Awareness of the Food and Drug Administration's Bad Ad Program and Education Regarding Pharmaceutical Advertising: A National Survey of Prescribers in Ambulatory Care Settings

The U.S. Food and Drug Administration's Bad Ad program educates health care professionals about false or misleading advertising and marketing and provides a pathway to report suspect materials. To assess familiarity with this program and the extent of training about pharmaceutical marketing, a sample of 2,008 health care professionals, weighted to be nationally representative, responded to an online survey. Approximately equal numbers of primary care physicians, specialists, physician assistants, and nurse practitioners answered questions concerning Bad Ad program awareness and its usefulness, as well as their likelihood of reporting false or misleading advertising, confidence in identifying such advertising, and training about pharmaceutical marketing. Results showed that fewer than a quarter reported any awareness of the Bad Ad program. Nonetheless, a substantial percentage (43%) thought it seemed useful and 50% reported being at least somewhat likely to report false or misleading advertising in the future. Nurse practitioners and physician assistants expressed more openness to the program and reported receiving more training about pharmaceutical marketing. Bad Ad program awareness is low, but opportunity exists to solicit assistance from health care professionals and to help health care professionals recognize false and misleading advertising. Nurse practitioners and physician assistants are perhaps the most likely contributors to the program.     

Communication experts' opinion on alcohol advertising through the electronic media in New Zealand

The debate over the influence of alcohol advertising on people'sdrinking behaviour and attitudes is one which many countrieshave experienced as they decide how and to what degree alcoholadvertising should be regulated Recently in New Zealand, policymakers examined the issue of whether alcohol advertising shouldbe allowed on the electronic media. In an effort to contributeto the debate, a qualitative study of communications' expertsopinions on alcohol advertising on television and radio wasconducted in 1991. This paper presents the results from thatstudy and compares the responses from the two main groupingsof informants. It also discusses the outcome of the policy debateand examines the limited influence the study had on the policymaking process. The respondents expressed concern about the macho imagery inalcohol advertising and its appeal to the young. The study alsosuggested that the strong association in alcohol advertisingbetween alcohol and sport was a concern of most informants andthat there was majority support for the argument that the messagesof alcohol companies needed to be balanced by health education.The absence of content relevant to public health concerns inalcohol advertising was acknowledged by informants to make theeducative task more difficult.     

When two sides go to war: newspaper reporting of ‘television food advertising restrictions’ as a solution to childhood obesity

Childhood overweight and obesity is a major public health problem in Australia and overseas. Food advertising during children's television programmes has been identified as one contributing factor to childhood obesity. The media plays an important role in informing the public and presenting arguments supporting and opposing solutions to childhood obesity. The aim of this study was to analyse newspaper coverage of the debate over restricting television food advertising as a solution to preventing childhood obesity. A newspaper search was conducted over the period July 2002 to July 2005. One hundred and sixty-six articles were analysed for article characteristics, speakers quoted, causes and solutions of childhood obesity and arguments presented. The majority of the articles (82, 49%) took a positive slant towards restricting television food advertising to children while 35 (21%) had a negative slant. The main causes of childhood obesity presented were: television advertising of unhealthy foods, lack of physical activity, increased screen time and time stretched parents. The main areas presented as solutions of childhood obesity were: policy changes to food advertising, supportive environments for physical activity, supportive environments for healthy eating and healthy eating policies. Strong arguments and strong language dominated the debate which remained polarised between health professionals and Federal government and industry. In spite of opposition towards restrictions on television food advertising to children, the media's stories played an important part in keeping the issue on the public and political agenda.     

Anthropology in Agricultural Health and Safety Research and Intervention

ABSTRACT

Agriculture remains a dangerous industry, even as agricultural science and technology continue to advance. Research that goes beyond technological changes to address safety culture and policy are needed to improve health and safety in agriculture. In this commentary, I consider the potential for anthropology to contribute to agricultural health and safety research by addressing three aims: (1) I briefly consider what the articles in this issue of the Journal of Agromedicine say about anthropologists in agricultural health and safety; (2) I discuss what anthropologists can add to agricultural health and safety research; and (3) I examine ways in which anthropologists can participate in agricultural health and safety research. In using their traditions of rigorous field research to understand how those working in agriculture perceive and interpret factors affecting occupational health and safety (their “emic” perspective), and translating this perspective to improve the understanding of occupational health professionals and policy makers (an “etic” perspective), anthropologists can expose myths that limit improvements in agricultural health and safety. Addressing significant questions, working with the most vulnerable agricultural communities, and being outside establishment agriculture provide anthropologists with the opportunity to improve health and safety policy and regulation in agriculture.     

Advocates, interest groups and Australian news coverage of alcohol advertising restrictions: content and framing analysis

ABSTRACT: BACKGROUND: Legislating restrictions on alcohol advertising is a cost-effective measure to reduce consumption of alcohol. Yet Australia relies upon industry self-regulation through voluntary codes of practice regarding the content, timing and placement of alcohol advertising. Ending industry self-regulation was recommended by the National Preventative Health Taskforce; a suggestion contested by the drinks industry. Debates about emerging alcohol-control policies regularly play out in the news media, with various groups seeking to influence the discussion. This paper examines news coverage of recommendations to restrict alcohol advertising to see how supporters and opponents frame the debate, with a view to providing some suggestions for policy advocates to advance the discussion. METHODS: We used content and framing analyses to examine 329 Australian newspaper items mentioning alcohol advertising restrictions over 24 months. All items were coded for mentions of specific types of advertising and types of advertising restrictions, the presence of news frames that opposed or endorsed advertising restrictions, statements made within each frame and the news-actors who appeared. RESULTS: Restrictions were the main focus in only 36% of 329 items. Alcohol advertising was conceived of as television (47%) and sport-related (56%). Restrictions were mentioned in non-specific terms (45%), or specified as restrictions on timing and placement (49%), or content (22%). Public health professionals (47%) appeared more frequently than drinks industry representatives (18%). Five supportive news frames suggested the policy is a sensible public health response, essential to protect children, needed to combat the drinks industry, required to stop pervasive branding, or as only an issue in sport. Four unsupportive frames positioned restrictions as unnecessary for a responsible industry, an attack on legitimate commercial activities, ineffective and 'nannyist', or inessential to government policy. Support varied among news-actors, with public health professionals (94%) more supportive than the public (68%), community-based organisations (76%), the government (72%), and the sports (16%), drinks (3%), or advertising (4%) industries. CONCLUSION: Restrictions on alcohol advertising currently have low newsworthiness as a standalone issue. Future advocacy might better define the exact nature of required restrictions, anticipate vocal opposition and address forms of advertising beyond televised sport if exposure to advertising, especially among children, is to be reduced.     

Primary Health Care: A Darling Downs Focus

ABSTRACT: Primary health care is a policy model Which integrates social principles into the functioning of the health system at the local level. There is increasing interest in primary health care policy development and in the implementation of primary health care due in part to: the challenge which primary health care raises to existing practice in health service planning and delivery; the changes in roles of health service professionals and consumers which primary health care demands, and the claims on resources which the implementation of primary health care may engender.
The conceptual basis of primary health care demands that decision-making be devolved to the local level. The organisational structure of the public health care system in Queensland, since regionalisation in July 1991, provides an environment which favours this localised decision-making. The Darling Downs Regional Health Authority, one of 13 regional health authorities in Queensland, released a 'Primary Health Care Discussion Paper' as an element in its strategy for primary health care implementation at the regional level. This paper was intended to demystify the concept, raise the level of debate and stimulate discussion about how primary health care might affect health professionals and the community.
This article analyses that discussion paper to illuminate the concept of primary health care emerging in the region and in Queensland Health. It also identifies potential barriers to the implementation of primary health care and outlines activities being undertaken in the region which illustrate ways in which primary health care can be manifested in local communities.     

Framing a public health debate over alcohol advertising: the Center on Alcohol Marketing and Youth 2002-2008

The experiences of the Center on Alcohol Marketing and Youth from 2002 to 2008 in re-framing a major public health issue and influencing public policy offer lessons for other public health movements. The Center pioneered new ways to use commercial market research data in public health surveillance and public debate. Combining a steady stream of reports and peer-reviewed articles with state and federal organizing and media advocacy, the Center re-framed a policy debate over alcohol marketing and youth, enabling measurable progress.     

Marketing as a tool to increase the effectiveness of public health plans. 2008 SESPAS Report

Recent years have seen a steady increase in social marketing applied to health with the aim of increasing public awareness and changing people's behavior. Programs or actions based on the principles of social marketing have been shown to be effective in improving public health. However, that is not the general rule in Spain, where health policies have been based on health plans directed more to economic efficiency than to citizens' needs. For a health marketing program to be effective, the following factors are necessary: 1) the program has a long-term temporal horizon for action; 2) the objectives are established in terms of behavioral changes; 3) market research is used as a source of information; 4) different actions are established according to the segments identified as targets; 5) the program is operationalized in the four variables of the marketing mix, namely, product, price, distribution and communication, and is not only based on advertising campaigns; 6) the core of the program is exchange, understood as the factors that motivate people to change in return for the promise of something beneficial to them; 7) the factors or forces that compete with the desired behavioral changes are neutralized, and 8) businesses' social responsibility is used as a mechanism to reinforce health improvement programs. The design of health marketing programs should include definition of strategic and operational actions aimed not only at potential adopters of the desired behavior but also at all agents who may help or hinder behavioral change (health professionals, the pharmaceutical industry, politicians, the advertising industry, and products and services with health-challenging objectives).     

It’s Time to Shine the Light on Direct-to-Consumer Advertising

Pharmaceutical marketing is undergoing a transition as the business, delivery, and consumption of health care have increasingly become part of a growing digital landscape. Changes in pharmaceutical promotion also coincide with federal “sunshine” regulations newly implemented under the Affordable Care Act that require disclosure of certain marketing and industry payments to physicians. Collectively, these trends could lead to fundamental shifts in physician-directed and direct-to-consumer advertising (DTCA) that have yet to be adequately identified or explored. In response, we advocate for greater DTCA transparency, especially in the emerging digital forms of DTCA, to complement forthcoming sunshine transparency data. This will allow more robust study and understanding of changes in overall pharmaceutical marketing trends and their impact on health care consumption and behavior. This can also lead to more targeted state and federal policy interventions leveraging existing federal transparency regulations to ensure appropriate marketing, sales, and consumption of pharmaceutical products.     

Local health policy development processes in the Netherlands: an expanded toolbox for health promotion

Although much research has been done on the existence and formation of risk and issue based health policies, there is only little insight in health policy development processes in a broader context. This hampers intervention in these policy processes to adequately develop integrated and effective health policies. Legislation in the Netherlands requires municipalities to develop and implement local health policies. These policies are supposed to aim at the promotion of health across sectors and with a strong community involvement. Health policy development processes have been studied in four Dutch municipalities. For each case, we identified a range of stakeholders and monitored the change or stability of their characteristics over 3 years. In addition, for each case, three overlaying maps of networks were made addressing communication and collaboration actions within the defined set of stakeholders. We point out a number of barriers which impede integrated policy development at the local level: the importance given to local health policy, the medical approach to health development, the organizational self-interest rather than public health concern, the absence of policy entrepreneurial activity. Furthermore, this article advocates the use of complementary theoretical frameworks and the expansion of the methodological toolbox for health promotion. The value of stakeholder and network analysis in the health promotion domain, at this stage, is two-fold. First, mapping relevant actors, their positions and connections in networks provides us with insight into their capacity to participate and contribute to health policy development. Second, these new tools contribute to a further understanding of policy entrepreneurial roles to be taken up by health promotion professionals and health authorities in favour of the socio-environmental approach to health. Notwithstanding the value of this first step, more research is required into both the practical application as well as in the theoretical connections with, for example, Multiple Streams theory.     

Health, morality, and infant feeding: British mothers' experiences of formula milk use in the early weeks

The way mothers feed their babies is, internationally, the subject of research, health policy initiatives, and popular discussion, which commonly affirm the mantra 'breast is best'. On one level, this mantra reflects scientific evidence about nutrition and maternal and infant health. From a socio-cultural perspective, the pro-breastfeeding message has, however, been considered an aspect of morality, which influences maternal identity in important ways. This article explores this idea. It does so primarily by reporting and discussing some findings from a study about British mothers' experiences of using formula milk for infant feeding. The paper begins by contextualising this discussion by briefly outlining some aspects of the construction of infant feeding as a social problem in Britain, focusing in particular on the influence of 'the new paradigm of health'.     

Drug advertising to the general public: conceptual parameters of a risk producer practice

This article analyzes some concepts relating to marketing, advertising, medications, regulation and manipulation. It discusses ethical and health surveillance parameters of drugs advertising for the general public. The focus of this work is the analysis of contradictions from a conceptual point of view between the practice of pharmaceutical advertising as a tool for the increase of sales and the conquest of markets versus the policy of rational use of medicines. Academic studies and monitoring of drugs advertising conducted by the National Health Surveillance Agency show that the contents of the advertising pieces oriented towards the general public overestimate the - sometimes dubious - qualities of their medication, focusing almost exclusively on the benefits and put them in a central position in the therapeutic process. They also fail to mention the risks inherent in their use. Rather than focusing on regulatory proposals aimed at creating constraints to this practice, this article discusses the impossibility, considering the interests of public health, of the coexistence of marketing with the policies for the correct, rational and safe use of drugs.     

'Confidentiality smokescreens' and carers for people with mental health problems: the perspectives of professionals

This paper reports on some of the findings from a collaborative study funded by the Big Lottery and led by Crossroads Caring for Carers about carers for people with mental health problems. The protection and use of information in mental health are firmly rooted in ethics and professional codes, law and policy, as well as values and professional practice. While government initiatives have attempted to augment the role and rights of carers, policy guidance involving information sharing between professionals and carers has failed to deal with the practical dilemmas of patient confidentiality. Professional codes and training neither explore nor develop the moral and ethical ground that stands between the service user's need for privacy and the carer's need for information. Policy and training guidance on confidentiality is scattered, ambiguous, confusing for professionals and inconsistent. There is uncertainty in practice about the information that professionals may share, and many professionals do not take into account carers' rights, not least to basic information to help them care for service users. 'Confidentiality smokescreens' may sometimes lead to information being withheld from carers. Professionals sometimes find it easier and safer to say nothing. In order to explore these issues from the perspectives of professionals, 65 participants were interviewed. The sample included directors and senior staff from the health, social care and voluntary sectors. Respondents were asked to comment at length on their understanding of confidentiality and information sharing with carers. Findings highlight confidentiality smokescreens that erect barriers that limit effective information sharing; issues involving confidentiality, risk management and carers in crisis; examples of good practice; and the need for the training of professionals on confidentiality issues and the rights of carers. This paper explores the challenge of confidentiality smokescreens from the perspective of professionals, and draws out implications for professional practice and training.     

Using a research framework to identify knowledge gaps in research on food marketing to children in Australia

Objective: Research in the field of food marketing to children requires a better understanding of the research gaps in order to inform policy development. The purpose of this paper was to propose a framework for classifying food marketing research, using Australian research on food marketing to children to demonstrate how this framework can be used to determine knowledge gaps.
Approach: A literature review of research databases and 'grey' material was conducted to identify research from the previous 10 years. Studies were classified according to their research focus, and media type, as either: exposure, including content analyses; effects of exposure, including opinions, attitudes and actions resulting from food marketing exposure; regulations, including the type and level of regulation that applies to food marketing; or breaches of regulations, including instances where marketing regulations have been violated.
Conclusion: The majority of Australian research on food marketing to children has focused on television advertising and exposure research. Research has consistently shown that the content of food marketing directed at children is predominately for unhealthy foods. There is a lack of research on the effects of food marketing, which would be valuable to inform policy.
Implications: The development of a logical framework for food marketing research allows for the identification of research gaps and enables research priorities to be identified.     

Health claims and functional foods

Australia and New Zealand are currently preparing a new food standard, which will allow the use of health claims for functional foods. The aims of this study were to summarise current regulatory proposals and to review recent research from the National Centre of Excellence in Functional Foods on the use and understanding of health claims. All relevant publications from the National Centre of Excellence in Functional Foods, cited in the annual reports from 2003 to 2007, were reviewed and summarised. Five publications have reported surveys of the use of health claims on food labels, in magazine advertising and on the Internet. High-level claims that do not comply with current food regulations are being used, particularly in advertising. Both dietitians and marketing experts agree that many of the claims currently used are potentially misleading. Focus group studies have shown that consumers are interested in health claims but are sceptical about their reliability from manufacturers without strong regulation. Experimental studies show that the format of claims, and the food on which they are carried, influence consumer acceptance. Many factors other than the actual words used in health claims influence consumer purchase decisions. However, current research indicates that claims can improve understanding of the benefits of functional foods and potentially support healthier food choices.     

Youth identity formation and contemporary alcohol marketing

This paper considers linkages between contemporary marketing theory and practice, and emerging conceptualizations of identity, to discuss implications for public health concerns over alcohol use among young people. Particular attention is paid to the theorizing of consumption as a component of youth identities and the ways in which developments of marketing praxis orients to such schemata. The authors’ analyses of exemplars of marketing materials in use in Aotearoa New Zealand, drawn from their research archive, emphasize the sophistication and power of such forms of marketing. They argue that public health policy and practice must respond to the interweaving of marketing and the self-making practices of young people to counter this complex threat to the health and well-being of young people.     

Emerging social media ‘platform’ approaches to alcohol marketing: a comparative analysis of the activity of the top 20 Australian alcohol brands on Facebook (2012-2014)

Social media platforms are important actors in the development of alcohol marketing techniques. While public health research has documented the activities of brands and consumers related to alcohol promotion and consumption on social media, there remains the need to develop an account of the native, participatory and data-driven advertising model of these platforms. This article examines the relationship between alcohol brands, media platforms and their users by analysing the activity of the 20 most popular alcohol brands’ Australian Facebook pages in 2012 and 2014. We report that the number of fans of alcohol brands increased by 52% from 2012 to 2014. While the number of posts dropped 12% from 2012 and 2014, total interactions with posts by users increased by 9%. Overall, brand activity and engagement became more consistent between 2012 and 2014. We argue that the changing character of user engagement with alcohol brands on Facebook can be related to changes in the platform architecture. Facebook is orchestrating a shift from exposure to engagement as its key advertising metric, and thus departing substantially from established mass media advertising paradigms. Effective policy responses to alcohol marketing in the digital era depend on a more rigorous examination of the marketing infrastructure of social media platforms.     

Self-regulation and the response to concerns about food and beverage marketing to children in the United States

The Institute of Medicine reported in 2005 that food and beverage marketing to children and youth is "out of balance with healthful diets". The dominant policy response in the United States has been to encourage self-regulation by the food, beverage, advertising, and media industries. From a nutrition perspective, this deference to the private sector may seem surprising. This article reviews current economic and legal perspectives on food marketing to children that are motivating the policy decision to attempt a period of self-regulation. The empirical literature on this topic has been reinvigorated by new data on marketing practices and expenditures. The article concludes by considering whether more directive policies are possible in the future.