warnings in the United States

This study reports consumer reactions to the graphic health warnings selected by the Food and Drug Administration to be placed on cigarette packs in the United States. We recruited three sets of respondents for an experimental study from a national opt-in e-mail list sample: (i) current smokers aged 25 or older, (ii) young adult smokers aged 18-24 and (iii) youth aged 13-17 who are current smokers or who may be susceptible to initiation of smoking. Participants were randomly assigned to be exposed to a pack of cigarettes with one of nine graphic health warnings or with a text-only warning statement. All three age groups had overall strong negative emotional (ß = 4.7, P < 0.001 for adults; ß = 4.6, P < 0.001 for young adults and ß = 4.0, P < 0.001 for youth) and cognitive (ß = 2.4, P < 0.001 for adults; ß = 3.0, P < 0.001 for young adults and ß = 4.6, P < 0.001 for youth) reactions to the proposed labels. The strong negative emotional and cognitive reactions following a single exposure to the graphic health warnings suggest that, with repeated exposures over time, graphic health warnings may influence smokers' beliefs, intentions and behaviors.

Exploring the potential for a mass media campaign to influence support for a ban on tobacco promotion at the point of sale

This study explores whether exposure to advertisements that focus on the negative effects of tobacco industry advertising and promotion at the point of sale (anti-POS advertising) influence: (i) attitude toward POS advertising; (ii) perceived impact of POS advertising on youth smoking; and (iii) support for a ban on tobacco promotion at the POS among adult non-smokers in New York. Data are from a split-sample, experimental study, using an online media tracking survey with embedded TV, radio and print advertising. Exposure to anti-POS advertising was associated with higher odds of holding a negative attitude toward POS advertising (OR 2.43, P < 0.001) and support for a ban on tobacco promotion at the POS (OR 1.77, P < 0.05), but not with perceived impact of POS tobacco advertisements on youth smoking. Findings suggest the possibility that a mass media campaign could be used to influence public attitude toward POS advertising and support for a ban on tobacco promotion at the POS.

The use of blood lactate concentration as an indicator of temperament and its impact on growth rate and tenderness of steaks from Simmental × Angus steers

The objective of this study was to evaluate the use of blood lactate concentration as an objective measure of beef cattle temperament and determine if the temperament of steers affected growth rate and tenderness of beef steaks. Angus×Simmental steers (n=154) were evaluated for blood lactate (BL), exit velocity (EV) and chute score (CS), and humanely harvested. Carcass characteristics were assessed and loin samples were obtained for tenderness evaluation. All measures of the temperament were significantly correlated to each other (r=0.14-0.47; P≤0.04). Steaks from steers in the medium BL classification were significantly more tender than steaks from steers from the high BL classification. The steers with faster EV tended to result in steaks with higher shear force values (P=0.07). The steers classified as fast growing resulted in steaks with lower shear force values (P=0.02) compared to steaks from steers classified as slow growing. Results suggest that the temperament contributes to variations in growth rate, blood lactate, and tenderness.

The impact of a state-sponsored mass media campaign on use of telephone quitline and web-based cessation services

INTRODUCTION

Most US smokers do not use evidence-based interventions as part of their quit attempts. Quitlines and Web-based treatments may contribute to reductions in population-level tobacco use if successfully promoted. Currently, few states implement sustained media campaigns to promote services and increase adult smoking cessation. This study examines the effects of Florida's tobacco cessation media campaign and a nationally funded media campaign on telephone quitline and Web-based registrations for cessation services from November 2010 through September 2013.

METHODS

We conducted multivariable analyses of weekly media-market-level target rating points (TRPs) and weekly registrations for cessation services through the Florida Quitline (1-877-U-CAN-NOW) or its Web-based cessation service, Web Coach (www.quitnow.net/florida).

RESULTS

During 35 months, 141,221 tobacco users registered for cessation services through the Florida Quitline, and 53,513 registered through Web Coach. An increase in 100 weekly TRPs was associated with an increase of 7 weekly Florida Quitline registrants (β = 6.8, P < .001) and 2 Web Coach registrants (β = 1.7, P = .003) in an average media market. An increase in TRPs affected registrants from multiple demographic subgroups similarly. When state and national media campaigns aired simultaneously, approximately one-fifth of Florida's Quitline registrants came from the nationally advertised portal (1-800-QUIT-NOW).

CONCLUSION

Sustained, state-sponsored media can increase the number of registrants to telephone quitlines and Web-based cessation services. Federally funded media campaigns can further increase the reach of state-sponsored cessation services.

The influence of antismoking television advertisements on cessation by race/ethnicity, socioeconomic status, and mental health status

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State's antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.

Effect of the first federally funded US antismoking national media campaign

BACKGROUND

Every year, smoking kills more than 5 million people globally, including 440,000 people in the USA, where the long-term decline in smoking prevalence has slowed. The US Centers for Disease Control and Prevention (CDC) delivered a national, 3-month antismoking campaign called Tips From Former Smokers (Tips) that started in March, 2012, in which hard-hitting, emotionally evocative television advertising was featured, depicting smoking-related suffering in real people. We aimed to assess the effects of the Tips campaign.

METHODS

We undertook baseline and follow-up surveys of nationally representative cohorts of adult smokers and non-smokers. The national effect of the Tips campaign was estimated by applying rates of change in the cohort before and after the campaign to US census data.

FINDINGS

3051 smokers and 2220 non-smokers completed baseline and follow-up assessments. 2395 (78%) smokers and 1632 (74%) non-smokers recalled seeing at least one Tips advertisement on television during the 3-month campaign. Quit attempts among smokers rose from 31.1% (95% CI 30.3-31.9) at baseline to 34.8% (34.0-35.7) at follow-up, a 12% relative increase. The prevalence of abstinence at follow-up among smokers who made a quit attempt was 13.4% (95% CI 9.7-17.2). Nationally, an estimated 1.64 million additional smokers made a quit attempt, and 220,000 (95% CI 159,000-282,000) remained abstinent at follow-up. Recommendations by non-smokers to quit grew from 2.6% at baseline to 5.1% at follow-up, and the prevalence of people talking with friends and family about the dangers of smoking rose from 31.9% (95% CI 31.3-32.5) to 35.2% (34.6-35.9), resulting in an estimated 4.7 million additional non-smokers recommending cessation services and more than 6 million talking about the dangers of smoking.

INTERPRETATION

The high-exposure Tips media campaign was effective at increasing population-level quit attempts. The growth in smokers who quit and became sustained quitters could have added from a third to almost half a million quality-adjusted life-years to the US population. Expanded implementation of similar campaigns globally could accelerate progress on the WHO Framework Convention on Tobacco Control and reduce smoking prevalence globally.

FUNDING

CDC, US Department of Health and Human Services.

Cigarette trafficking in five northeastern US cities

BACKGROUND

Cigarette taxation is effective in reducing tobacco use in the USA. However, these benefits are reduced when taxes are unpaid. Cigarette trafficking (ie, the illegal importation of cigarettes into a high-tax jurisdiction from a lower-tax jurisdiction) is well documented in high-tax places like New York City (NYC), but the extent of trafficking in other northeastern cities is relatively unknown.

OBJECTIVE

To estimate the extent of cigarette trafficking in Boston, NYC, Philadelphia, Providence and Washington, DC, and project the benefits of reducing cigarette trafficking for recouping lost taxes and reducing smoking in these cities.

METHODS

Littered cigarette packs were collected from a random sample of Census tracts in five US cities. Data collection yielded 1439 total littered packs. The share of cigarette packs bearing proper local, known non-local, foreign or unknown, or no tax stamp was calculated for each city. These data were used to estimate tax revenue recovery if cigarette trafficking could be eliminated. We also estimated the extent to which eliminating cigarette trafficking would reduce cigarette consumption.

RESULTS

Overall, 58.7% of packs did not have a proper local tax stamp, and 30.5-42.1% were attributed to trafficking. We estimate that eliminating cigarette trafficking would result in declines in youth smoking prevalence ranging from negligible in low-tax cities like Philadelphia to up to 9.3% in higher-tax NYC. We estimate that these five cities could recoup $680-729 million annually in cigarette tax revenue if cigarette trafficking was eliminated.

CONCLUSIONS

Reducing cigarette trafficking would increase the effectiveness of tobacco taxes in reducing smoking and generate additional tax revenue, particularly in higher-taxed cities. Federal action to reduce cigarette trafficking, such as a track-and-trace system, is needed.

The impact of cessation media messages on cessation-related outcomes: results from a national experiment of smokers

PURPOSE

Examine effects of exposure to two types of cessation advertisements on changes in cessation-related outcomes.

DESIGN

Experimental data from a nationally representative, longitudinal sample of smokers, collected in three waves over 4 weeks.

SETTING

National. Subjects. Three thousand and two adult U.S. smokers aged 18+ completed baseline and follow-up interviews at 2 and 4 weeks, from December 2010 to February 2011.

INTERVENTION

Six randomly assigned conditions consisting of repeated exposure to cessation advertisements: why-to-quit advertisements featuring emotional, personal testimonies (1: WTQ-T) or graphic images (2: WTQ-G); how-to-quit advertisements (3: HTQ), a combination of both (4: WTQ-T + HTQ; 5: WTQ-G + HTQ), and no-ad condition (6: control).

MEASURES

Cessation-related beliefs, attitudes, intentions, and quitting behavior.

ANALYSIS

Multivariable ordinary least squares and logistic regressions testing whether exposure to antitobacco television advertisements were associated with changes in tobacco-related outcomes.

RESULTS

Exposure to WTQ-T or WTQ-G advertisements, both alone and combined with HTQ advertisements, elicited positive change in beliefs, attitudes, and intentions as compared to controls. Smokers in three of four WTQ conditions were substantially more likely to have quit smoking at 4 weeks than controls (odds ratios range from 5.9 to 10.1, p < .05 or better). No effects were found for the HTQ-only condition.

CONCLUSION

Exposure to WTQ advertisements markedly increases the odds that a smoker will quit in the study period, suggesting positive movement toward successful, long-term cessation. HTQ advertisements did not enhance advertising effectiveness and may not be suitable as a primary message strategy.

Perceived effectiveness of cessation advertisements: the importance of audience reactions and practical implications for media campaign planning

Cessation television ads are often evaluated with measures of perceived effectiveness (PE) that gauge smokers' reactions to the ads. Although measures of PE have been validated for other genres of public service announcements, no studies to our knowledge have demonstrated the predictive validity of PE for cessation TV ads specifically. We analyzed data from a longitudinal Web survey of smokers in the United States to assess whether measures of PE for cessation TV ads are causally antecedent to cessation-related outcomes. These data consisted of baseline and 2-week follow-up surveys of 3,411 smokers who were shown a number of cessation TV ads and were asked to provide their appraisals of PE for those messages. We found that baseline PE for the ads was associated with increased negative feelings about smoking, increased outcome expectations about the benefits of quitting, increased consideration of the benefits of quitting, increased desire to quit, and increased intentions to quit smoking at follow-up. Results suggest that measures of PE for cessation TV ads can be powerful predictors of likely ad success. Hence, our findings support the use of PE in quantitative ad pretesting as part of a standard regimen of formative research for cessation television campaigns.

Repeated Exposure to Media Messages Encouraging Parent-Child Communication about Sex: Differential Trajectories for Mothers and Fathers

Purpose.

To examine changes in parent-child communication related to sexual behavior after exposure to public health messages.

Design.

Randomized, controlled trial that was part of precampaign message testing.

Setting.

Exposure occurred online or through DVDs mailed to participants and viewed on their personal computers. Data collection occurred via a secure Web site.

Patients.

Participants included parents (n = 1969) living with a child age 10 to 14 years drawn from a nationally representative sample of U.S. households.

Intervention.

Treatment participants were exposed to video, audio, and print advertisements that promoted the benefits of speaking to their children early and often about delaying initiation of sexual activity; messages also directed parents to an informational Web site.

Measures.

The dependent variable assessed frequency of parent-child communication related to sexual behavior. The primary independent variable was treatment assignment.

Analysis.

Longitudinal growth modeling that included five waves of data.

Results.

The trajectory of growth over time differed between fathers in the treatment group and fathers in the control group (F [1, 2357] = 4.15; p < .042), indicating more frequent communication among treatment fathers than among control fathers. Trajectories did not differ between mothers in treatment and control groups.

Conclusion.

This study demonstrates that father-child and mother-child communication patterns differ over time in response to public health messages. Findings have implication for researchers developing health marketing campaigns.

Effectiveness of a national media campaign to promote parent-child communication about sex

BACKGROUND

Although there is debate on the effectiveness of youth-focused abstinence education programs, research confirms that parents can influence their children's decisions about sexual behavior. To leverage parent-based approaches to adolescent sexual health, the U.S. Department of Health and Human Services launched the Parents Speak Up National Campaign (PSUNC) to encourage parent-child communication about sex. Previous experimental studies have found the campaign to be efficacious in increasing parent-child communication. But to date, the actual reach of the campaign and its real-world effectiveness in promoting parent-child communication has not been established. The present study addresses this gap.

METHOD

The authors surveyed 1,804 parents of 10- to14-year-old children from the nationally representative Knowledge Networks online panel. The survey included questions about parents' awareness of PSUNC ads and parent-child communication behaviors. The authors also analyzed market-level data on campaign gross rating points, a measure of market-level intensity of PSUNC advertising in the United States. Multivariate regressions were used to examine the association between PSUNC exposure and a three-item scale for parent-child communication.

RESULTS

Overall, 59.4% of parents in the sample reported awareness of PSUNC. The authors found that higher market-level PSUNC gross rating points were associated with increased parent-child communication. Similar relationships were observed between self-reported awareness of PSUNC and increased frequency of communication and recommendations to wait. These associations were particularly strong among mothers.

CONCLUSIONS

This study provides the first field-based data on the real-world reach and effectiveness of PSUNC among parents. The data support earlier experimental trials of PSUNC, showing that the campaign is associated with greater parent-child communication, primarily among mothers. Further research may be needed to develop additional messages for fathers.

Effects of media messages on parent-child sexual communication

Parent-child communication about sex is an important reproductive health outcome. Consistent, positive perceptions of communication by parents and children can promote behavioral outcomes such as delaying sexual debut and increasing contraceptive use. The authors investigated whether exposure to messages from the Parents Speak Up National Campaign (PSUNC), a social marketing campaign to promote increased parent-child sexual communication, led to increased children's self-reports of communication. Also, the authors examined whether PSUNC message exposure increased agreement about communication between parents and their children. In a randomized experimental design, the authors surveyed children of parents exposed and not exposed to PSUNC messages. Parents and children completed online instruments asking matched questions about sexual attitudes, beliefs, and communication. The authors matched 394 parents and children for analysis. They used ordinal logistic regression modeling and kappa statistics. Children of parents exposed to PSUNC messages were more likely to (a) report sexual communication than were those not exposed and (b) agree with their parents about extent and content. Parent-child pairs of the same gender, younger pairs, and non-White pairs were more likely to agree. Overall, PSUNC message exposure appears to have promoted more extensive sexual communication. Future research should examine behavioral mechanisms and message receptivity among subgroups of parents and children.

Antismoking media campaign and smoking cessation outcomes, New York State, 2003-2009

INTRODUCTION

The New York Tobacco Control Program (NY TCP) is one of the largest state tobacco control programs in the United States. Little research has been published on the effectiveness of its antismoking media campaign. The objective of this study was to examine whether exposure to NY TCP's statewide antismoking media campaign corresponded to smoking outcomes.

METHODS

We used data from the 2003 through 2009 New York Adult Tobacco Survey to evaluate exposure to NY TCP advertising, cessation intentions, quit attempts, and cigarette consumption among New York adult smokers. We also used data from the 2003 through 2009 New York Behavioral Risk Factor Surveillance System (BRFSS) and the 2003 through 2009 National Health Interview Survey (NHIS) to examine smoking prevalence among New York adults compared with US adults.

RESULTS

From 2003 through 2009, smokers' exposure to NY TCP advertising increased from 6% to 45%, the prevalence of 30-day intentions to quit increased from 26% to 35%, and the prevalence of quit attempts increased from 46% to 62%. Average cigarettes smoked per day decreased from 15 in 2003 to 11 in 2009. The New York BRFSS and NHIS both showed significant downward trends in adult smoking prevalence. The decline during this period was greater in New York (18%) than in the United States as a whole (5%).

CONCLUSION

NY TCP's campaign generated significant increases in exposure to advertising over time that corresponded with changes in key cessation- and smoking-related outcomes. Findings suggest that NY TCP's sustained implementation of evidence-based cessation advertisements contributed to these changes.

Efficacy of an HIV testing campaign's messages for African American women

We conducted a Web-based randomized controlled experiment to test the efficacy of the Take Charge. Take the Test. (TCTT) campaign messages. The experiment had two conditions: (a) exposure to campaign messages and (b) no exposure. Participants completed a baseline assessment, exposure condition participants were exposed to campaign materials for 2 weeks, and all participants completed a follow-up survey at 2- and 6-weeks postbaseline. Multivariate results indicate that exposure to TCTT messages was associated with increases in key knowledge items targeted by the campaign, intentions to get tested for HIV, and increases in peer-to-peer communication about getting an HIV test.

Effectiveness of a mass media campaign in promoting HIV testing information seeking among African American women

"Take Charge. Take the Test." (TCTT), a media campaign promoting HIV testing among African American women, was piloted in Cleveland and Philadelphia from October 2006 to October 2007. This study assesses TCTT's effectiveness in promoting HIV testing information seeking among target audiences in each pilot city. The authors analyzed data on telephone hotlines promoted by the campaign and the www.hivtest.org Web site to examine trends in hotline calls and testing location searches before, during, and after the campaign. Cleveland hotline data were available from October 1, 2005, through February 28, 2008, for a total of 29 months (N = 126 weeks). Philadelphia hotline data were available from May 1, 2006, through February 28, 2008, for a total of 22 months (N = 96 weeks). The authors assessed the relation between market-level measures of the campaign's advertising activities and trends in hotline call volume and testing location searches. They found a significant relation between measures of TCTT advertising and hotline calls. Specifically, they found that increases in advertising gross ratings points were associated with increases in call volume, controlling for caller demographics and geographic location. The campaign had similar effects on HIV testing location searches. Overall, it appears the campaign generated significant increases in HIV information seeking. Results are consistent with other studies that have evaluated the effects of media campaigns on similar forms of information seeking. This study illustrates useful methods for evaluating campaign effects on information seeking with data on media implementation, hotline calls, and zip code-based searches for testing locations.

Social cognitive mediators of parent-child sexual communication

OBJECTIVE

To test a social cognitive behavior change model and identify mediators of the effects of the Parents Speak Up National Campaign (PSUNC) on parent-child sexual communication.

METHODS

Investigators used 5 waves of data from an online randomized controlled trial. Latent variables were developed based on item response theory and confirmatory factor analysis. Structural equation modeling was used to test mediation.

RESULTS

Outcome expectations mediated effects of social norms and self-efficacy on sexual communication. Other hypothesized mediators were not confirmed.

CONCLUSIONS

Interventions to promote parent-child sexual communication should target outcome expectations. Future research should investigate parents' health information seeking.

Evaluation of sexual communication message strategies

Parent-child communication about sex is an important proximal reproductive health outcome. But while campaigns to promote it such as the Parents Speak Up National Campaign (PSUNC) have been effective, little is known about how messages influence parental cognitions and behavior. This study examines which message features explain responses to sexual communication messages. We content analyzed 4 PSUNC ads to identify specific, measurable message and advertising execution features. We then develop quantitative measures of those features, including message strategies, marketing strategies, and voice and other stylistic features, and merged the resulting data into a dataset drawn from a national media tracking survey of the campaign. Finally, we conducted multivariable logistic regression models to identify relationships between message content and ad reactions/receptivity, and between ad reactions/receptivity and parents' cognitions related to sexual communication included in the campaign's conceptual model. We found that overall parents were highly receptive to the PSUNC ads. We did not find significant associations between message content and ad reactions/receptivity. However, we found that reactions/receptivity to specific PSUNC ads were associated with increased norms, self-efficacy, short- and long-term expectations about parent-child sexual communication, as theorized in the conceptual model. This study extends previous research and methods to analyze message content and reactions/receptivity. The results confirm and extend previous PSUNC campaign evaluation and provide further evidence for the conceptual model. Future research should examine additional message content features and the effects of reactions/receptivity.

The impact of state tobacco control program funding cuts on teens' exposure to tobacco control interventions: evidence from Florida

PURPOSE

Explore the impact of dramatic budget cuts to the Florida Tobacco Control Program (FTCP) on Florida teens' exposure to tobacco control interventions.

DESIGN

Survey data on teens in Florida and a comparison sample of the remainder of the United States. Data were collected in six waves between 2002 and 2006, with three waves collected before and three waves collected after the FTCP budget cut in fiscal year (FY) 2004.

SETTING

Florida.

SUBJECTS

Twelve- to 17-year-old teens in Florida and the remainder of the United States. Between spring 2002 and summer 2006, 7841 interviews of Florida teens and 10,875 interviews of teens in the remainder of the United States were conducted.

MEASURES

Exposure to FTCP interventions, including tobacco countermarketing, school and community organizations, and in-school tobacco prevention curricula.

ANALYSIS

Multivariable logistic regression models were used to test whether declines in Florida youth's exposure to FTCP interventions were associated with the FTCP budget cut.

RESULTS

Following the FY2004 FTCP budget cut, there were greater declines in teens' exposure to tobacco countermarketing campaigns in Florida compared with the remainder of the United States (odds ratio [OR]  =  .42; p < .001). The FY2004 budget cut also may have had an impact on exposure to in-school tobacco prevention curricula and school youth organizations (OR  =  .67; p < .001).

CONCLUSION

Program budget cuts in Florida resulted in significant declines in exposure to some FTCP interventions (particularly tobacco countermarketing). Research on the correlates of smoking suggests that these budget cuts could have a significant impact on tobacco-related outcomes among teens.

Promoting calls to a quitline: quantifying the influence of message theme, strong negative emotions and graphic images in television advertisements

OBJECTIVE

To understand the relative effectiveness of television advertisements that differ in their thematic focus and portrayals of negative emotions and/or graphic images in promoting calls to a smokers' quitline.

METHODS

Regression analysis is used to explain variation in quarterly media market-level per smoker calls to the New York State Smokers' Quitline from 2001 to 2009. The primary independent variable is quarterly market-level delivery of television advertisements measured by target audience rating points (TARPs). Advertisements were characterised by their overall objective--promoting cessation, highlighting the dangers of secondhand smoke (SHS) or other--and by their portrayals of strong negative emotions and graphic images.

RESULTS

Per smoker call volume is positively correlated with total TARPs (p<0.001), and cessation advertisements are more effective than SHS advertisements in promoting quitline call volume. Advertisements with graphic images only or neither strong negative emotions nor graphic images are associated with higher call volume with similar effect sizes. Call volume was not significantly associated with the number of TARPs for advertisements with strong negative emotions only (p=0.71) or with both graphic images and strong emotions (p=0.09).

CONCLUSIONS

Exposure to television advertisements is strongly associated with quitline call volume, and both cessation and SHS advertisements can be effective. The use of strong negative emotions in advertisements may be effective in promoting smoking cessation in the population but does not appear to influence quitline call volume. Further research is needed to understand the role of negative emotions in promoting calls to quitlines and cessation more broadly among the majority of smokers who do not call quitlines.