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Background

The Accreditation Council for Graduate Medical Education (ACGME) requires an annual evaluation of all ACGME-accredited residency and fellowship programs to assess program quality. The results of this evaluation must be used to improve the program. This manuscript describes a metric to be used in conducting ACGME-mandated annual program review of ACGME-accredited anesthesiology residencies and fellowships.

Methods

A variety of metrics to assess anesthesiology residency and fellowship programs are identified by the authors through literature review and considered for use in constructing a program "report card."

Results

Metrics used to assess program quality include success in achieving American Board of Anesthesiology (ABA) certification, performance on the annual ABA/American Society of Anesthesiology In-Training Examination, performance on mock oral ABA certification examinations, trainee scholarly activities (publications and presentations), accreditation site visit and internal review results, ACGME and alumni survey results, National Resident Matching Program (NRMP) results, exit interview feedback, diversity data and extensive program/rotation/faculty/curriculum evaluations by trainees and faculty. The results are used to construct a "report card" that provides a high-level review of program performance and can be used in a continuous quality improvement process.

Conclusions

An annual program review is required to assess all ACGME-accredited residency and fellowship programs to monitor and improve program quality. We describe an annual review process based on metrics that can be used to focus attention on areas for improvement and track program performance year-to-year. A "report card" format is described as a high-level tool to track educational outcomes.

To obtain a quantitative measure of the extent to which graduate education and qualification for specialty practice have become an integral part of the total educational experience, samples of the graduating classes of 1960, 1964, 1968 and 1970 of Canadian medical schools were tracked through postgraduate educational training and into specialty certification. From the 1960 cohort 65% chose a career recognized by special certifying exams in Canada and/or the United States, entered a residency, completed it and achieved certification of special competence. From the 1970 cohort, by the end of 1972 approximately 50% had entered a recognized specialty training program leading to certification. The diminishing trend toward specialty practice is demonstrated by reviewing the comparative figures in the 1964 and 1968 cohorts. Evidence garnered in this study indicates a continuing strong motivation for specialty practice although family medicine and/or general practice appear increasingly attractive as career choices. Strong provincial educational forces as well as social and other forces will probably continue to modify career selection and may lead an increasing number of Canadian medical graduates into family practice.

Objective. To determine the perceptions of junior pharmacy faculty members with US doctor of pharmacy (PharmD) degrees regarding their exposure to residency, fellowship, and graduate school training options in pharmacy school. Perceptions of exposure to career options and research were also sought.

Methods. A mixed-mode survey instrument was developed and sent to assistant professors at US colleges and schools of pharmacy.

Results. Usable responses were received from 735 pharmacy faculty members. Faculty members perceived decreased exposure to and awareness of fellowship and graduate education training as compared to residency training. Awareness of and exposure to academic careers and research-related fields was low from a faculty recruitment perspective.

Conclusions. Ensuring adequate exposure of pharmacy students to career paths and postgraduate training opportunities could increase the number of PharmD graduates who choose academic careers or other pharmacy careers resulting from postgraduate training.

An overview of medical education at both the undergraduate and postgraduate levels in Canadian faculties of medicine is provided. Particular attention is focused on changes that have occurred in the 1990s and their effect on medical students and on educational programs. Also considered are the effects of reductions in the number of entry-level positions for residency training and the changes in educational requirements for licensure on senior medical students.

OBJECTIVE

In the United States, the Food and Drug Administration (FDA) requires that all direct-to-consumer advertising (DTCA) contain both an accurate statement of a medication’s effects (“truth”) and an even-handed discussion of its benefits and risks/adverse effects (“fair balance”). DTCA for medications to treat rare diseases such as bleeding disorders is unlikely to be given high priority for FDA review.

METHODS

We reviewed all DTCA for bleeding disorder products appearing in the patient-directed magazine HemeAware from January, 2004 to June, 2006. We categorized the information presented in each advertisement as benefit, risk/adverse effect, or neither, and assessed the amount of text and type size devoted to each. We also assessed the readability of each type of text using the Flesch Reading Ease Score (FRES, where a score of ≥ 65 is considered of average readability), and assessed the accuracy of the advertising claims utilizing a panel of five bleeding disorder experts.

RESULTS

A total of 39 unique advertisements for 12 products were found. On average, approximately twice the amount of text was devoted to benefits as compared to risks/adverse effects, and the later was more difficult to read (FRES of 20.45 for risks/adverse effects versus 32.08 for benefits; difference of 11.56 [95% CI: 4.52, 18.60]). Only about two-thirds of the advertising claims were considered by a majority of the experts to be based on at least low-quality evidence.

CONCLUSION

As measured by our methods, print DTCA for bleeding disorders may not reach the FDA’s standards of truth and fair balance.

Background

Journal advertising is one of the main sources of medicines information to doctors. Despite the availability of regulations and controls of drug promotion worldwide, information on medicines provided in journal advertising has been criticized in several studies for being of poor quality. However, no attempt has been made to systematically summarise this body of research. We designed this systematic review to assess all studies that have examined the quality of pharmaceutical advertisements for prescription products in medical and pharmacy journals.

Methods and Findings

Studies were identified via searching electronic databases, web library, search engine and reviewing citations (1950 – February 2006). Only articles published in English and examined the quality of information included in pharmaceutical advertisements for prescription products in medical or pharmacy journals were included. For each eligible article, a researcher independently extracted the data on the study methodology and outcomes. The data were then reviewed by a second researcher. Any disagreements were resolved by consensus. The data were analysed descriptively. The final analysis included 24 articles. The studies reviewed advertisements from 26 countries. The number of journals surveyed in each study ranged from four to 24 journals. Several outcome measures were examined including references and claims provided in advertisements, availability of product information, adherence to codes or guidelines and presentation of risk results. The majority of studies employed a convenience-sampling method. Brand name, generic name and indications were usually provided. Journal articles were commonly cited to support pharmaceutical claims. Less than 67% of the claims were supported by a systematic review, a meta-analysis or a randomised control trial. Studies that assessed misleading claims had at least one advertisement with a misleading claim. Two studies found that less than 28% of claims were unambiguous clinical claims. Most advertisements with quantitative information provided risk results as relative risk reduction. Studies were conducted in 26 countries only and then the generalizability of the results is limited.

Conclusions

Evidence from this review indicates that low quality of journal advertising is a global issue. As information provided in journal advertising has the potential to change doctors' prescribing behaviour, ongoing efforts to increase education about drug promotion are crucial. The results from our review suggest the need for a global pro-active and effective regulatory system to ensure that information provided in medical journal advertising is supporting the quality use of medicines.

Senders and receivers influence dynamic characteristics of the signals used for mate attraction over different time scales. On a moment-to-moment basis, interactions among senders competing for a mate influence dynamic characteristics, whereas the preferences of receivers of the opposite gender exert an influence over evolutionary time. We observed and recorded the calling patterns of the bird-voiced treefrog Hyla avivoca, to assess how the dynamic characters of calls vary during interactions among groups of males in a chorus. This question was also addressed using playback experiments with males. Playback experiments with females showed how changes in dynamic call properties are likely to affect male mating success. Frogs calling in pairs, groups, or in response to playbacks produced longer calls than did isolated males. During call overlap, males often increased the duration of the silent interval (gaps) between the pulses of their calls so that the pulses of the calls of two neighbors interdigitated. This change resulted in increased variability of pulse rate, a traditionally static acoustic property; however, males also produced high proportions of non-overlapped calls in which variability in pulse rate was low and had species-typical values. Females preferred long calls to short and average-duration calls, and non-overlapped calls to overlapped calls. Given a choice between pairs of overlapped calls, females preferred pairs in which the proportion of overlap was low and pairs in which the pulses of such calls interdigitated completely. The observed patterns of vocal competition thus reflect the preferences of conspecific females, which have influenced the evolution of the calling behavior of H. avivoca.

This study investigated correlates of outdoor advertising panel density in predominantly African American neighborhoods in New York City. Research shows that black neighborhoods have more outdoor advertising space than white neighborhoods, and these spaces disproportionately market alcohol and tobacco advertisements. Thus, understanding the factors associated with outdoor advertising panel density has important implications for public health. We linked 2000 census data with property data at the census block group level to investigate two neighborhood-level determinants of ad density: income level and physical decay. Results showed that block groups were exposed to an average of four ad spaces per 1,000 residents and that vacant lot square footage was a significant positive predictor of ad density. An inverse relationship between median household income and ad density did not reach significance, suggesting that relative affluence did not protect black neighborhoods from being targeted for outdoor advertisements.

Alcohol advertisements may influence impulsive, risky behaviors indirectly, via automatically-activated attitudes toward alcohol. Results from an experiment in which participants were exposed to either four alcohol advertisements, four control advertisements, or four drunk driving public service advertisements, suggested that alcohol advertisements had more measurable effects on implicit, than on explicit attitude measures. Moreover, there were significant indirect paths from alcohol advertisement exposure through automatically-activated alcohol attitudes on willingness to engage in risky alcohol-related behaviors, notably drinking and driving. A mechanism that may explain how these advertisements activate automatic, non-deliberative alcohol attitudes was investigated. Associative evidence was found supportive of an evaluative conditioning mechanism, in which positive responses to an alcohol advertisement may lead to more positive automatically-activated attitudes toward alcohol itself.

Acquiring a faculty position in academia is extremely competitive and now typically requires more than just solid research skills and knowledge of one’s field. Recruiting institutions currently desire new faculty that can teach effectively, but few postdoctoral positions provide any training in teaching methods. Fellowships in Research and Science Teaching (FIRST) is a successful postdoctoral training program funded by the National Institutes of Health (NIH) providing training in both research and teaching methodology. The FIRST program provides fellows with outstanding interdisciplinary biomedical research training in fields such as neuroscience. The postdoctoral research experience is integrated with a teaching program which includes a How to Teach course, instruction in classroom technology and course development and mentored teaching. During their mentored teaching experiences, fellows are encouraged to explore innovative teaching methodologies and to perform science teaching research to improve classroom learning. FIRST fellows teaching neuroscience to undergraduates have observed that many of these students have difficulty with the topic of neuroscience. Therefore, we investigated the effects of interactive teaching methods for this topic. We tested two interactive teaching methodologies to determine if they would improve learning and retention of this information when compared with standard lectures. The interactive methods for teaching action potentials increased understanding and retention. Therefore, FIRST provides excellent teaching training, partly by enhancing the ability of fellows to integrate innovative teaching methods into their instruction. This training in turn provides fellows that matriculate from this program more of the characteristics that hiring institutions desire in their new faculty.

Objective

The purpose of this study was to determine resident satisfaction with an acute care psychiatric clinic designed in collaboration with a nearby community mental health center. We also sought to demonstrate that this rotation helps meet program requirements for emergency psychiatry training, provides direct assessments of resident interviewing skills and clinical knowledge in the postgraduate year-1, and provides exposure to public sector systems of care.

Methods

We developed a resident satisfaction questionnaire and fielded it to each of the residents who participated in the clinic over the first 3 years. Data were collected, organized, and analyzed.

Results

Of the 15 residents in the acute care psychiatric clinic, 12 completed and returned the satisfaction questionnaires. Educational aspects of the clinic experience were rated favorably.

Conclusions

This postgraduate year-1 acute care psychiatric clinic provides a mechanism for the fulfillment of emergency psychiatry training as well as direct supervision of clinical encounters, which is a satisfactory and useful educational experience for trainees.

OBJECTIVE: To determine the preferences of program directors for various grading systems and other criteria in selecting students for residency training positions through the Canadian Resident Matching Service (CaRMS). DESIGN: Questionnaire survey. PARTICIPANTS: All 110 directors of residency training programs in Ontario. SETTING: Ontario medical schools. OUTCOME MEASURES: Weighting of importance of different screening tools (e.g., grading systems, personal interview, dean's letter) used during undergraduate training. RESULTS: Of the 110 directors 96 (87%) responded. Of the 92 who rated the various grading practices 35 (38%) preferred a numeric grading system, 26 (28%) a letter grading system, 23 (25%) an honours/pass/fail system and 8 (9%) a pass/fail system. Most of the respondents from each school favoured a grading system that was more discriminating than the one used at their location. The personal interview was regarded as the most important screening tool by 80 (83%) of the respondents; the dean's letter was considered to be very useful by only 16 (17%). CONCLUSIONS: More value was placed by program directors on a numeric or other more discriminating grading system than on the pass/fail system. Although the grading system provides only one type of screening mechanism it raises the question of whether there should be a policy for uniform grading practices for all Canadian students.

In a survey of 16 program directors of residency training in family medicine, respondents were asked about numbers and types of third-year positions they offer. As Canadian educational programs move toward implementing or expanding 2-year prelicensure requirements, many directors are exploring the need to add even more positions for adequate training in primary care. Respondents offered suggestions on tailoring strategies in view of the educational, political, and economic climate.

Objective

The six core competencies designated by Accreditation Council for Graduate Medical Education (ACGME) are essential for establishing a patient centre holistic medical system. The authors developed a faculty programme to promote the postgraduate year 1 (PGY1) resident, ACGME six core competencies. The study aims to assess the clinical instructors' perception, attitudes and subjective impression towards the various sessions of the ‘faculty development programme for teaching ACGME competencies.’

Methods

During 2009 and 2010, 134 clinical instructors participated in the programme to establish their ability to teach and assess PGY1 residents about ACGME competencies.

Results

The participants in the faculty development programme reported that the skills most often used while teaching were learnt during circuit and itinerant bedside, physical examination teaching, mini-clinical evaluation exercise (mini-CEX) evaluation demonstration, training workshop and videotapes of ‘how to teach ACGME competencies.’ Participants reported that circuit bedside teaching and mini-CEX evaluation demonstrations helped them in the interpersonal and communication skills domain, and that the itinerant teaching demonstrations helped them in the professionalism domain, while physical examination teaching and mini-CEX evaluation demonstrations helped them in the patients' care domain. Both the training workshop and videotape session increase familiarity with teaching and assessing skills. Participants who applied the skills learnt from the faculty development programme the most in their teaching and assessment came from internal medicine departments, were young attending physician and had experience as PGY1 clinical instructors.

Conclusions

According to the clinical instructors' response, our faculty development programme effectively increased their familiarity with various teaching and assessment skills needed to teach PGY1 residents and ACGME competencies, and these clinical instructors also then subsequently apply these skills.

Article summary

Article focus

In order to train PGY1 residents, we need to help clinical instructors to become familiar with the teaching and assessment skills that form the Accreditation Council for Graduate Medical Education six core-competencies.

Our study used a self-reported questionnaires based analysis to evaluate the clinical instructors' perception to our faculty development programme.

Key messages

Participants reported that their most commonly used skills were learnt from itinerant and circuit bedside teaching, and mini-clinical evaluation exercise evaluation demonstration in our programme.

Participants also reported that the 40 h basic training course improved their abilities to train and assess PGY1 residents in patient care, interpersonal and communication skills, and medical knowledge domains whereas postcourse training workshop and videotape session enhanced their ability in system-based practice, practice-based learning and improvement, and professionalism domains.

A serial follow-up questionnaire suggested that the degree of participant application of skills learnt from our programme increased progressively after finishing the 40 h basic training course, the postcourse training workshop and videotape session.

Strengths and limitations of this study

According to the clinical instructors' responses, our programme effectively increased their familiarity with teaching and assessment skills needed when teaching PGY1 residents' Accreditation Council for Graduate Medical Education competencies and that these skills were subsequently applies.

This study was limited by the fact that questionnaire used to track and assess the effectiveness of the training programme may have had information and recall bias. In addition, this study had a relatively small sample size and did not contain a control group. However, no controlled educational trials on this subject have been published as yet.

The CMA Board of Directors has responded to growing physician concern about prescription-drug advertising aimed at patients by issuing a position paper that calls for strict rules governing such ads. It also called for development of a code of behaviour to regulate the advertisements. The paper says this advertising must be evidence based and generic, and must not be related to specific brand names. There is particular concern that the ads often advise patients to seek more information from physicians, which will lead to increased utilization of the health care system. Capped global budgets mean the cost of providing the additional service must be borne by doctors.

Some or all of the promotional activities of pharmaceutical companies are typically governed through self-regulatory codes administered by industry associations. However, the conflicts between the commercial objectives and the ethical and scientific goals of promotion can potentially lead to serious weaknesses in the way in which these codes are enforced. This paper focuses on 5 critical aspects involved in the enforcement of codes governing pharmaceutical promotion: mechanisms for recognizing violations, composition of monitoring committees, sanctions for code violations, the quantity and quality of information in reports issued about complaints and code violations, and the circulation these reports receive. The Code of Marketing Practices of the Pharmaceutical Manufacturers Association of Canada (PMAC) has serious weaknesses in all of these areas. Although the Pharmaceutical Advertising Advisory Board's Code of Advertising Acceptance avoids many of the deficiencies of the PMAC code, it, too, has weaknesses. Proposals for strengthening the enforcement of both codes are offered.

Objective

Throughout North America, increasing emphasis is being placed on surgical fellowships. Surgical educators and trainees have raised concerns that the escalating focus on fellowships may threaten the educational mission of more novice trainees. Our objective was to collect opinions from multiple perspectives (faculty, fellows and residents) regarding fellowship structure, fellow selection and the impact of clinical fellowships on urology resident training.

Methods

We anonymously surveyed 52 members of a major academic urology training program (University of Toronto) with established fellowship training programs for their opinions regarding fellowship structure, fellow selection, and the impact on resident training and education.

Results

The overall response rate was 88%. We identified significant differences of opinion among faculty, fellows and residents regarding fellowship structure, fellow selection and the impact on resident education. Specifically, faculty and fellows supported the addition of more fellows, felt that certain complex cases should be designated as “fellow cases” and that residents' research opportunities were not restricted. Residents felt that fellows “steal” operative cases, that performing operations with the fellow is not equivalent to performing operations with faculty alone and that fellowship candidates should perform an operation with division faculty as part of the application process. There was agreement that fellowship programs add value to residents' overall education, that fellows should participate in the call schedule and that fellows' role in the operating room needs to be better defined with respect to case volume and selection. Proficiency in technical skills, clinical knowledge, teaching and teamwork were cited as the most attractive characteristics of an effective clinical fellow.

Conclusion

Residency and fellowship program directors must clearly define the role of the fellow and outline the limits of surgical practice, establish clear and consistent guidelines outlining responsibilities (operative, clinical and on-call), and open lines of communication to ensure that all opinions are recognized and addressed. Finally, they must select fellows with proficient technical skills, clinical knowledge, teaching ability and work ethic to ensure that they focus on “specialized” training.

SYNOPSIS

Objectives.

African Americans currently bear the greatest burden of morbidity and mortality due to smoking, and exposure to pro-tobacco media messages predicts smoking. This study compared the concentration (proportion of media messages that are for tobacco) and density (pro-tobacco media messages per person) of pro-tobacco media messages between African American and Caucasian markets.

Methods.

We searched Medline (1966 to June 2006), PsychINFO (1974 to June 2006), and CINAHL (1982 to June 2006) for studies from peer-reviewed journals directly comparing the volume of pro-tobacco media messages in African American and Caucasian markets. From each study, we extracted the number of total media messages, the number of tobacco-related messages, and the number of residents living in each market area. We calculated the concentration and density of tobacco advertising in each market.

Results.

Out of 131 studies identified, 11 met eligibility criteria, including seven comparing billboard/signage in African American and Caucasian markets and four comparing magazine advertising in African American and Caucasian markets. Meta-analysis estimated a pooled odds ratio of 1.7 (95% confidence interval [CI] 1.1, 2.6) for a given billboard being smoking-related in African American vs. Caucasian market areas (i.e., concentration). The pooled rate ratio of the density of smoking-related billboards was 2.6 (95% CI 1.5, 4.7) in African American vs. Caucasian market areas. Magazine data were insufficient for meta-analysis.

Conclusion.

Available data indicated that African Americans are exposed to a higher volume of pro-tobacco advertising in terms of both concentration and density. These findings have important implications for research, policy measures, and educational interventions involving racial disparities due to tobacco.

The Program Requirements for Fellowship Education identify the knowledge and skills that physicians must master through the course of a training program to be certified in the subspecialty of clinical informatics. They also specify accreditation requirements for clinical informatics training programs. The AMIA Board of Directors approved this document in November 2008.

Background

Televised anti-tobacco advertising has been shown to be effective for discouraging smoking initiation; however, purchasing broadcasting time is very costly. This study investigated the relative impact of the broadcast volume (media weight) and the emotional content of an ad as predictors of advertising recall.

Methods

The data come from a random-digit-dialed survey conducted in 2001 and 2002 of 3863 youth aged 12–17. Media weight was based on commercial TV ratings data. The emotional intensity of advertisements was derived from the ratings made by independent youth judges.

Results

Data analyses were conducted between 2005 and 2007. Results indicated that media weight was a significant predictor of recall, but the emotional content of the ad was an even stronger predictor. Also, ads low in emotional intensity required more media weight than those high in emotional intensity to achieve the same amount of increase in recall.

Conclusions

This study extends prior research that highlights the importance of emotional intensity for effective anti-tobacco advertising. It also indicates that, relative to unemotional advertisements, emotionally arousing advertisements require fewer broadcasts to achieve the same level of recall, and hence are likely to be less costly to a public health campaign.

Understanding changes in attitudes towards others is critical to understanding human behaviour. Neuropolitical studies have found that the activation of emotion-related areas in the brain is linked to resilient political preferences, and neuroeconomic research has analysed the neural correlates of social preferences that favour or oppose consideration of intrinsic rewards. This study aims to identify the neural correlates in the prefrontal cortices of changes in political attitudes toward others that are linked to social cognition. Functional magnetic resonance imaging (fMRI) experiments have presented videos from previous electoral campaigns and television commercials for major cola brands and then used the subjects' self-rated affinity toward political candidates as behavioural indicators. After viewing negative campaign videos, subjects showing stronger fMRI activation in the dorsolateral prefrontal cortex lowered their ratings of the candidate they originally supported more than did those with smaller fMRI signal changes in the same region. Subjects showing stronger activation in the medial prefrontal cortex tended to increase their ratings more than did those with less activation. The same regions were not activated by viewing negative advertisements for cola. Correlations between the self-rated values and the neural signal changes underscore the metric representation of observed decisions (i.e., whether to support or not) in the brain. This indicates that neurometric analysis may contribute to the exploration of the neural correlates of daily social behaviour.

Background

The question of whether Indian dentists should advertise their services is an important issue with significant ethical and professional implications. Individual dentists may feel the need to advertise in order to establish or grow a dental practice, but what effect does this have on the standing of the profession as a whole? As health care professionals are bound by a code of ethics, should dentists be allowed to advertise?

Purpose

The purpose of this study is to examine the attitudes of Indian dentists to the issue of advertising. It also aims to explore whether advertising could have positive benefits (to increase the community’s awareness of dental health care, encourage better quality dental services, decrease unemployment in the industry, and help consumers choose a dentist), or, on the contrary, whether advertising could have a negative impact by undermining the reputation of the industry, in particular the definition of dentistry as a medical profession.

Methods

Of 1500 eligible participants, 423 dentists (28.2%) participated in the study. The questionnaire, comprising 14 questions, was provided to the respondents. The data was collected and analyzed by applying the “Chi-squared test” of association and the “Z test” of difference between two proportions at 5% and 1% levels of significance (ie, P = 0.05 and P = 0.01).

Results

A majority of 56.02% of the respondents were in favor of dentists advertising their services. The majority of dentists in favor of advertising were in the youngest age group (22–30 years, 75.86%). The older age groups were more likely to agree and comply with the government ban on advertising by dentists.

Conclusion

While Indian culture and law does not regard advertising as ethical, in recent years there has been a change in the attitudes of dental professionals to the issue of advertising.

BACKGROUND: Since the advent of direct-to-consumer (DTC) advertising in the 1980s, there have been numerous studies and surveys on the topic, addressing issues as varied as its impact on patient understanding of health conditions to its repercussions for drug spending. However, until 2001, there was a dearth of research on DTC advertising's impact on minority populations, specifically the African-American community. The National Medical Association (NMA) remedied that in 2001 by undertaking a landmark study that gauged African-American physicians' perceptions of DTC advertising, its impact on the doctor-patient relationship and, perhaps most importantly, its role in educating underserved populations about critical health issues and potential treatments. In 2006, the NMA decided to once again poll its members on this critical issue to gauge not only current perceptions but how the community's understanding of DTC advertising has changed since 2001. RESULTS: The 2006 survey revealed several clear trends: NMA physicians are more positive toward DTC advertising now than they were in 2001; African-American physicians see DTC advertising as providing substantial educational benefits; physicians believe that DTC advertising helps rather than hurts the doctor-patient relationship; and African-American physicians see the benefits of DTC advertising outweighing its drawbacks. It must be noted that NMA physicians also had clear concerns about DTC advertising that point to potential areas of improvement for pharmaceutical companies.

Background

Recent research has shown that neighborhood characteristics are associated with obesity prevalence. While food advertising in periodicals and television has been linked to overweight and obesity, it is unknown whether outdoor advertising is related to obesity.

Methods

To test the association between outdoor food advertising and obesity, we analyzed telephone survey data on adults, aged 18–98, collected from 220 census tracts in Los Angeles and Louisiana. We linked self-reported information on BMI and soda consumption with a database of directly observed outdoor advertisements.

Results

The higher the percentage of outdoor advertisements promoting food or non-alcoholic beverages within a census tract, the greater the odds of obesity among its residents, controlling for age, race and educational status. For every 10% increase in food advertising, there was a 1.05 (95% CI 1.003 - 1.093, p<0.03) greater odds of being overweight or obese, controlling for other factors. Given these predictions, compared to an individual living in an area with no food ads, those living in areas in which 30% of ads were for food would have a 2.6% increase in the probability of being obese.

Conclusions

There is a relationship between the percentage of outdoor food advertising and overweight/obesity.

Background

In February 2003, a comprehensive ban on tobacco promotion came into effect in the United Kingdom, which prohibited tobacco marketing through print and broadcast media, billboards, the internet, direct mail, product placement, promotions, free gifts, coupons and sponsorships.

Objective

To investigate the impact of the UK's comprehensive ban on tobacco promotion on adult smokers' awareness of tobacco marketing in the UK relative to Canada, the United States and Australia.

Design

A total of 6762 adult smokers participated in two waves of a random digit dialled telephone survey across the four countries. Wave 1 was conducted before the UK ban (October–December 2002) and Wave 2 was conducted after the UK ban (May–September 2003).

Key measures

Awareness of a range of forms of tobacco marketing.

Results

Levels of tobacco promotion awareness declined significantly among smokers in the UK after implementation of the advertising ban. Declines in awareness were greater in those channels regulated by the new law and change in awareness of tobacco promotions was much greater in the UK than the other three countries not affected by the ban. At least in the short term, there was no evidence that the law resulted in greater exposure to tobacco promotions in the few media channels not covered by the law. Notwithstanding the apparent success of the UK advertising ban and the controls in other countries, 9–22% of smokers in the four countries still reported noticing things that promoted smoking “often or very often” at Wave 2.

Conclusions

The UK policy to ban tobacco advertising and promotion has significantly reduced exposure to pro‐tobacco marketing influences. These findings support the effectiveness of comprehensive bans on advertising and promotion, as included in the Framework Convention on Tobacco Control.