Exploring Environmental Barriers and Facilitators to Inclusion on a University Campus for Autistic Students.

Background: Attending university allows individuals to build independence, develop social networks, and attain valuable qualifications, contributing to enhanced outcomes in adulthood. However, autistic people have poorer participation rates and outcomes in university than those with all other disabilities or without disabilities. Most research conducted with autistic young adults in the university environment focuses on their social and communicative challenges and supports rather than on how the physical environment impacts an autistic student's university experience. Therefore, there is a need for research into how the sensory aspects of the university environment can affect the well-being and outcomes of autistic students. Methods: This qualitative study explored the experiences of seven autistic university students in the physical spaces of an Australian university. Using a semi-structured interview guide, and photo-elicitation, we collected data in one-on-one interviews with seven autistic undergraduate students. Results: We found that sensory aspects of physical spaces on university campuses are both enabling and challenging for autistic students. These aspects not only impact how students navigate and utilize aspects of the campus, but they also influence how students engage and participate at university. Autistic students need the space and resources to manage sensory overload on campus, and universities that seek to support autistic students need to consider the physical and sensory needs of this cohort. Conclusions: Inclusive university education requires attention to the physical aspects of campuses that support the mental and physical well-being of autistic students.

Why was this study done?: Autistic people are less likely to enroll in and complete further education than those with all other disabilities or without disabilities. Most research conducted with autistic young adults in the university environment focuses on their social and communication challenges, rather than the enabling and disabling aspects of the physical university environment. What was the purpose of this study?: This study aimed to capture and understand autistic students' experiences in navigating and participating in the physical spaces in an Australian university. What did the researchers do?: We interviewed seven undergraduate university students about the places and spaces on the university campus that they found challenging and enabling. Participants took photographs of these spaces before the interview and brought the photographs with them for discussion. What were the results of the study?: We found that the participants readily identified places on the campus that were both enabling and challenging. Physical aspects that were challenging included noisy spaces, crowded areas, and spaces with bright artificial lights. These spaces impacted on their ability to participate and succeed in their studies. They also impacted on their ability to interact with other students, their enjoyment of university, and their physical and emotional well-being. Comfortable spaces that allowed them to recharge were those that were quiet, less busy, had lower levels of sensory input, and allowed them to unmask. What do these findings add to what was already known?: Previous research on the university experience of autistic students has focused primarily on social and educational supports. Research on sensory-friendly education settings has typically focused on primary and secondary education. This study provides evidence of the importance of physical and sensory environments in the educational experience of autistic students in a postsecondary environment. What are potential weaknesses in the study?: The main weakness of the study is the small number of participants (n = 7) and that they were all drawn from one university. While this limits the generalizability of the findings, this was an exploratory study and an important first step in developing our understanding of barriers and facilitators to inclusion on a university campus. How will these findings help autistic adults now or in the future?: While this is a small-scale exploratory study, and there is a need for more research in this area, there are some simple takeaways that could be implemented by universities at minimal cost to support the inclusion of autistic students. For example, sensory input could be reduced by lowering the volume of piped music or reducing the number or brightness of lights. Simple supports for students experiencing sensory overload could include quiet times in cafeterias and access to sensory retreat rooms. At a minimum, our findings could serve as a starting point for discussions between university administrators and autistic students about necessary environmental adjustments to create more inclusive campuses.

'Most people have no idea what autism is': Unpacking autism disclosure using social media analysis.

LAY ABSTRACT: Autism disclosure - that is sharing their autism diagnosis or identity with a person or people - is a difficult decision for many autistic people. While telling people they are autistic can be positive and helpful, it can also create a lot of problems. What we have learnt is that disclosure is really complicated. Rather than asking research participants questions about what might happen, we looked at what people were saying on public social media posts (Reddit and Twitter) about what did happen. We used three years of posts that were related to autism disclosure from a wide range of adults (autistic and non-autistic). Four main ideas were created from our data, with the key finding being that society does not understand autism. This lack of understanding creates problems for autistic people in work, dating, healthcare and mental health. The remaining ideas were that autistic people should have privacy and be treated with respect, that autistic representation can help society and that non-autistic people need to do more to help autistic people. Our findings support that society needs to do more through autism advocacy, better media representation and more public role models. Increasing the accuracy of understanding of autism across society will mean that autistic people can feel safer to disclose if they want to.

Perception of the Portrayal of Autism in Netflix's Atypical Within the Autism Community.

Background: Fictional portrayals of autism play a role in raising awareness, shaping knowledge, and influencing attitudes toward autism. However, the accuracy of these portrayals is a topic of debate. Limited research has been conducted with the autism community regarding their perceptions of fictional portrayals of autism. This study aimed to explore autistic people's perceptions of the accuracy, educational benefits, and impact of Atypical, a Netflix comedy drama series focused on the experiences of an autistic protagonist. Methods: Participants were 77 members of the autism community (autistic N = 65, parent/partner N = 12), recruited via social media. Participants completed a cross-sectional predominantly qualitative survey. We undertook descriptive statistical analyses on the quantitative data and used a reflexive thematic analysis approach to analyze the qualitative data. Results: The majority of participants described Sam's portrayal as accurate, emphasizing that it was accurate as one example of autism. Family members appeared more likely to perceive Atypical as having informative benefit and being likely to improve attitudes toward autism than were autistic people. The primary concerns identified were the stereotypical representation of a popular media image of autism, the lack of diversity, and the depiction of autism as a burden or challenge for the protagonist and his family. Conclusions: This study builds on previous research on the portrayal of autism in entertainment media by investigating the perception of the autism community regarding one such fictional portrayal. It identifies that for entertainment media to better represent the lived experience of autistic people and improve community understanding of autism, there is a need for increased diversity of portrayals and for the involvement of autistic people in the development and production process.

Why was this study done?: Portrayals of autism on television and in movies may increase autism awareness and knowledge and improve attitudes toward autistic people. However, they may also reinforce autism stereotypes and negative attitudes. Research shows that there are an increasing number of autistic characters in movies and television stories. Some studies find that these portrayals are largely accurate, others that they are misleading, and some that they are mixed. What has not been studied is what members of the autism community think about the accuracy, value, and likely impacts of these fictional portrayals. What was the purpose of this study?: The purpose of this study was to explore the perceptions of members of the autism community­autistic people and their families­about the Netflix television series Atypical and its autistic main character Sam Gardner. What did the researchers do?: The researchers recruited 77 people who had watched Atypical: 65 autistic people, 10 parents of autistic children, and 2 partners of autistic adults. Participants were recruited through social media and completed an anonymous online survey. Questions addressed their perceptions of the accuracy of the portrayal of Sam as an autistic person, and whether they thought the show would improve autism knowledge and attitudes. What were the results of the study?: The majority of participants thought that Sam's portrayal of autism within Atypical was accurate and that it would have some degree of educational benefit for non-autistic people. Family members appeared more likely than autistic people to think that Sam's portrayal was accurate, to believe that the show had educational benefit, and to agree that the show was likely to lead to more positive attitudes about autism. Participants expressed concern that Sam's portrayal was a stereotypical male representation of autism that was not representative of the broader autistic community and that the show presented a deficit-focused view of autism. What do these findings add to what was already known?: This study provides valuable information regarding the autism community's perceptions of the accuracy of the portrayals of autism, the potential educational benefit, and the likely influence on attitudes. It identifies that for entertainment media to better represent the lived experience of autistic people and improve community understanding of autism, there is a need for increased diversity of portrayals. What are potential weaknesses in the study?: The main weaknesses of the study are the overrepresentation of females (64%), the focus on a single television series with a male protagonist, and the limited detail on the participants' life experiences due to the anonymous nature of the study. How will these findings help autistic adults now or in the future?: This study should assist in advocacy with the producers of entertainment media, enabling them to hear the voices of the autism community and take on board their suggestions for more inclusive and representative portrayals of autism. Doing so has the potential to raise awareness, acceptance, and appreciation of autistic people in the broader community.

Advice for autistic people considering a career in academia.

LAY ABSTRACT: One of the recognised strengths of autistic people is their ability to absorb and retain large amounts of information; autistic children and adolescents are often described as 'little professors'. So, is the life of a university researcher or teacher the ideal career for an autistic person? In this study, 37 autistic people working in universities and colleges provide advice to young people considering a future career as an academic. They emphasise the importance of understanding the complexities and requirements of the role, understanding and valuing yourself and your strengths, and finding the right people to work with and learn from. They also discuss the importance of maintaining a balance between work and well-being, and between caution and passion. The life of an academic can be ideally suited to an autistic person, but it can also be very challenging.

Representation of autism in fictional media: A systematic review of media content and its impact on viewer knowledge and understanding of autism.

LAY ABSTRACT: The way autism is represented in fictional media can impact people's views of autistic people. For example, representations may contribute to negative views of autistic people as being unusual or dangerous, or they may challenge stereotypes and instead highlight the strengths of autistic people. This work aimed to review previous research to understand how autistic people have been represented in fictional media (Part A). It also sought to understand whether viewing fictional portrayals of autism has an impact on people's knowledge of autism and attitudes towards autistic people (Part B). Of 14 studies that were included in Part A, several unhelpful and stereotypical portrayals of autism emerged. Positive portrayals were those that highlighted the strengths of autistic people and reflected nuance. There is a need for greater diversity in representation of autism in fictional media. For example, not all autistic people are white heterosexual males. Across the five studies included in Part B, there were no improvements in people's knowledge of autism after watching or reading a short segment from a fictional TV series or novel that depicts an autistic person. Although there was a significant improvement in people's attitudes towards autistic people, these findings do not provide a complete picture given the short length of the media exposure and small number of studies. Future studies should investigate how multiple exposures to the representation of autistic people in both fictional and non-fictional sources can affect people's understanding of autism. There is also a need to develop more accurate and respectful ways of measuring people's knowledge of, and attitudes towards, autism.

Understanding the Experiences of Food Insecurity in Older Adult Households.

Food insecurity is a pressing multidimensional problem that negatively impacts the health and well-being of a significant number of the older population. Finding ways to better address nutritional issues among this vulnerable population is vital to their well-being. Using a mixed-methods approach, we conducted semi-structured phone interviews with a representative sample of 434 low-income older adult households in Tennessee. The aim of this study is to assess the prevalence of food insecurity, examine ongoing barriers, and, using qualitative data, to explore the diverse daily experiences older adults face when confronted with a food insecure lifestyle. Based on the USDA Adult 10-Item Household Screening Module, we found that 30% in our sample were designated as marginally, low or very low food secure. Many of those most vulnerable (older women, widowed or divorced, poor health and below the poverty line) constantly struggled with food insecurity. Being food insecure was attributed to limited financial resources, lack of transportation, health limitations, and a poor psychological state. Utilizing food stretching practicing, governmental agencies offering food supplements, family/friends, religious groups and personal resilience were common coping strategies. Implications and recommendations for service providers are offered.

Autistics working in academia: What are the barriers and facilitators?

LAY ABSTRACT: Academia appears to provide an ideal career option for autistic people: the opportunity to lock ourselves away in an ivory tower and utilise our extensive knowledge of a very specific topic. We know autistic people are underrepresented in postsecondary education, and there is a growing body of research on how to make universities more inclusive. What is missing from the literature is the voices of autistic people who have survived the university experience and gone on to become university teachers and researchers. Increasing the visibility of autistics in academia, and exploring the barriers and facilitators they experience in an academic career, is important to raise the aspirations of future university students and graduates. This study included 37 autistic academics from various disciplines and countries, exploring their perceptions of the positive and negative aspects of being an autistic in academia.

Measuring the Wrong Thing the Right Way? Time to Rethink Autism Research Tools.

Awareness and understanding of autism are increasing, sometimes in small incremental steps and sometimes through paradigm shifts. Much of this is driven by autistic advocates, whose voices are increasingly recognized as experts in their own lived experiences. The growing presence of autistic people in autism research-as participants, advisors, and (co)researchers-has brought about changes in the quality and relevance of autism research. We are seeing more studies by autistic autism researchers, more studies on issues of importance to autistic people, and more studies utilizing methodologies that resonate with autistic people. However, there remains a reliance on measures that are technically "valid" and "reliable" rather than relevant. As long as this is the case, we will continue to see studies published that "explain autism" in ways that do not reflect autistic experiences. Autism research is still making incremental changes and it is time for a paradigm shift.

"Why is this topic important?": Research into the experiences of autistic people is used to inform policy, practice, and community understanding. It is important that autism research respects and reflects autistic voices. Current research often uses scientific instruments that are not consistent with our lived experience of autism. "What is the purpose of this article?": This article explains why the current approach to research­encouraging the use of existing measures and incremental change­is harmful to autism research and to autistic people. It provides examples of commonly used tools and explains why they are problematic. The article aims at encouraging a discussion into why the findings of autism research are often inconsistent with the experiences of autistic people. "What personal or professional perspectives do the authors bring to this topic?": I am an autistic adult, the mother of two autistic adults and an autism advocate. I am also an autism researcher with a background in public health and communication. "What is already known about this topic?": Academic journals aim at publishing papers that present the best and most accurate research projects. Researchers are encouraged to use tools that have been developed and tested in previous studies, because these are considered to be "reliable" (consistent) and "valid" (accurate). Researchers are discouraged from developing new measures or making major changes to existing ones. So, it can be hard to publish community-driven research that uses tools developed by autistic people. "What do the authors recommend?": I recommend that autism researchers ensure that the tools they use to study autism actually measure the experiences of autistic people. I also recommend that we stop relying on existing measures that do not make sense to autistic people and work with autistic people to develop better tools. "How will these recommendations help autistic adults now or in the future?": These recommendations will help autistic adults by making autism research more relevant and useful. Research that reflects our actual experiences will improve community understanding of autism. It will also lead to better policies and practices that meet the needs and aspirations of autistic people.

Inclusion, Exclusion and Isolation of Autistic People: Community Attitudes and Autistic People's Experiences.

There is limited research examining the inclusion of autistic people in their local communities. This paper reports on two Australian studies which explored this gap, focusing on both autistic people's experiences and non-autistic people's attitudes towards autistic individuals. Study One was conducted with primarily non-autistic people (n = 2,383), and Study Two with primarily parents and carers of autistic people (n = 1,297 people). The majority of non-autistic adults perceived discrimination against autistic people in the community; consistent with the experiences of autistic people and their carers. Of particular concern was more negative attitudes towards, and experiences of, autistic adults. There is an urgent need to improve society's acceptance and inclusion of autistic people of all ages.

Motivators of Inappropriate Ovarian Cancer Screening: A Survey of Women and Their Clinicians.

Background: This study examined why women and doctors screen for ovarian cancer (OC) contrary to guidelines. Methods: Surveys, based on the Theoretical Domains Framework, were sent to women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer and family physicians and gynecologists who organized their screening. Results: Of 1264 Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer women, 832 (65.8%) responded. In the past 2 years, 126 (15.1%) had screened. Most of these (n = 101, 80.2%) would continue even if their doctor told them it is ineffective. For women, key OC screening motivators operated in the domains of social role and goals (staying healthy for family, 93.9%), emotion and reinforcement (peace of mind, 93.1%), and beliefs about capabilities (tests are easy to have, 91.9%). Of 531 clinicians 252 (47.5%) responded; a minority (family physicians 45.8%, gynecologists 16.7%) thought OC screening was useful. For gynecologists, the main motivators of OC screening operated in the domains of environmental context (lack of other screening options, 27.6%), and emotion (patient peace of mind, 17.2%; difficulty discontinuing screening, 13.8%). For family physicians,, the strongest motivators were in the domains of social influence (women ask for these tests, 20.7%), goals (a chance these tests will detect cancer early, 16.4%), emotion (patient peace of mind, 13.8%), and environmental context (no other OC screening options, 11.2%). Conclusion: Reasons for OC screening are mostly patient driven. Clinician knowledge and practice are discordant. Motivators of OC screening encompass several domains, which could be targeted in interventions to reduce inappropriate OC screening.

Autism in Australia: Community Knowledge and Autistic People's Experiences.

This paper presents two studies that explored community attitudes to autism in Australia; and autistic people and their families' perspectives of community attitudes. In Study One 2424 (primarily non-autistic) people completed a survey on autism-related knowledge and attitudes; identifying a number of misperceptions and knowledge gaps in the general community. In Study Two 1353 people (primarily parents and carers of autistic people) completed a survey on autism-related experiences; identifying that the community's awareness of autism does not appear to extend to understanding how to support autistic people. There is a need for more research which integrates the perspectives of both autistic people and the broader community; and the development of communication and education interventions, with rather than about autistic people.

Breast Cancer Chemoprevention: Use and Views of Australian Women and Their Clinicians.

Guidelines endorse the use of chemoprevention for breast cancer risk reduction. This study examined the barriers and facilitators to chemoprevention use for Australian women at increased risk of breast cancer, and their clinicians. Surveys, based on the Theoretical Domains Framework, were mailed to 1,113 women at ≥16% lifetime risk of breast cancer who were enrolled in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer cohort study (kConFab), and their 524 treating clinicians. Seven hundred twenty-five women (65%) and 221 (42%) clinicians responded. Only 10 (1.4%) kConFab women had ever taken chemoprevention. Three hundred seventy-eight (52%) kConFab women, two (3%) breast surgeons, and 51 (35%) family physicians were not aware of chemoprevention. For women, the strongest barriers to chemoprevention were side effects (31%) and inadequate information (23%), which operate in the Theoretical Domains Framework domains of "beliefs about consequences" and "knowledge," respectively. Strongest facilitators related to tamoxifen's long-term efficacy (35%, "knowledge," "beliefs about consequences," and "goals" domains), staying healthy for family (13%, "social role" and "goals" domains), and abnormal breast biopsy (13%, "environmental context" domain). The strongest barrier for family physicians was insufficient knowledge (45%, "knowledge" domain) and for breast surgeons was medication side effects (40%, "beliefs about consequences" domain). The strongest facilitators for both clinician groups related to clear guidelines, strong family history, and better tools to select patients ("environmental context and resources" domain). Clinician knowledge and resources, and beliefs about the side-effect consequences of chemoprevention, are key domains that could be targeted to potentially enhance uptake. PREVENTION RELEVANCE: Despite its efficacy in reducing breast cancer incidence, chemoprevention is underutilised. This survey study of Australian women and their clinicians used behavioural change theory to identify modifiable barriers to chemoprevention uptake, and to suggest interventions such as policy change, educational resources and public campaigns, that may increase awareness and use.See related Spotlight by Vogel, p. 1.

Children and tutor's perspectives on a homework support program in Melbourne: A university-school partnership.

This study focuses on a homework program where an Australian University partnered with a school to support children from culturally and linguistically diverse backgrounds. Undergraduate tutors, paired with a child each semester, provided weekly learning support. This exploratory study aimed to understand the experiences of the children participating in the program and any benefits received. Nineteen children participated in activity-based focus groups, and seven undergraduate tutors participated in one-on-one interviews. Overarching themes identified were as follows: making homework club enjoyable, program outcomes, tutor-child relationship and transitioning to a new tutor. Although children were required to do homework they usually avoided, the task was made less onerous and even enjoyable because of the relationship the children had with their tutor, the support received and new skills learnt. The tutor-child relationship was deeply valued, with the tutor's role going beyond instructional support to also providing social and emotional support and a sense of belonging in line with Social Support Theory. Both the children and tutors expressed contrasting views about the experience of children transitioning to a new tutor each semester and this departs from the extant literature. The challenges related to the loss of connection, while positive aspects concerned the opportunity to make new friends and learn from different teaching styles. Given these contrasting findings, it is worth considering how the transition process can be managed and explained to children and increase the chances of positive adaptation. Despite the relatively short-term nature of the tutor-child relationship, the children expressed clear academic, social and emotional benefits. The findings suggest that semester-based university-school homework tutoring programs can be effective despite their short-term nature, provided due consideration is given to the transition process. These findings address the paucity of research exploring short-term programs of this nature.

Australian lessons for developing and testing a culturally inclusive health promotion campaign.

The purpose of the study was to develop and test culturally appropriate health promotion materials that were seen to be socially inclusive in regard to blood donation within the Australian-African community. Materials were produced in multiple languages (English, Arabic, Swahili and Kirundi) and were initially developed based on previous pilot data, with feedback from the project partner (Australian Red Cross Blood Service) and the African community. Seven formative focus groups with 62 participants were then conducted to ensure the materials would be effective, credible and culturally acceptable to the target audience, including preferred messages, taglines and images. The response confirmed that quotes and images from community members (as opposed to actors) were critical to ensure messages were engaging and believable, and had meaningful taglines that were perceived to be authentic. The refined materials were then used in a community intervention study. The evaluation included an assessment of respondents' views of the messages post-intervention. Of the 281 African migrants who saw the campaign materials during the intervention period, the majority (75.8%) strongly agreed that the materials made them feel part of the wider Australian community. These results suggest that engagement in developmental activities with targeted communities is important for creating positively viewed culturally targeted public health campaigns. A six-step process is suggested that could be used by other organizations to ensure that messages are acceptable to targeted migrant communities.

An Australian study on the benefits of pastoral care to aged care residents in Christian affiliated homes.

This study aimed to understand the experience of pastoral care (PC), that is, the provision of support, comfort and spiritual counselling, from the perspective of Australian aged care residents. A survey research design captured feedback on participants' PC experience. Outcomes were reported by 575 residents (aged 53-102) across 41 sites. The majority perceived that they received a high quality of care (92%) and benefited from their meeting with the pastoral practitioner (80%), 'often' or 'all of the time'. A few significant differences were found based on participants' gender, spirituality (i.e. connection and meaning), religiosity (i.e. faith beliefs and religious practices) and well-being. Females and participants who identified as both religious and spiritual were more likely to feel that their faiths/beliefs were valued. Those with greater psychological well-being, as defined by the World Health Organisation (1998), were more likely to report receiving a high quality of care and greater benefits from receiving PC than those with poorer well-being. Three overarching themes and eight subthemes were identified from the open-ended responses: 1) personal qualities of the pastoral practitioner; caring, supportive, understanding and empathetic; 2) pastoral practitioner met specific needs; spiritual and religious, friendship and company and assistance, advice and help; and 3) positive impact on the participant; feeling listened to, peaceful and valued, accepted and respected. The qualitative findings resonate with Maslow's Hierarchy of Needs, to feel safe, belong and have self-esteem. There was a synergy between what participants desire in the care they receive, as expressed in the open-ended questions, and what the pastoral practitioners provide, as indicated in the quantitative findings. A study strength was its mixed-method, multi-site and cross-organisational context, enabling PC to be explored across a diverse sample. Future research should consider a pre- and post-test survey to more comprehensively capture the impact and benefits of PC.

'Coming Out' with Autism: Identity in People with an Asperger's Diagnosis After DSM-5.

Asperger's Syndrome was introduced as a separate diagnostic category in the DSM-4 (1994). Its subsequent absorption into autism spectrum disorder in the DSM-5 (2013) led to vigorous debate and concerns about the loss of the unique Asperger's identity. Existing research has identified that adults previously diagnosed with Asperger's have expressed a diverse range of opinions regarding the DSM-5 changes. This Australian study explored the role of disability identity development in responses to the change through semi-structured interviews with 12 adults diagnosed with Asperger's under the DSM-4. Their different views did not appear to be a function of demographic variables; a connection was identified between participants' views of the change and differing stages of integration with the Asperger's and/or autism identities.

HIV Health Care Transition Readiness: Embracing the Opportunity and Challenge.

Because of effective treatment and prolonged survival, thousands of young adult people living with HIV will need to transfer their health care to adult care providers. However, many lack basic essential skills and are not prepared for this transition. Many providers do not assess transition readiness on a regular basis. Validated transition readiness assessment tools can help providers guide interventions based on identified skill and knowledge deficits. Our purpose was to describe the impact of incorporating a validated Transition Readiness Assessment Questionnaire (TRAQ) into clinical practice. A retrospective chart review of 48 patients with HIV, ages 22-24 years, showed that the use of the TRAQ significantly affected provider interventions in the area of medication management (odds ratio: 0.02). Overall, the use of the TRAQ did not increase clinical interventions; however, it enabled providers to identify knowledge or skill deficits not previously addressed and to plan future clinical interventions to meet individual patient needs.

'You could get sick, disgusting': an analysis of alcohol counter-advertisements created by children.

Advertisements are persuasive texts designed to communicate ideas explicitly and implicitly through visual grammar. Counter-advertisements allow students to engage with advertising texts as creators rather than consumers and challenge media messages. Based in critical media literacy theory, this paper explores how elementary students interpret and redesign advertisements to create meaning. This study focused on the messages upper-elementary school students created about alcohol following a 10-lesson alcohol media literacy programme. Text from the counter-advertisements (n = 161) was analysed using discourse analysis. The counter-advertisements were also content analysed for message content, persuasion strategies and production components using a media literacy framework. The content of male-targeted, female-targeted and gender-neutral ads was compared using chi-square analyses. The four main themes identified in the discourse and content analysis were 'vomit', 'sick', 'danger' and 'poison', highlighting an emphasis on short-term consequences of alcohol misuse. Sensory (un)appeal was the most frequently used persuasion strategy, while objects/symbols and colour were the most frequently used production components. The use of these devices differed depending upon the advertisement's target gender. Involving elementary students in the redesign of advertisements is a powerful pedagogy that enables students to demonstrate their understanding of media literacy practices and create health promotion messages.