Mixed messages on tobacco: comparative exposure to public health, tobacco company- and pharmaceutical company-sponsored tobacco-related television campaigns in the United States, 1999-2003

AIMS: To describe and compare the extent of exposure among youth and adults to antitobacco advertising funded by tobacco control agencies, and to smoking-related advertising from tobacco and pharmaceutical companies. DESIGN: Archival records of television advertising exposures from Nielsen Media Research for the largest 75 media markets in the United States from 1999 to 2003. MEASUREMENTS: Mean monthly advertising exposures for households with televisions and adolescents aged 12-17 years for: state tobacco control programs; the national American Legacy Foundation (Legacy) program; tobacco company advertising for youth smoking prevention, parent advertising and corporate image; pharmaceutical company advertising for nicotine replacement therapy and Zyban; and other miscellaneous tobacco-related advertising. FINDINGS: Combined tobacco company youth/parent advertising exposures matched those for combined State/Legacy campaigns (4.56 advertisements/month versus 4.97 advertisements/month among households; 3.05 advertisements/month versus 3.38 advertisements/month among adolescents). Tobacco company corporate image advertising averaged 3.25 advertisements/month among households and 0.73 advertisements/month among adolescents. Tobacco company advertising exceeded public health-sponsored advertising by a factor of 1.57-1, and among youth by 1.11-1. Pharmaceutical companies were the largest sponsor of tobacco-related advertising for households (10.37 advertisements/month) and provided significant exposure among adolescents (2.61 advertisements/month). CONCLUSIONS: This is the first study to demonstrate systematically that public health-sponsored antitobacco campaigns in the United States are matched or exceeded by tobacco company advertising, as well as pharmaceutical cessation product advertising. Research is needed to determine whether such advertising may dilute or undermine the established benefits of tobacco control-sponsored campaigns.     

The effect of screen advertising on children's dietary intake: A systematic review and meta‐analysis

Evidence indicates that screen advertising for unhealthy food results in significant increases in dietary intake among children. This review was undertaken with the main aim of estimating the quantitative effect of screen advertising in experimental and nonexperimental conditions on children's dietary intake. Systematic searches were undertaken of interdisciplinary databases. Studies from 1980 to April 2018, all geography and languages, were included; participants were children and adolescents aged between 2 and 18 years; the intervention was screen advertising; and the outcome was dietary intake. Meta‐analyses were conducted for measured and nonmeasured outcomes. Food advertising was found to increase dietary intake among children (age range 2‐14, mean 8.8 years) in experimental conditions for television (TV) advertising and advergames. Meta‐analysis revealed that children exposed to food advertising on TV (11 studies) and advergames (five studies) respectively consumed an average 60.0 kcal (95% confidence interval [CI], 3.1‐116.9) and 53.2 kcal (95% CI, 31.5‐74.9) more than children exposed to nonfood advertising. There was also an effect by body mass index (BMI). Findings from nonexperimental studies revealed that exposure to TV food advertising was positively associated with and predictive of dietary intake in children. Short‐term exposure to unhealthy food advertising on TV and advergames increases immediate calorie consumption in children.     

USE OF HIGH‐DOSE GADOLINIUM AS CONTRAST MEDIA TO AVOID RADIOCONTRAST MEDIA‐INDUCED NEPHROPATHY

Patients at risk for radiocontrast media‐induced nephropathy (RCIN) with suspected peripheral vascular disease were evaluated with high‐dose (0.4 mmol/kg) gadolinium‐based (Gd) contrast angiography (AG). The patients who were considered susceptible to RCIN were defined by having one or more of the following: (1) pre‐existing serum creatinine (SCr) >124 μmol/l, (2) diabetes mellitus and (3) age >60 years. An increase in SCr ≥ 44 μmol/l or ≥ 25% of baseline was considered significant. Ten patients underwent peripheral AG using a high dose of Gd without any adverse reaction. The mean age was 67.8 years. Nine (90%) patients were diabetic. The quality of these images was satisfactory for diagnosis in eight out of 10 patients. None of these patients had significant change in SCr. The mean SCr (±SD) before, at 48 hours and at 72 hours after AG were 182 ± 97, 177 ± 99 and 177 ± 98 μmol/l, respectively. Based on this limited study, Gd is a promising agent for peripheral angiographic study. In patients at risk for RCIN, the high dose of Gd appears to be safe without obvious nephrotoxicity.     

From the Cover: Advertisements impact the physiological efficacy of a branded drug

We conducted randomized clinical trials to examine the impact of direct-to-consumer advertisements on the efficacy of a branded drug. We compared the objectively measured, physiological effect of Claritin (Merck & Co.), a leading antihistamine medication, across subjects randomized to watch a movie spliced with advertisements for Claritin or advertisements for Zyrtec (McNeil), a competitor antihistamine. Among subjects who test negative for common allergies, exposure to Claritin advertisements rather than Zyrtec advertisements increases the efficacy of Claritin. We conclude that branded drugs can interact with exposure to television advertisements.     

Successful transfemoral aortic Edwards® SAPIEN® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent

Severe anaphylactoid reaction after the use of iodinated contrast media are rare but can contraindicate the use of contrast agent. It was the case of a 53‐year‐old woman suffering from symptomatic severe aortic stenosis, recused for cardiac surgery because of deleterious effects of chest‐wall irradiation, with porcelain aorta. We decided to implant a 23‐mm Edwards^® SAPIEN^® transcatheter aortic valve via a femoral route without using any contrast media. The implantation was successful after surgical approach of the femoral artery, transesophageal echocardiography guiding, and localization of native leaflets and coronary trunk with catheters. Immediate and one month post‐interventional follow‐up was favorable and echocardiography showed a good functioning of the aortic bioprosthesis. Although conventional angiography is the best way to visualize the good positioning of the valve before deployment, our case suggests that, in special situations, transfemoral implantation of an Edwards^® SAPIEN^® aortic bioprosthesis is feasible without any contrast injection. © 2012 Wiley Periodicals, Inc.     

Direct‐to‐consumer genetic testing for addiction susceptibility: a premature commercialisation of doubtful validity and value

Genetic research on addiction liability and pharmacogenetic research on treatments for addiction have identified some genetic variants associated with disease risk and treatment. Genetic testing for addiction liability and treatment response has not been used widely in clinical practice because most of the genes identified only modestly predict addiction risk or treatment response. However, many of these genetic tests have been commercialized prematurely and are available direct to the consumer (DTC). The easy availability of DTC tests for addiction liability and lack of regulation over their use raises a number of ethical concerns. Of paramount concern is the limited predictive power and clinical utility of these tests. Many DTC testing companies do not provide the consumer with the necessary genetic counselling to assist them in interpreting and acting on their test results. They may also engage in misleading marketing to entice consumers to purchase their products. Consumers' genetic information may be vulnerable to misuse by third parties, as there are limited standards to protect the privacy of the genetic information. Non‐consensual testing and inappropriate testing of minors may also occur. The United States Food and Drug Administration plans to regulate DTC genetic tests. Based on the ethical concerns we discuss below, we believe there is a strong case for regulation of DTC genetic tests for addiction liability and treatment response. We argue that until this occurs, these tests have more potential to cause harm than to contribute to improved prevention and treatment of addiction.     

Contrast‐induced nephropathy

Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast‐induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either ≥0.5 mg/dl or by ≥25% from baseline within the first 2–3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri‐procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non‐ionic low‐osmolar contrast media are preferred over the high‐osmolar contrast media in patients with renal impairment. © 2007 Wiley‐Liss, Inc.     

Acute and subacute stent occlusion; risk-reduction by ionic contrast media.

AIMS: Current data concerning the influence of X-ray contrast media on the incidence of thrombotic complications in interventional cardiology are controversial. The effect of ionic contrast media on acute (< or =72 h) and subacute (< or =30 days) stent thrombosis has not been investigated. METHODS: Three thousand, nine hundred and ninety consecutive patients underwent coronary stent placement. Group I (n=1808) received non-ionic contrast media while group II (n=2182) was given the ionic Ioxaglate. All patients were treated with a standard regimen of aspirin and ticlopidine for 4 weeks post intervention. RESULTS: Both acute and subacute stent occlusion occurred more frequently in patients receiving non-ionic contrast media compared to ionic contrast media (acute stent occlusion: 1.3% in group I vs 0.3% in group II, P=0.001; subacute stent occlusion: 2.4% in group I vs 0.7% in group II, P=0.001). The incidence of the combined clinical end-point of coronary artery bypass grafting, target lesion revascularization, and overall mortality within 12 months was significantly reduced by the use of Ioxaglate (22.9% vs 16.3%, P=0.001). CONCLUSIONS: Based upon these data, we recommend the use of Ioxaglate in coronary interventions when stent placement is anticipated.     

Evidence of a possible link between obesogenic food advertising and child overweight

A recent review of the literature concluded that advertising of foods on television may influence children's food choices and encourage unhealthy diets, but the review acknowledged there was a lack of clear evidence in coming to this conclusion. The present paper examines ecological evidence for a link between advertising to children and the risk of overweight using data from surveys of advertising on children's television and estimates of the prevalence of overweight among children, in the USA, Australia and eight European countries. A significant association was found between the proportion of children overweight and the numbers of advertisements per hour on children's television, especially those advertisements that encourage the consumption of energy‐dense, micronutrient‐poor foods (r = 0.81, P < 0.005). A weaker, negative association was found between the proportion of children overweight and the number of advertisements encouraging healthier diets (r = ?0.56, P < 0.10). The quantity of advertising on children's television appears to be related to the prevalence of excess body weight among children. Furthermore, the content of the advertising appears to have a specific effect. The findings justify the need for taking precautionary measures to reduce children's exposure to obesogenic marketing practices.     

TRENDS IN CIGARETTE CONSUMPTION IN AUSTRALIA

Historical trends are presented showing an increase in total cigarette consumption but a fall in the number of adult male smokers. The prevalence of smoking among children appears to have increased. The role of tobacco advertising and reduced cigarette prices are discussed. The need to prevent children from taking up smoking is emphasised, and recent data show that the earlier a child begins to smoke, the higher will be the subsequent daily cigarette consumption.