VicHealth is funding projects which aim to reduce the harms from tobacco and help more Victorians live smokefree.
Research is essential to build knowledge and encourage innovative solutions. VicHealth’s Research Grants provide an opportunity for research teams to trial an innovative idea, research a new concept or methodology, or to develop better supporting evidence relevant to the theory, policy and practice of health promotion.
By supporting excellent research that aims to reduce the harms from tobacco, improving the overall skills of researchers, providing networking opportunities for researchers and connecting research to policy and practice, we increase the impact of health promotion and public health programs that have a focus on tobacco.
NHMRC Partnership Grant
Which types of emotions in anti-smoking ads motivate smokers to quit, especially disadvantaged smokers?
VicHealth is a proud industry partner on this successful National Health and Medical Research (NHMRC) Partnership Grant which aims to investigate the optimum levels and types of emotion evoked by anti-smoking ads about the health effects of smoking in the broad population.
The partnership project also aims to examine the impact of emotion in anti-smoking ads among those smokers experiencing disadvantage to inform whether campaign messages need to be tailored for disadvantaged groups.
This important research will inform tobacco and other health related social marketing campaigns in Victoria.
- Dr Sarah Durkin, Prof Melanie Wakefield, Megan Bayly, Cancer Council Victoria
- Dr Lois Biener, University of Massachusetts
Smoking wields the greatest burden of illness upon those least able to afford it, with consistently higher smoking prevalence among disadvantaged groups. As those with greater disadvantage have poorer quit rates, investigating ways to increase quitting among these smokers has the potential to reduce one of the major factors driving poorer health in these groups. Higher smoking prevalence among those with greater disadvantage has led to many calls for tailoring anti-smoking communications to be specifically relevant to these groups. However, whether this should lead to tailored media campaign strategies is unclear.
Both Australian and international research provides strong evidence that mass media tobacco control campaigns successfully increase smoking cessation and reduce population smoking prevalence. As consistent and sufficient broadcast of televised mass media tobacco control campaigns requires a considerable investment by governments, it is important that public health agencies better understand factors that optimize campaign effectiveness.
The two techniques most commonly used to persuade smokers to quit in Australian anti-tobacco ads have been to show either the likely physical threat or the interpersonal loss associated with health effects of smoking. The Research team’s work indicates that different emotions are generated to different degrees by these different types of ads: fear and sadness, respectively. The type of negative emotion evoked is likely to be important because different emotions have different motivational and behavioural functions. Fear tends to motivate action towards escaping from a threat, while sadness tends to motivate people to look inward for possible solutions and/or help from others.
As most of the highly emotional ads previously aired and studied have tended to generate negative emotional reactions, it has not been possible to disentangle the effect of the level of emotion from whether a negative or positive emotion was utilised. Advertising research indicates that when a positive emotion message is as arousing as a negative emotion message, positive messages are better remembered than negative ones, so it is also possible that strong positive anti-smoking messages may do better than strong negative emotion messages.
Tailoring message content to specific population subgroups, such as those with greater disadvantage, can potentially increase message relevance and persuasion. However, campaigns that focus on issues common to all subgroups (e.g., being around for your children in the future) may work equally well across the entire population. Importantly, campaign tailoring is usually more expensive than a general audience strategy because it requires far greater investment in the ad development process. Given the finite resources for public health campaigns, this may result in a lower proportion of funds spent actually airing these ads, resulting in lower rates of exposure to campaign messages.
This research will improve our understanding of the use of emotion in anti-smoking ads to maximise the potential of the investment in future public health campaigns.
The research is currently underway with completion anticipated in late 2016.
VicHealth Innovation Research Grant
New solutions for reducing the harm of tobacco smoking with highly addicted smokers: A pilot study of electronic nicotine devices for smoking cessation with drug and alcohol treatment clients
The research will aim to investigate new ways to support cessation with AOD clients, particularly whether ENDS can sustain a quit attempt and prevent relapse. The research will provide pilot data to assist the design and planning of an adequately-powered larger superiority trial.
- Professor Billie Bonevski
- Professor Dan Lubman
- Dr Coral Gartner
- Professor Ron Borland
- Professor Amanda Baker
- Dr Cathy Segan
- Dr Victoria Manning
In Australia, up to 95% of people entering Alcohol and Other Drug (AOD) treatment services smoke tobacco, which is five times greater than for the general adult population. Smokers with comorbid substance dependence are more likely to die from tobacco-related causes than from other substance-related causes.
Although smoking prevalence among AOD treatment clients is high, most smokers are interested in quitting and have attempted to quit smoking in the last 12 months.
While 85% of quit attempts using standard medication and behavioural support fail in the long term among general population smokers, this rate is even higher amongst smokers with AOD use.
New ways are needed to support people with substance abuse disorders to quit smoking to reduce the health effects and the significant financial stress and social isolation amongst this already disadvantaged group.
Electronic Nicotine Devices (ENDs) are a novel approach with significant potential to increase cessation and reduce tobacco-related harm amongst smokers who have been resistant to other quit smoking interventions. In addition to the provision of nicotine to reduce cravings and withdrawal symptoms, ENDs also address the behavioural aspect of smoking cigarettes.
ENDs allow users to continue taking nicotine without the enormous health-related harms associated with tobacco smoking. Safety and efficacy as a smoking cessation strategy has been demonstrated when compared to other forms of nicotine replacement therapy (NRT) in trials with general population smokers, but the evidence on ENDs is still emerging and there is little research among priority populations, whom may benefit most.
The project will provide essential information for the design of a larger superiority trial which will be powered to assess the safety and efficacy of ENDs compared to NRT use for sustained cessation and harm reduction outcomes in AOD clients.
This research will contribute to the evidence base to inform policy development regarding the adoption of harm reduction approaches for tobacco within the AOD treatment setting. Harm reduction is an approach commonly used within the AOD treatment setting, however it has not been tested for tobacco smoking.
The research is currently underway with completion anticipated in late 2018.
Understanding how people make inferences about harm in relation to nicotine products and implications for smoking cessation
This research project aims to increase our knowledge of smokers’ current beliefs about how conventional cigarettes differ in harmfulness and addictiveness. Practical applications may include enabling more effective communication with smokers about the risks of conventional cigarettes and the risks and relative benefits of other nicotine delivery devices.
- Professor Ron Borland, Mr Bill King and Dr Hua Yong, Cancer Council Victoria
This research will investigate how people make judgements about the relative harmfulness and addictiveness of different types of cigarettes, e-cigarettes (also referred to as personal vapourisers or PVs) and pharmaceutical nicotine replacement products (NRT). By harmfulness, we mean the degree to which users of particular nicotine products are exposed to carcinogens and other toxic substances. By addictiveness we mean the degree to which regular users of particular nicotine products become dependent upon them to have pleasurable experiences and to avoid unpleasant ones, such as intense cravings.
Although there are ongoing efforts by tobacco control authorities to inform smokers that different types of cigarette are unlikely to differ significantly in either harmfulness or addictiveness, there is evidence of widespread belief among smokers that certain types of cigarette constitute “less harmful” choices in comparison to “standard” or “regular” cigarettes. Many smokers may be reassuring themselves with the belief that, even if they are doing something harmful, they are at least choosing to smoke “less harmful” cigarettes. Others may convince themselves that the cigarettes they currently smoke are much less harmful than standard ones and, consequently, they are not significantly harming their health by continuing to smoke.
At the same time as some smokers are judging that certain types of cigarette are substantially less harmful and/or addictive than experts are advising, they may be making harmfulness and addictiveness judgments about other nicotine products that differ markedly from expert advice and adversely affect their health as a consequence. For instance, some smokers report being concerned about the safety of NRT products and are unwilling to consider using them in a quit attempt. From an expert standpoint, this concern is ill-founded, as nicotine replacement products have been thoroughly researched, are proven to be effective and safe aids to quitting smoking, and have only minor and well-characterized side-effects. Being concerned about the harmfulness of NRT might not be a problem for those who are willing and able to quit unassisted, but it could deter some smokers from making a quit attempt.
E-cigarettes (which are also called personal vapourisers) are relatively new products in the Australian market. They have become increasingly popular over the past few years, despite their current ambiguous regulatory status in Australia. The risk profile of e-cigarettes is much less well characterised than those of cigarettes or nicotine replacement therapy products but the available evidence is consistent with e-cigarettes being substantially less harmful than cigarettes and somewhat less addictive. Unless the currently available evidence is seriously misleading, e-cigarettes provide a real harm reduction option for current smokers who wish to continue using nicotine as a recreational drug. E-cigarettes may also provide a useful quitting tool for some smokers. Whether individual smokers are willing to consider e-cigarettes for harm reduction or as tools for eventually quitting, all nicotine use will depend in part on how harmful and addictive they perceive these products to be in comparison to cigarettes.
Using in-depth interviews, focus group interviews and an internet-based survey, the research will develop a clearer picture of current risk perceptions of nicotine products both across the three main categories of products and within each of those three categories. The research will also investigate background beliefs, attitudes and values and styles of thinking which shape those risk perceptions. The findings will be applied to crafting more effective public education messages about smoking and nicotine products, as well as to developing recommendations for future regulation of cigarettes, e-cigarettes and NRT.
The research is currently underway with completion anticipated in June 2016.
Scoping the opportunities to expand access to and use of nicotine replacement therapy to improve smoking cessation
- Project led by Alfred Health
The health, social and economic costs of smoking are profound. It is estimated that smoking kills approximately 15,000 Australians and costs Australia $31.5 billion in social (including health) and economic costs annually.
Reducing the costs from smoking requires a comprehensive approach that prevents people from taking up smoking, protects people from second-hand smoke, and importantly supports people to quit smoking by providing them with environment and tools that are most likely to lead to a successful quit attempt.
Tobacco dependence is a chronic and relapsing condition that makes quitting smoking very difficult. Some people take multiple attempts over a number of years to quit smoking.
Given the level of harm from tobacco and the difficulty associated with quitting smoking, it is important that we make available evidence based cessation approaches to give people the best chance of quitting. One approach with a significant evidence base is the use of nicotine replacement therapy (NRT), particularly in conjunction with counselling.
This scoping project will explore the latest evidence based approaches for using NRT in different doses and durations to support successful smoking cessation, compare the evidence to existing practice in Australia, and recommend opportunities to overcome policy and practice barriers that may prevent these evidence based approaches from being used in Australia.
The outcomes from the scoping project will inform VicHealth’s future work in the area of improving smoking cessation and reducing the harm from tobacco.<h4"> </h4">