Digital alcohol marketing and gender: A narrative synthesis.

ISSUES: Alcohol marketing on social media platforms is pervasive and effective, reaching wide audiences and allowing interaction with users. We know little about the gendered nature of digital alcohol marketing, including how women and men are portrayed, how different genders respond and implications for gender relations. This review aimed to identify how males, females and other genders are targeted and represented in digital alcohol marketing, and how they are encouraged to engage with digital alcohol marketing content. APPROACH: A narrative synthesis approach was employed. Academic literature and research reports were searched for studies on digital alcohol marketing published within the previous 10 years with a range of methods and designs. We reviewed the studies, extracted data relevant to gender and synthesised findings thematically. KEY FINDINGS: The review included 17 articles and 7 reports with a range of designs and methods, including content analyses of digital material, interviews, focus groups and surveys. Our analysis identified three conceptual themes that captured many of the gendered results, namely: (i) leveraging a diversity of idealised femininities; (ii) amplifying hegemonic masculinity; and (iii) infiltrating everyday gendered life. IMPLICATIONS AND CONCLUSION: Alcohol marketing on social media is highly gendered and is designed to embed itself into everyday life in agile ways that reinforce traditional and evolving gendered stereotypes, activities, lifestyles and roles. Gendered engagement strategies are widely used to link alcohol to everyday gendered activities and identities to encourage alcohol purchase and consumption. This marketing normalises alcohol consumption and reproduces harmful gender norms and stereotypes.

Home drinking practices among middle-class adults in midlife during the COVID-19 pandemic: Material ubiquity, automatic routines and embodied states.

INTRODUCTION: Harmful drinking is increasing among mid-life adults. Using social practice theory, this research investigated the knowledge, actions, materials, places and temporalities that comprise home drinking practices among middle-class adults (40-65 years) in Aotearoa New Zealand during 2021-2022 and post the COVID-19 pandemic lockdowns. METHODS: Nine friendship groups (N = 45; 26 females, 19 males from various life stages and ethnicities) discussed their drinking practices. A subset of 10 participants (8 female, 2 male) shared digital content (photos, screenshots) about alcohol and drinking over 2 weeks, which they subsequently discussed in an individual interview. Group and interview transcripts were thematically analysed using the digital content to inform the analysis. RESULTS: Three themes were identified around home drinking practices, namely: (i) alcohol objects as everywhere, embedded throughout spaces and places in the home; (ii) drinking practices as habitual, automatic and conditioned to mundane everyday domestic chores, routines and times; and (iii) drinking practices intentionally used by participants to achieve desired embodied states to manage feelings linked to domestic and everyday routines. DISCUSSION AND CONCLUSIONS: Alcohol was normalised and everywhere within the homes of these midlife adults. Alcohol-related objects and products had their own agency, being entangled with domestic routines and activities, affecting drinking in both automatic and intentional ways. Developing alcohol policy that would change its ubiquitous and ordinary status, and the 'automatic' nature of many drinking practices, is needed. This includes restricting marketing and availability to disrupt the acceptability and normalisation of alcohol in the everyday domestic lives of adults at midlife.

Women, alcohol consumption and health promotion: the value of a critical realist approach.

Research on women's drinking occurs in largely disparate disciplines-including public health, health promotion, psychology, sociology, and cultural studies-and draws on differing philosophical understandings and theoretical frameworks. Tensions between the aims and paradigmatic underpinnings of this research (across and within disciplines) have meant that knowledge and insight can be frequently disciplinary-specific and somewhat siloed. However, in line with the social and economic determinants of the health model, alcohol research needs approaches that can explore how multiple gender-related factors-biological, psycho-social, material, and socio-cultural-combine to produce certain drinking behaviours, pleasures and potential harms. We argue that critical realism as a philosophical underpinning to research can accommodate this broader conceptualization, enabling researchers to draw on multiple perspectives to better understand women's drinking. We illustrate the benefit of this approach by presenting a critical realist theoretical framework for understanding women's drinking that outlines interrelationships between the psychoactive properties of alcohol, the role of embodied individual characteristics and the material, institutional and socio-cultural contexts in which women live. This approach can underpin and foster inter-disciplinary research collaboration to inform more nuanced health promotion practices and policies to reduce alcohol-related harm in a wide range of women across societies.

Research has shown that over the last few decades women's alcohol consumption has increased alongside rising rates of alcohol-related harm. A range of different research approaches explores women's drinking. However, many researchers have worked within their own disciplines with little input from other alternative, and sometimes inconsistent, approaches. In this paper, we argue that critical realism is an approach that can enable researchers to draw on a variety of research perspectives to provide greater insight and understanding of women's drinking. We illustrate how this can benefit knowledge of women's drinking by exploring the interrelationships between the properties of alcohol as a psychoactive substance, the role of individual characteristics and experiences, and the realities of women's lives. Critical realism is also able to incorporate the social and economic determinants of health model that critically considers the role of individual aspects, living and working conditions, and social and cultural factors on health behaviours. By contributing to an understanding of diverse drinking practices, this approach can assist health promotion policy and practice seeking to prevent and reduce alcohol-related harm in a wide range of women across societies.

Alcohol and drinking within the lives of midlife women: A meta-study systematic review.

BACKGROUND: A range of societal changes have created positive and encouraging environments for women's alcohol use. Within this context, in Western countries there is evidence of rising rates of alcohol consumption and related harms among midlife and older women. It is timely and important to explore the role of alcohol in the lives of midlife women to better understand observed data trends and to develop cohort specific policy responses. Focussing on Western countries and those with similar mixed market systems for alcohol regulation, this review aimed to identify 1) how women at midlife make sense of and account for their consumption of alcohol; 2) factors that play a role; and 3) the trends in theoretical underpinnings of qualitative research that explores women's drinking at midlife. METHODS: A meta-study approach was undertaken. The review process involved extracting and analysing the data findings of eligible research, as well as reviewing the contextual factors and theoretical framing that actively shape research and findings. RESULTS: Social meanings of alcohol were interwoven with alcohol's psycho-active qualities to create strong localised embodied experiences of pleasure, sociability, and respite from complicated lives and stressful circumstances in midlife women. Drinking was shaped by multiple and diverse aspects of social identity, such as sexuality, family status, membership of social and cultural groups, and associated responsibilities, underpinned by the social and material realities of their lives, societal and policy discourses around drinking, and how they physically experienced alcohol in the short and longer term. CONCLUSION: For harm reduction strategies to be successful, further research effort should be undertaken to understand alcohol's diverse meanings and functions in women's lives and the individual, material, and socio-cultural factors that feed into these understandings. As well as broad policies that reduce overall consumption and "de-normalise" drinking in society, policy-makers could usefully work with cohorts of women to develop interventions that address the functional role of alcohol in their lives, as well as policies that address permissive regulatory environments and the overall social and economic position of women.

'A little bubble of utopia': constructions of a primary care-based pilot clinic providing gender affirming hormone therapy.

The provision of gender affirming hormone therapy for transgender and non-binary people is a rapidly developing area of gender affirming healthcare. While research indicates the benefits of providing gender affirming hormone therapy through interdisciplinary primary care-based models, less is known about how service users and providers construct their understandings of affirmative approaches. In this paper, we present findings from a discourse analysis of four service users' and four healthcare professionals' talk about a primary care-based pilot clinic providing gender affirming hormone therapy in Aotearoa New Zealand. Participants employed notions of pathologisation, time, and agency in their talk to construct the clinic as a personal setting which gave service users time to make their own health decisions, while constructing hospitals as impersonal with lengthy wait times. The assessment-driven nature of best practice guidelines that governed clinicians' decision-making was constructed as constraining users' agency. Findings highlight the ongoing importance of aligning gender affirming hormone therapy with other non-disease types of healthcare, and suggest new ways for achieving this through affirmative approaches to healthcare.

Critical health psychology in New Zealand: Developments, directions and reflections.

We examine how critical health psychology developed in New Zealand, taking an historical perspective to document important influences. We discuss how academic appointments created a confluence of critical researchers at Massey University, how interest in health psychology arose and expanded, how the critical turn eventuated and how connections, both local and international, were important in building and sustaining these developments. We discuss the evolution of teaching a critical health psychology training programme, describe the research agendas and professional activities of academic staff involved and how this sustains the critical agenda. We close with some reflections on progress and attainment.

Social networking and young adults' drinking practices: innovative qualitative methods for health behavior research.

OBJECTIVES: Understandings of health behaviors can be enriched by using innovative qualitative research designs. We illustrate this with a project that used multiple qualitative methods to explore the confluence of young adults' drinking behaviors and social networking practices in Aotearoa, New Zealand. METHOD: Participants were 18-25 year old males and females from diverse ethnic, class, and occupational backgrounds. In Stage 1, 34 friendship focus group discussions were video-recorded with 141 young adults who talked about their drinking and social networking practices. In Stage 2, 23 individual interviews were conducted using screen-capture software and video to record participants showing and discussing their Facebook pages. In Stage 3, a database of Web-based material regarding drinking and alcohol was developed and analyzed. RESULTS: In friendship group data, young adults co-constructed accounts of drinking practices and networking about drinking via Facebook as intensely social and pleasurable. However, this pleasure was less prominent in individual interviews, where there was greater explication of unpleasant or problematic experiences and practices. The pleasure derived from drinking and social networking practices was also differentiated by ethnicity, gender, and social class. Juxtaposing the Web-based data with participants' talk about their drinking and social media use showed the deep penetration of online alcohol marketing into young people's social worlds. CONCLUSIONS: Multiple qualitative methods, generating multimodal datasets, allowed valuable nuanced insights into young adults' drinking practices and social networking behaviors. This knowledge can usefully inform health policy, health promotion strategies, and targeted health interventions.

'See it doesn't look pretty does it?' Young adults' airbrushed drinking practices on Facebook.

A range of negative health outcomes are associated with young adults' drinking practices. One key arena where images of, and interaction about, drinking practices occurs is social networking sites, particularly Facebook. This study investigated the ways in which young adults' talked about and understood their uses of Facebook within their drinking practices. Face-to-face, semi-structured interviews were conducted with seven New Zealand young adults as they displayed, navigated and talked about their Facebook pages and drinking behaviours. Our social constructionist thematic analysis identified three major themes, namely 'friendship group belonging', 'balanced self-display' and 'absences in positive photos'. Drinking photos reinforced friendship group relationships but time and effort was required to limit drunken photo displays to maintain an overall attractive online identity. Positive photos prompted discussion of negative drinking events which were not explicitly represented. Together these understandings of drinking photos function to delimit socially appropriate online drinking displays, effectively 'airbrushing' these visual depictions of young adults' drinking as always pleasurable and without negative consequences. We consider the implications of these findings for ways alcohol health initiatives may intervene to reframe 'airbrushed' drinking representations on Facebook and provoke a deeper awareness among young people of drinking practices and their online displays.

Staying 'in the zone' but not passing the 'point of no return': embodiment, gender and drinking in mid-life.

Public health approaches have frequently conceptualised alcohol consumption as an individual behaviour resulting from rational choice. We argue that drinking alcohol needs to be understood as an embodied social practice embedded in gendered social relationships and environments. We draw on data from 14 focus groups with pre-existing groups of friends and work colleagues in which men and women in mid-life discussed their drinking behaviour. Analysis demonstrated that drinking alcohol marked a transitory time and space that altered both women's and men's subjective embodied experience of everyday gendered roles and responsibilities. The participants positioned themselves as experienced drinkers who, through accumulated knowledge of their own physical bodies, could achieve enjoyable bodily sensations by reaching a desired level of intoxication (being in the zone). These mid-life adults, particularly women, discussed knowing when they were approaching their limit and needed to stop drinking. Experiential and gendered embodied knowledge was more important in regulating consumption than health promotion advice. These findings foreground the relational and gendered nature of drinking and reinforce the need to critically interrogate the concept of alcohol consumption as a simple health behaviour. Broader theorising around notions of gendered embodiment may be helpful for more sophisticated conceptualisations of health practices.

Morality, responsibility and risk: the importance of alternative perspectives in vaccination research.

BACKGROUND: The four papers presented in this special section together provide a striking example of the importance of eliciting people's understandings and meanings of vaccinations, from parents and children to health and medical professionals. PURPOSE: This commentary reflects on the findings of the papers in this special section and considers them within a broader sociocultural view on vaccination research. METHODS: The four papers in the special section were integrated with previous research and scholarship on public health and vaccinations. RESULTS: The studies demonstrate how both uptake of vaccinations and their meanings vary by cultural context, most notably across Eastern and Western Europe, and the fundamental role that political, economic and healthcare systems play. Nevertheless, there are many similarities across seemingly diverse contexts. Three specific tensions are apparent across the findings (and within other vaccination research). These tensions revolve around (1) responsible citizen versus responsible individual, (2) scientific knowledge versus lay understandings and (3) uncertainty and risk versus certainty and trust. CONCLUSION: Threaded through these tensions are discourses around citizenship, trust, morality, gender and power that are important to consider in research on vaccinations.

"Everyone can loosen up and get a bit of a buzz on": young adults, alcohol and friendship practices.

In countries with liberalised alcohol policies, alcohol harm reduction strategies predominantly focus on young adults' excessive drinking harms and risks. However, research shows such risks are largely irrelevant for young adults, who emphasise the sociability, release, pleasure and fun of drinking. Friendship is a central part of their lives and an integral part of their drinking experiences. This study aimed to explore everyday friendship practices, drinking, and pleasure in young people's routine and shared social lives. Twelve friendship discussion groups were conducted in urban and non-urban New Zealand, with 26 women and 25 men aged 18-25 years. Our Foucauldian discursive analysis enabled us to identify how the young adults drew on drinking as 'friendship fun' and 'friends with a buzz' discourses to construct drinking as a pleasurable and socially embodied friendship practice. Yet the young adults also drew on 'good always outweighs bad experiences' and friendship 'caring and protection' discourses to smooth over disruptive negative drinking experiences. Together these discourses function to justify young adults' drinking as friendship pleasure, minimising alcohol harms, and setting up powerful resistances to individualised risk-based alcohol-harm reduction campaigns. These findings are discussed in terms of new insights and implications for alcohol harm reduction strategies that target young adults.

Uncertainty in medicine: meanings of menopause and hormone replacement therapy in medical textbooks.

Menopause is understood, portrayed, and experienced in diverse ways. The dominant biomedical perspective medicalizes menopause as a biological 'hormone deficiency' requiring 'treatment' with hormone replacement therapy (HRT). Alternative perspectives view menopause as discursively located within particular socio-historical times and places, or privilege women's embodied experiences of menopause. We argue that the meanings of menopause and HRT should be debated within a context where the biological and the social, or the body and culture, intersect. The present study examined international medical student textbooks as sites of current biomedical knowledge, communicated for a new generation of health professionals. We undertook a Foucauldian discourse analysis on eight widely-used, international medical textbooks across physiology, pathology and pharmacology subject areas to identify the ways in which menopause and HRT are portrayed. Our results showed that menopause continues to be represented through dominant culturally infused 'failure' discourses and is portrayed as a 'precursor to disease' with HRT as the treatment. However, this knowledge is somewhat destabilized by a discourse of 'uncertainty and speculation' regarding the physiology of menopause and the potential effects of HRT. Knowledge about menopause, osteoporosis, and HRT was constructed as tentative, but the 'quest' for new knowledge was constructed as on the verge of 'exciting discoveries'. We argue that bio-social understandings of menopause and HRT, and their medical uncertainties, need to be addressed in medical curricula to ensure that doctors engage with midlife women in appropriate and positive ways, especially given the increased call for women's involvement in decision-making at this time.

Cancer ward: patient perceptions in oncology.

The novel Cancer ward (Solzhenitsyn, 1968) was used to examine the perceptions that cancer patients hold regarding their illness and its treatment, and how these perceptions relate to theoretical models in health psychology. Excerpts were identified, categorized and interpreted using the Self-Regulation Model of illness. The model's dimensions of illness perceptions were apparent throughout Cancer ward. Patients held specific representations about cancer, many of which are similar to those found today. Analysing a novel on cancer provides insight into patients' embodied experiences and perceptions of cancer and treatment. Incorporating illness perceptions into medical care improves the quality of life of patients.

Maori healers' views on wellbeing: the importance of mind, body, spirit, family and land.

From an indigenous and holistic perspective, the current dominant biomedical model of health and illness has a limited view of people and their wellbeing. The present study aimed to explore Maori spiritual healers' views on healing and healing practices, and the implications of these for conceptualisations of holism, health and wellbeing. Six indigenous Maori in Aotearoa/New Zealand took part in in-depth, semi-structured interviews with a Maori researcher from March to September 2007. Transcribed interviews were analysed using interpretative phenomenological analysis techniques. We found that Maori cultural perspectives influenced views of the mind, body, spirit and healers also identified two additional aspects as significant and fundamental to a person's health, namely whanau/whakapapa [family and genealogy] and whenua [land]. We propose a model called Te Whetu [The Star], with 5 interconnected aspects; namely, mind, body spirit, family, and land. Results are discussed in terms of the contribution of Maori knowledge to our understandings of health and wellbeing, and their implications for conceptualising holism, as well as health policy and care for Maori and other indigenous populations.

The doctor, the breath and Thomas Bernhard: using novels in health psychology.

The use of literature in medical education has increased greatly in recent years, as attested to by growth in the medical humanities field. In this article we argue that literary texts may be beneficial for use in health psychology, illustrated by an analysis of patient-physician interaction in the novel Breath by Thomas Bernhard. Reading novels can impact on people's health-related behaviours. Using novels in our teaching and training can illustrate that there are alternative, useful ways of gaining health-related knowledge beyond objective, scientific rationality. Novels are able to show health, illness, disability and suffering in their full human, social and spiritual contexts, and therefore should be considered seriously in our health psychology endeavours.

Psychological well-being across 1 year with rheumatoid arthritis: coping resources as buffers of perceived stress.

OBJECTIVES: Using the transactional model of stress and coping, the present study investigated whether specific coping resources act as buffers of the relationship between perceived stress and psychological well-being among rheumatoid arthritis (RA) patients. DESIGN: A longitudinal observational study was carried out with assessments at baseline, 6 months and 1 year. METHODS: Measures of perceived stress, coping resources (optimism/pessimism, social support and explicit active coping strategies) and psychological well-being (anxiety, depression and life satisfaction) were completed by 134 RA patients. Demographics, RA duration, pain, fatigue, functional disability, antidepressant use and physical comorbidities were recorded and statistically controlled for. RESULTS: Perceived stress had the strongest relationship with psychological well-being at baseline, and affected anxiety after 6 months. Optimism and pessimism predicted psychological well-being across 1 year. Active behavioural coping buffered an association of stress with depression at baseline, while baseline active cognitive coping buffered the effect of baseline stress on life satisfaction after 6 months. CONCLUSIONS: Patients with RA under greater perceived stress who do not use active coping strategies appear to be at risk of psychological comorbidity and may therefore benefit from interventions teaching specific active coping strategies. Larger observational studies and interventions are required to confirm and extend these findings.

'Hardcore drinking': portrayals of alcohol consumption in young women's and men's magazines.

Young adults and young women in particular are drinking more alcohol than ever before, with implications for risky behaviours and long-term health. This study explored the ways in which alcohol and drinking were represented in six monthly UK magazines (three targeted at young men, three at young women) across a three-month period (18 magazines). We identified three main discourses across the texts, namely the drug alcohol; masculinity and machismo; and drinking as normality. These discourses constructed women's and men's drinks and drinking behaviours in sharp contrast. Drinking was aligned with traditional masculine images, although new kinds of drinks were aligned with traditional feminine images--and derided in men's magazines. Findings highlight how gender, constructed in relation to the other, is an important aspect of representations of drinking patterns in young adults.

Well-being in rheumatoid arthritis: the effects of disease duration and psychosocial factors.

This study examined the multivariate relationships of psychosocial factors with well-being in rheumatoid arthritis (RA). Fifty-five patients with early RA (seven years) completed questionnaires on psychosocial factors and psychological and physical well-being. Illness perceptions related to worse depression and life satisfaction (especially in early RA) and to longer morning stiffness (especially in intermediate RA). Optimism related to lower pain in early and intermediate RA. Social support related to lower fatigue in established RA. Indications for interventions targeted by disease duration are discussed.