We examined the longitudinal impact of self-reported exposure to pro- and anti-tobacco media on adolescents' susceptibility to smoking, using in-school surveys from a culturally diverse sample. Ethnicity and acculturation also were examined as potential moderators. Middle-school students (N = 2,292) completed self-report questionnaires during the 6th, 7th, and 8th grades. Chi-square analyses were conducted to determine whether reported exposure to pro- and anti-tobacco media varied according to ethnicity, acculturation, and immigration status. Logistic regression models were used to examine whether pro- and anti-tobacco media exposure in 6th grade was associated with susceptibility to smoking by later grades. Recall of people smoking in television programs and pro-tobacco advertisements in stores was associated with adolescent smoking susceptibility. Exposure to anti-tobacco advertisements on television protected against susceptibility. No significant interaction effects between pro- and anti-tobacco media exposure on smoking susceptibility were found. Ethnicity and acculturation did not moderate these associations. Our longitudinal study provides evidence that pro-tobacco media and advertising increases susceptibility to smoking over time. More important, anti-tobacco advertisements are not sufficient to reduce the harmful effects of adolescent exposure to pro-tobacco media. Policy-level interventions such as restrictions in tobacco advertising may be necessary to prevent adolescent smoking.

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Adolescents from different ethnic groups show different cigarette smoking prevalence rates, suggesting potential differences in receptivity to and influences from protobacco media. Understanding these differences will be helpful in tailoring smoking prevention and cessation programs for diverse adolescent populations in the United States. Data from cross-sectional surveys of 20,332 randomly sampled California boys and girls, 12-17 years of age, were analyzed. Results indicate that receptivity to protobacco media was lower among African Americans, Asian Americans, and Hispanics than among White youth. There was a consistent dose-response relationship between receptivity to protobacco media and 30-day cigarette smoking across ethnic groups. Having a cigarette brand preference was associated with the highest risk for cigarette smoking, having a favorite tobacco ad showed the lowest risk, while having received or being willing to use tobacco promotional items was associated with a moderate risk. After controlling for 13 covariates, the odds ratio for receptivity to protobacco media and 30-day cigarette smoking was significant for Whites (RR = 1.38, p < 0.01) and Hispanics (RR = 1.46, p < 0.01), but not for African American (RR = 1.05, p > 0.05) and Asian American (RR = 1.17, p > 0.05) youth. African American, Asian American, and Hispanic adolescents have a lower level of receptivity to protobacco media than do Whites. The association between media receptivity and 30-day cigarette smoking exists for all four ethnic groups without controlling for other smoking predictor variables, but only for Hispanics and Whites when other variables are controlled. Protecting adolescents from protobacco advertising influences is an important element in tobacco control among ethnic minority youth.

This study uses the Diffusion of Innovations Theory to examine the role of mass media-generated interpersonal communication in the adoption of antitobacco norms among opinion leaders in California. Data were collected from 503 key community opinion leaders within 18 California counties in 1997 as part of the Independent Evaluation of the California Tobacco Control Program. Results provide support for the proposition that tobacco control policies and behaviors of opinion leaders can be categorized according to stages in the innovation decision process. As hypothesized, the level of mass media-generated interpersonal communication was dependent upon an individual's stage of adoption such that the frequency of ad discussion increased with advancing stages on the continuum. Regression analyses also confirmed a strong positive associative trend between ad discussion and stage of adoption. Further analysis provided evidence that the impact of campaign exposure on adoption of antitobacco norms was mediated through discussion of the ads, highlighting the importance of social diffusion processes. This study provides evidence regarding the importance of using a stage-based framework to understand the role of communication channels at distinct stages of innovation adoption and among various community opinion leaders.

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Exposure to tobacco-related marketing has been implicated as one of the risk factors for tobacco use among adolescents. However, tobacco-related marketing exposure has been measured in different ways in different studies, including perceived pervasiveness, receptivity, recognition, recall, and affect. It is not known whether these measures represent one or more underlying constructs and how these underlying constructs are associated with adolescent smoking status. This study analyzed data from 5,870 eighth-grade students in California, collected in 1996-1997 as part of the Independent Evaluation of the California Tobacco Control, Prevention, and Education Program. An exploratory factor analysis of multiple measures of tobacco-related marketing exposure revealed four distinct factors: perceived pervasiveness of protobacco marketing, perceived pervasiveness of antitobacco marketing, recognition of specific anti-tobacco advertisements, and receptivity to protobacco marketing. Receptivity to pro-tobacco marketing showed the strongest association with smoking status; higher levels of receptivity were associated with higher levels of smoking. Two measures of exposure to anti-tobacco marketing (perceived pervasiveness of anti-tobacco marketing and recognition of specific anti-tobacco ads) were highest among established smokers and lowest among susceptible nonsmokers. The same pattern was evident for perceived pervasiveness of pro-tobacco marketing. Results suggest that exposure to tobacco-related marketing is a multidimensional construct, and each dimension may have a unique contribution to the process of smoking initiation. Because adolescents are exposed to numerous pro- and anti-tobacco messages, it is important to develop anti-tobacco media campaigns that can successfully counter pro-tobacco marketing efforts. Potential strategies include targeting the susceptible nonsmokers who are at high risk for smoking and developing messages to decrease receptivity.

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Background: The aim of surgical antibiotic prophylaxis (SAP) is to prevent surgical site infection (SSI) by administering an appropriate antimicrobial agent perioperatively. However, SAP may be associated with adverse effects and incurs added costs. The primary objective of this prospective study is to establish whether clinicians are adhering to existing perioperative antibiotic prophylaxis guidelines in terms of indication, dosage and timing of SAP. Secondary objectives are to determine the proportion of patients receiving inappropriate antibiotics, and to evaluate correct practice concerning re-dosing and duration of SAP. Methods: A cross-sectional prospective audit of the anaesthetic records and prescription charts of surgical patients was conducted at Groote Schuur Hospital, a tertiary level teaching hospital in Cape Town, South Africa, over a period of one week. Data were collected by anaesthetists – blinded to the study objectives – and the investigators; then captured on Excel spreadsheets and compared to existing SAP guidelines. Descriptive statistics and binary logistic regression were used for analysis. Results: Of the 192 patients consented, 180 questionnaires were completed for data analysis. The median age of participants was 44.5 years (IQR: 31.5–58), with a preponderance of females (58.7%). SAP was administered in 149 cases (82.8%) and withheld in 31 (17.2%). This was appropriate in 91.9% (137/149) and 77.4% (24/31) respectively. Twelve patients (6.7%) received inappropriate antibiotics and in seven (3.9%) it was inappropriately withheld. Of the 156 patients who should have received SAP, choice of drug was correct in 121 (77.6%), dosage in 110 (70.5%) and timing in 87 (55.8%). Absolute compliance was achieved in 44.4% (80/180). Errors were mostly related to timing, re-dosing and duration of SAP. Conclusion: Anaesthetists and surgeons at Groote Schuur Hospital demonstrate variable adherence to surgical antibiotic prophylaxis guidelines. Interventions aimed at improving compliance are warranted.