Managing " wicked " issues like the tobacco epidemic is addressed using a combination of Open Sys... more Managing " wicked " issues like the tobacco epidemic is addressed using a combination of Open Systems Thinking (OST) and Actor–Network Theory (ANT). OST was used to construct a model of the tobacco problem as a management system acting in a broader environment. This highlighted several problems with the current system but provided no mechanism for reform. ANT, the " sociology of translation, " was used for understanding how change occurs. Unlike systems thinking, ANT focuses the contest for change on heterogeneous networks of human and nonhuman actors that must be constructed through a process of defining and defending models of change, building alliances, gaining public acceptance, and finally achieving institutional acceptance of the reform (or of some compromise). We then show how this dual approach can shed light on a current challenge in controlling tobacco, the issue of product regulation, and the broader issue of harm reduction versus harm elimination.
To determine whether greater mass media campaign exposure may assist recent quitters to avoid rel... more To determine whether greater mass media campaign exposure may assist recent quitters to avoid relapse. Using date of data collection and postcode, media market estimates of televised tobacco-control advertising exposure measured by gross ratings points (GRPs) were merged with a replenished cohort study of 443 Australians who had quit in the past year. Participants' demographic and smoking characteristics prior to quitting, and advertising exposure in the period after quitting, were used to predict relapse 1 year later. In multivariate analysis, each increase in exposure of 100 GRPs (i.e., 1 anti-smoking advertisement) in the three-month period after the baseline quit was associated with a 5% increase in the odds of not smoking at follow-up (OR = 1.05, 95% CI 1.02-1.07, p < 0.001). This relationship was linear and unmodified by length of time quit prior to the baseline interview. At the mean value of 1081 GRPs in the 3 months after the baseline-quit interview, the predicted probability of being quit at follow-up was 52%, whereas it was 41% for the minimum (0) and 74% for the maximum (3,541) GRPs. Greater exposure to tobacco-control mass media campaigns may reduce the likelihood of relapse among recent quitters.
To describe patterns of alcohol use in a nationally-representative sample of New Zealand smokers.... more To describe patterns of alcohol use in a nationally-representative sample of New Zealand smokers. The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from a national survey: the NZ Health Survey (NZHS). From this sample we surveyed adult smokers (n=1376). A third (33.1%) of these smokers had a drinking pattern that was considered hazardous (i.e., AUDIT scores greater than and equal to 8). These figures were much higher than for non-smokers in the NZHS (at 13.1%). In both the univariate and multivariate analyses, hazardous drinking patterns were significantly more common among: younger smokers, male smokers, and Māori smokers (e.g., adjusted odds ratio for the latter: 1.43, 95%CI: 1.05-1.95). The same pattern of more hazardous drinking was also seen (but in the univariate analysis only), for smokers with financial stress and for moderate individual-level deprivation. These findings provide additional evidence that hazardous drinking patterns are elevated in New Zealand smokers overall and particularly in some groups of smokers. Given the international evidence that hazardous drinking may impede quitting, policy makers could consider the potential benefits of improved alcohol control as part of the national strategy to curtail the tobacco epidemic and achieve the government's "Smokefree Nation 2025" goal. Such an approach could also reduce this country's high levels of alcohol-related harm and reduce gender and ethnic health inequalities.
Exposure to secondhand smoke (SHS) from burning tobacco products causes disease and premature dea... more Exposure to secondhand smoke (SHS) from burning tobacco products causes disease and premature death among non-smoking adults and children. The objective of this study was to determine the nature, extent and demographic correlates of SHS exposure among adults in low- and middle-income countries with a high burden of tobacco use. Data were obtained from the Global Adult Tobacco Survey (GATS), a nationally representative household survey of individuals 15 years of age or older. Interviews were conducted during 2008-2010 in Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam. Descriptive statistics were used to determine the prevalence and correlates of SHS exposure in homes, workplaces, government buildings, restaurants, public transportation and healthcare facilities. Exposure to SHS in the home ranged from 17.3% (Mexico) to 73.1% (Vietnam). Among those who work in an indoor area outside the home, SHS exposure in the workplace ranged from 16.5% (Uruguay) to 63.3% (China). Exposure to SHS ranged from 6.9% (Uruguay) to 72.7% (Egypt) in government buildings, 4.4% (Uruguay) to 88.5% (China) in restaurants, 5.4% (Uruguay) to 79.6% (Egypt) on public transportation, and 3.8% (Uruguay) to 49.2% (Egypt) in healthcare facilities. A large proportion of adults living in low- and middle-income countries are exposed to SHS in their homes, workplaces, and other public places. Countries can enact and enforce legislation requiring 100% smoke-free public places and workplaces, and can also conduct educational initiatives to reduce SHS exposure in homes.
This study examined and compared results from two questionnaire pretesting methods (i.e., behavio... more This study examined and compared results from two questionnaire pretesting methods (i.e., behavioral coding and cognitive interviewing [CI]) to assess systematic measurement bias in survey questions for adult smokers across six countries (United States, Australia, Uruguay, Mexico, Malaysia, and Thailand). Protocol development and translation involved multiple bilingual partners in each linguistic/cultural group. The study was conducted with convenience samples of 20 adult smokers in each country. Behavioral coding and CI methods produced similar conclusions regarding measurement bias for some questions; however, CI was more likely to identify potential response errors than behavioral coding. Coordinated qualitative pretesting of survey questions (or postsurvey evaluation) is feasible across cultural groups and can provide important information on comprehension and comparability. The CI appears to be a more robust technique than behavioral coding, although combinations of the two might be even better.
To assess the extent to which intensity and timing of televised anti-smoking advertising emphasiz... more To assess the extent to which intensity and timing of televised anti-smoking advertising emphasizing the serious harms of smoking influences quit attempts. Using advertising gross rating points (GRPs), we estimated exposure to tobacco control and nicotine replacement therapy (NRT) advertising in the 3, 4-6, 7-9 and 10-12 months prior to follow-up of a replenished cohort of 3037 Australian smokers during 2002-08. Using generalized estimating equations, we related the intensity and timing of advertising exposure from each source to the likelihood of making a quit attempt in the 3 months prior to follow-up. Tobacco control advertising in the 3-month period prior to follow-up, but not in more distant past periods, was related to a higher likelihood of making a quit attempt. Each 1000 GRP increase per quarter was associated with an 11% increase in making a quit attempt [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.03-1.19, P = 0.009)]. NRT advertising was unrelated to quit attempts. Tobacco control advertising emphasizing the serious harms of smoking is associated with short-term increases in the likelihood of smokers making a quit attempt. Repeated cycles of higher intensity tobacco control media campaigns are needed to sustain high levels of quit attempts.
This study examined support for and reported compliance with smoke-free policy in air-conditioned... more This study examined support for and reported compliance with smoke-free policy in air-conditioned restaurants and other similar places among adult smokers in Malaysia and Thailand. Baseline data (early 2005) from the International Tobacco Control Southeast Asia Survey (ITC-SEA), conducted face-to-face in Malaysia and Thailand (n = 4005), were used. Among those attending venues, reported total smoking bans in indoor air-conditioned places such as restaurants, coffee shops, and karaoke lounges were 40% and 57% in Malaysia and Thailand, respectively. Support for a total ban in air-conditioned venues was high and similar for both countries (82% Malaysian and 90% Thai smokers who believed there was a total ban), but self-reported compliance with bans in such venues was significantly higher in Thailand than in Malaysia (95% vs 51%, P < .001). As expected, reporting a ban in air-conditioned venues was associated with a greater support for a ban in such venues in both countries.
C. A. Perz, C. C. DiClemente, and J. P. Carbonari (1996) claim support for the transtheoretical m... more C. A. Perz, C. C. DiClemente, and J. P. Carbonari (1996) claim support for the transtheoretical model notion that success in smoking cessation involves doing the right thing at the right time: emphasising experiential change processes during the contemplation and preparation stages and shifting to behavioral process activities during action. A key methodological limitation of Perz et al. was their failure to control for stage of change, a measure that has been shown to be predictive of cessation. This study replicates the prospective findings of Perz et al. in a different data set, then controls for stage of change when it is predictive of cessation, and finds that the measures of "appropriate" change process use developed by Perz et al. no longer predict cessation. The authors conclude that stage of change, in particular the distinction between smoking and not smoking, is more important than change process use in predicting cessation outcomes.
Introduction:This paper is concerned with the effects of cigarette pack warning labels on quittin... more Introduction:This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were “noticing warning labels during last month,” “reading or looking closely at warning labels,” “avoiding looking at labels during last month,” “thinking about health risks of smoking because of the warning labels, “more likely to quit because of the warning labels,” and “stopping from having a cigarette when about to smoke one because of the labels.”Methods:A total of 2,006 adult smokers in Malaysia were surveyed in face-to-face interviews using a standardized questionnaire. Of those, 1,919 male smokers were included in the analyses.Results:The responses “more likely to quit because of the warning labels” and “stopped from having a cigarette when about to smoke one” significantly predicted all stages of change and self-efficacy, independent of the other measures. In addition, thinking about the health risks and reading the warnings more often added extra predictive capacity but only in the early stages of contemplating change.Discussion:Less intense processing of the information may be important in initiating thoughts, but cognitions about quitting and foregoing cigarettes are the key mechanisms by which warnings stimulate quitting intentions and help smokers feel capable of succeeding. Malaysian smokers appear to respond to warnings in ways comparable with those from developed countries.
... Arizona. This project was supported by a grant from the National Cancer Institute (CA62968; D... more ... Arizona. This project was supported by a grant from the National Cancer Institute (CA62968; David Buller, PI) and by a National Health and Medical Research Council of Australia Traveling Fellowship to Ron Borland. Correspondence ...
... Many Australian income studies have used Henderson equivalence scales developed by the Commis... more ... Many Australian income studies have used Henderson equivalence scales developed by the Commission of ... Thus anti-smoking campaigns and policies can effect improvements in material conditions ... This research was supported by a grant from the Victorian Health Promotion ...
The ABCD(E) rule and the seven-point checklist are diagnostic aids that have proven to be useful ... more The ABCD(E) rule and the seven-point checklist are diagnostic aids that have proven to be useful in the hands of physicians; however, little is known of their value to patients with respect to aiding self-detection. The objective of this study was to investigate features that patients notice when identifying melanomas and to explore how well these features correspond to the ABCD(E) rule and the seven-point checklist. A retrospective, modified, case-control study involving patient interviews was performed. All interviews were conducted through the private consulting rooms of a Melbourne dermatologist (JWK) and a Newcastle plastic surgeon (CH) prior to the result of pathology being known to the patients and the interviewers. Sixty-seven patients with benign pigmented skin lesions and 46 patients with melanomas were included. Using a logistic regression model, the change in size/new lesion and change in colour (major criteria, seven-point checklist) were most useful in differentiating between melanomas and benign pigmented lesions in the hands of patients [odds ratio (OR), 4.74; 95% confidence interval (CI), 1.85-12.19; P=0.001; OR, 4.27; 95% CI, 1.62-11.26; P=0.003, respectively). The ABCD(E) rule failed to discriminate between melanoma and other benign pigmented skin lesions. It can be concluded that, of the patients' observations, changes in size or colour were most important in distinguishing between benign pigmented lesions and melanomas. Such features therefore deserve emphasis in public education campaigns. Medical professionals should also remember to seek a history of change in assessing pigmented skin lesions.
Methods. Telephone survey respondents provided detailed accounts of activities engaged in, time s... more Methods. Telephone survey respondents provided detailed accounts of activities engaged in, time spent outside, and hat, clothing, and sunscreen coverage in the 4 hr around the solar midday on both weekend days, as well as skin type, sociodemographic descriptors, and ...
Managing " wicked " issues like the tobacco epidemic is addressed using a combination of Open Sys... more Managing " wicked " issues like the tobacco epidemic is addressed using a combination of Open Systems Thinking (OST) and Actor–Network Theory (ANT). OST was used to construct a model of the tobacco problem as a management system acting in a broader environment. This highlighted several problems with the current system but provided no mechanism for reform. ANT, the " sociology of translation, " was used for understanding how change occurs. Unlike systems thinking, ANT focuses the contest for change on heterogeneous networks of human and nonhuman actors that must be constructed through a process of defining and defending models of change, building alliances, gaining public acceptance, and finally achieving institutional acceptance of the reform (or of some compromise). We then show how this dual approach can shed light on a current challenge in controlling tobacco, the issue of product regulation, and the broader issue of harm reduction versus harm elimination.
To determine whether greater mass media campaign exposure may assist recent quitters to avoid rel... more To determine whether greater mass media campaign exposure may assist recent quitters to avoid relapse. Using date of data collection and postcode, media market estimates of televised tobacco-control advertising exposure measured by gross ratings points (GRPs) were merged with a replenished cohort study of 443 Australians who had quit in the past year. Participants' demographic and smoking characteristics prior to quitting, and advertising exposure in the period after quitting, were used to predict relapse 1 year later. In multivariate analysis, each increase in exposure of 100 GRPs (i.e., 1 anti-smoking advertisement) in the three-month period after the baseline quit was associated with a 5% increase in the odds of not smoking at follow-up (OR = 1.05, 95% CI 1.02-1.07, p < 0.001). This relationship was linear and unmodified by length of time quit prior to the baseline interview. At the mean value of 1081 GRPs in the 3 months after the baseline-quit interview, the predicted probability of being quit at follow-up was 52%, whereas it was 41% for the minimum (0) and 74% for the maximum (3,541) GRPs. Greater exposure to tobacco-control mass media campaigns may reduce the likelihood of relapse among recent quitters.
To describe patterns of alcohol use in a nationally-representative sample of New Zealand smokers.... more To describe patterns of alcohol use in a nationally-representative sample of New Zealand smokers. The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from a national survey: the NZ Health Survey (NZHS). From this sample we surveyed adult smokers (n=1376). A third (33.1%) of these smokers had a drinking pattern that was considered hazardous (i.e., AUDIT scores greater than and equal to 8). These figures were much higher than for non-smokers in the NZHS (at 13.1%). In both the univariate and multivariate analyses, hazardous drinking patterns were significantly more common among: younger smokers, male smokers, and Māori smokers (e.g., adjusted odds ratio for the latter: 1.43, 95%CI: 1.05-1.95). The same pattern of more hazardous drinking was also seen (but in the univariate analysis only), for smokers with financial stress and for moderate individual-level deprivation. These findings provide additional evidence that hazardous drinking patterns are elevated in New Zealand smokers overall and particularly in some groups of smokers. Given the international evidence that hazardous drinking may impede quitting, policy makers could consider the potential benefits of improved alcohol control as part of the national strategy to curtail the tobacco epidemic and achieve the government's "Smokefree Nation 2025" goal. Such an approach could also reduce this country's high levels of alcohol-related harm and reduce gender and ethnic health inequalities.
Exposure to secondhand smoke (SHS) from burning tobacco products causes disease and premature dea... more Exposure to secondhand smoke (SHS) from burning tobacco products causes disease and premature death among non-smoking adults and children. The objective of this study was to determine the nature, extent and demographic correlates of SHS exposure among adults in low- and middle-income countries with a high burden of tobacco use. Data were obtained from the Global Adult Tobacco Survey (GATS), a nationally representative household survey of individuals 15 years of age or older. Interviews were conducted during 2008-2010 in Bangladesh, Brazil, China, Egypt, India, Mexico, the Philippines, Poland, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam. Descriptive statistics were used to determine the prevalence and correlates of SHS exposure in homes, workplaces, government buildings, restaurants, public transportation and healthcare facilities. Exposure to SHS in the home ranged from 17.3% (Mexico) to 73.1% (Vietnam). Among those who work in an indoor area outside the home, SHS exposure in the workplace ranged from 16.5% (Uruguay) to 63.3% (China). Exposure to SHS ranged from 6.9% (Uruguay) to 72.7% (Egypt) in government buildings, 4.4% (Uruguay) to 88.5% (China) in restaurants, 5.4% (Uruguay) to 79.6% (Egypt) on public transportation, and 3.8% (Uruguay) to 49.2% (Egypt) in healthcare facilities. A large proportion of adults living in low- and middle-income countries are exposed to SHS in their homes, workplaces, and other public places. Countries can enact and enforce legislation requiring 100% smoke-free public places and workplaces, and can also conduct educational initiatives to reduce SHS exposure in homes.
This study examined and compared results from two questionnaire pretesting methods (i.e., behavio... more This study examined and compared results from two questionnaire pretesting methods (i.e., behavioral coding and cognitive interviewing [CI]) to assess systematic measurement bias in survey questions for adult smokers across six countries (United States, Australia, Uruguay, Mexico, Malaysia, and Thailand). Protocol development and translation involved multiple bilingual partners in each linguistic/cultural group. The study was conducted with convenience samples of 20 adult smokers in each country. Behavioral coding and CI methods produced similar conclusions regarding measurement bias for some questions; however, CI was more likely to identify potential response errors than behavioral coding. Coordinated qualitative pretesting of survey questions (or postsurvey evaluation) is feasible across cultural groups and can provide important information on comprehension and comparability. The CI appears to be a more robust technique than behavioral coding, although combinations of the two might be even better.
To assess the extent to which intensity and timing of televised anti-smoking advertising emphasiz... more To assess the extent to which intensity and timing of televised anti-smoking advertising emphasizing the serious harms of smoking influences quit attempts. Using advertising gross rating points (GRPs), we estimated exposure to tobacco control and nicotine replacement therapy (NRT) advertising in the 3, 4-6, 7-9 and 10-12 months prior to follow-up of a replenished cohort of 3037 Australian smokers during 2002-08. Using generalized estimating equations, we related the intensity and timing of advertising exposure from each source to the likelihood of making a quit attempt in the 3 months prior to follow-up. Tobacco control advertising in the 3-month period prior to follow-up, but not in more distant past periods, was related to a higher likelihood of making a quit attempt. Each 1000 GRP increase per quarter was associated with an 11% increase in making a quit attempt [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.03-1.19, P = 0.009)]. NRT advertising was unrelated to quit attempts. Tobacco control advertising emphasizing the serious harms of smoking is associated with short-term increases in the likelihood of smokers making a quit attempt. Repeated cycles of higher intensity tobacco control media campaigns are needed to sustain high levels of quit attempts.
This study examined support for and reported compliance with smoke-free policy in air-conditioned... more This study examined support for and reported compliance with smoke-free policy in air-conditioned restaurants and other similar places among adult smokers in Malaysia and Thailand. Baseline data (early 2005) from the International Tobacco Control Southeast Asia Survey (ITC-SEA), conducted face-to-face in Malaysia and Thailand (n = 4005), were used. Among those attending venues, reported total smoking bans in indoor air-conditioned places such as restaurants, coffee shops, and karaoke lounges were 40% and 57% in Malaysia and Thailand, respectively. Support for a total ban in air-conditioned venues was high and similar for both countries (82% Malaysian and 90% Thai smokers who believed there was a total ban), but self-reported compliance with bans in such venues was significantly higher in Thailand than in Malaysia (95% vs 51%, P < .001). As expected, reporting a ban in air-conditioned venues was associated with a greater support for a ban in such venues in both countries.
C. A. Perz, C. C. DiClemente, and J. P. Carbonari (1996) claim support for the transtheoretical m... more C. A. Perz, C. C. DiClemente, and J. P. Carbonari (1996) claim support for the transtheoretical model notion that success in smoking cessation involves doing the right thing at the right time: emphasising experiential change processes during the contemplation and preparation stages and shifting to behavioral process activities during action. A key methodological limitation of Perz et al. was their failure to control for stage of change, a measure that has been shown to be predictive of cessation. This study replicates the prospective findings of Perz et al. in a different data set, then controls for stage of change when it is predictive of cessation, and finds that the measures of "appropriate" change process use developed by Perz et al. no longer predict cessation. The authors conclude that stage of change, in particular the distinction between smoking and not smoking, is more important than change process use in predicting cessation outcomes.
Introduction:This paper is concerned with the effects of cigarette pack warning labels on quittin... more Introduction:This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were “noticing warning labels during last month,” “reading or looking closely at warning labels,” “avoiding looking at labels during last month,” “thinking about health risks of smoking because of the warning labels, “more likely to quit because of the warning labels,” and “stopping from having a cigarette when about to smoke one because of the labels.”Methods:A total of 2,006 adult smokers in Malaysia were surveyed in face-to-face interviews using a standardized questionnaire. Of those, 1,919 male smokers were included in the analyses.Results:The responses “more likely to quit because of the warning labels” and “stopped from having a cigarette when about to smoke one” significantly predicted all stages of change and self-efficacy, independent of the other measures. In addition, thinking about the health risks and reading the warnings more often added extra predictive capacity but only in the early stages of contemplating change.Discussion:Less intense processing of the information may be important in initiating thoughts, but cognitions about quitting and foregoing cigarettes are the key mechanisms by which warnings stimulate quitting intentions and help smokers feel capable of succeeding. Malaysian smokers appear to respond to warnings in ways comparable with those from developed countries.
... Arizona. This project was supported by a grant from the National Cancer Institute (CA62968; D... more ... Arizona. This project was supported by a grant from the National Cancer Institute (CA62968; David Buller, PI) and by a National Health and Medical Research Council of Australia Traveling Fellowship to Ron Borland. Correspondence ...
... Many Australian income studies have used Henderson equivalence scales developed by the Commis... more ... Many Australian income studies have used Henderson equivalence scales developed by the Commission of ... Thus anti-smoking campaigns and policies can effect improvements in material conditions ... This research was supported by a grant from the Victorian Health Promotion ...
The ABCD(E) rule and the seven-point checklist are diagnostic aids that have proven to be useful ... more The ABCD(E) rule and the seven-point checklist are diagnostic aids that have proven to be useful in the hands of physicians; however, little is known of their value to patients with respect to aiding self-detection. The objective of this study was to investigate features that patients notice when identifying melanomas and to explore how well these features correspond to the ABCD(E) rule and the seven-point checklist. A retrospective, modified, case-control study involving patient interviews was performed. All interviews were conducted through the private consulting rooms of a Melbourne dermatologist (JWK) and a Newcastle plastic surgeon (CH) prior to the result of pathology being known to the patients and the interviewers. Sixty-seven patients with benign pigmented skin lesions and 46 patients with melanomas were included. Using a logistic regression model, the change in size/new lesion and change in colour (major criteria, seven-point checklist) were most useful in differentiating between melanomas and benign pigmented lesions in the hands of patients [odds ratio (OR), 4.74; 95% confidence interval (CI), 1.85-12.19; P=0.001; OR, 4.27; 95% CI, 1.62-11.26; P=0.003, respectively). The ABCD(E) rule failed to discriminate between melanoma and other benign pigmented skin lesions. It can be concluded that, of the patients' observations, changes in size or colour were most important in distinguishing between benign pigmented lesions and melanomas. Such features therefore deserve emphasis in public education campaigns. Medical professionals should also remember to seek a history of change in assessing pigmented skin lesions.
Methods. Telephone survey respondents provided detailed accounts of activities engaged in, time s... more Methods. Telephone survey respondents provided detailed accounts of activities engaged in, time spent outside, and hat, clothing, and sunscreen coverage in the 4 hr around the solar midday on both weekend days, as well as skin type, sociodemographic descriptors, and ...
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Papers by Ron Borland