When novel, GHWL on cigarette packs increase cognitive processing among adolescents. However, this effect diminishes after 5 years, suggesting more regular message refreshment is needed. Australia's adoption of plain packaging is intended to undermine positive pack appeal and increase warning salience.

Aims: While recent evidence suggests that higher alcohol outlet density is associated with greater alcohol use among adolescents, influence of the four main outlet types on youth drinking within urban and regional communities is unknown. This study provides the first investigation of this relationship. Design:Repeated cross-sectional surveys with random samples of secondary students clustered by school. Mixed effects logistic regression analyses examined the association between each outlet type and the drinking outcomes, with interaction terms used to test urban/regional differences. Measurements:The key outcome measures were past month alcohol use, risky drinking amongst all students and risky drinking amongst past week drinkers. For each survey year, students were assigned a postcode-level outlet density (number of licenses per 1,000 population) for each outlet type (general, on-premise, off-premise, clubs). Findings:Interaction terms revealed a significant association between off-premises outlet density and risky drinking among all adolescents in urban [OR=1.36, 95% confidence interval (CI) = 1.05-1.75, p<.05) but not regional areas. Similarly, club density was associated with the drinking outcomes in urban communities only. General and on-premises density was associated with alcohol use and risky drinking among all adolescents.

ObjectiveTo examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on Australian adolescents’ cognitive processing of warnings and awareness of different health consequences of smoking.MethodsCross-sectional school-based surveys conducted in 2011 (prior to introduction of standardised packaging, n=6338) and 2013 (7–12 months afterwards, n=5915). Students indicated frequency of attending to, reading, thinking or talking about warnings. Students viewed a list of diseases or health effects and were asked to indicate whether each was caused by smoking. Two—‘kidney and bladder cancer’ and ‘damages gums and teeth’—were new while the remainder had been promoted through previous health warnings and/or television campaigns. The 60% of students seeing a cigarette pack in previous 6 months in 2011 and 65% in 2013 form the sample for analysis. Changes in responses over time are examined.ResultsAwareness that smoking causes bladder cancer increased between 2011 and 2013 (p=0.002). There was high agreement with statements reflecting health effects featured in previous warnings or advertisements with little change over time. Exceptions to this were increases in the proportion agreeing that smoking was a leading cause of death (p<0.001) and causes blindness (p<0.001). The frequency of students reading, attending to, thinking or talking about the health warnings on cigarette packs did not change.ConclusionsAcknowledgement of negative health effects of smoking among Australian adolescents remains high. Apart from increased awareness of bladder cancer, new requirements for packaging and health warnings did not increase adolescents’ cognitive processing of warning information.

While Australian adolescents' exposure to alcohol advertising on television reduced between 1999 and 2011, higher levels of past-month television alcohol advertising were associated with an increased likelihood of adolescents' drinking. The reduction in television alcohol advertising in Australia in the late 2000s may have played a part in reducing adolescents' drinking prevalence.

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