Intertribal Talking Circle for the prevention of alcohol and drug use among Native American youth.

The purpose of this study was to examine the impact of a culturally based intervention, the Intertribal Talking Circle program, compared to a standard alcohol and drug abuse education, the Be A Winner program. Community-based participatory research was used to implement a two-condition, quasi-experimental study. The sample included 540 Native American youth ages 10-12 years old from three tribal areas in the United States. Data were collected at baseline, 6 and 12-months post-intervention for both the intervention and control groups using demographic, cultural identity, alcohol use, and drug use questionnaires. Regression models evaluated participants' improvement in decreasing alcohol and drug use and increasing cultural identity. Findings revealed that alcohol and drug use decreased more significantly among youth who participated in the Intertribal Talking Circle (ITC) intervention program than youth who participated in a standard alcohol and drug abuse education Be A Winner (BAW) program. Cultural identity also increased more significantly among participants who completed the Talking Circle intervention program. Native American youth ages 10-12 years old respond positively to a culturally based intervention for the reduction of alcohol and drug use. The findings highlight the importance of cultural values and identity and their significance in preventing and reducing alcohol and drug use among Native American youth.

Cultural Identity and the Academic, Social, and Psychological Adjustment of Adolescents with Immigration Background.

As Western societies become more ethnically and culturally diverse, understanding the acculturation of immigrant youth is essential for fostering social cohesion. How the cultural identity formation of ethnic minority adolescents relates to their academic, social, and psychological adjustment is an important and as yet unresolved research question. This study examined to what extent identifying with the heritage and/or host culture is an individual resource or risk factor for the adjustment of immigrant youth in Germany. A random sample of 15-17-year-olds (N = 1992; Mage_w1 = 15.3 years, SD = 0.64; 44.5% girls; 44.7% students with immigrant background) was assessed twice: at the end of 9th and 10th grade. Academic performance and three dimensions of social/psychological adjustment (school attachment, self-esteem, and life satisfaction) were examined. Results showed that biculturalism was the modal identification pattern. Contrary to expectations, cultural identification did not differ systematically with perceived distance from the majority culture. Multivariate structural equation modeling revealed that both heritage and host identification can be developmental resources, but that their effects are dependent on the dimension of adjustment; biculturalism only proved to be a cumulative resource for school attachment. The domain specificity of the findings challenges the generalization claims of predominant acculturation theories.

Adolescent Cultural Identity Development in Context: The Dynamic Interplay of the Identity Project With Classroom Cultural Diversity Climate in Italy and Germany.

While both the classroom cultural diversity climate and curriculum-based interventions can promote cultural identity development, they have not been studied together. Drawing on theories of ethnic-racial identity development, the current study aimed to understand the dynamic interplay of a curriculum-based intervention (the Identity Project) with the classroom cultural diversity climate (heritage culture and intercultural learning, critical consciousness socialization and equal treatment) on cultural identity exploration and resolution. Our sample included 906 mid-adolescents in Italy (32.36% immigrant descent, Mage (SD) = 15.12 (0.68) years, 51.73% female), and 504 early adolescents in Germany (53.86% immigrant descent, Mage (SD) = 12.82 (0.89) years, 42.37% female). Bayesian multivariate linear models show that the Identity Project and a stronger critical consciousness climate in the classroom before the intervention promoted cultural identity exploration at post-test in both countries. However, effects of the intervention and facets of the diversity climate on subsequent resolution were only observed in Italy. There was some evidence that the intervention could alter the classroom cultural diversity climate in Germany, while the intervention could compensate for a less positive diversity climate in the slightly older sample in Italy. Thus, it seems promising to systematically build in opportunities to engage with students' diverse heritage cultures and identities when developing new curricula, as well as to train teachers to implement such curricula.

A commercial tobacco and alcohol use intervention for urban Native American youth.

OBJECTIVE: Westernized alcohol and commercial tobacco use prevention approaches for Native Americans have not been effective, or sustainable. The overall objective of this study examined the effect of the culturally based Urban Talking Circle (UTC) intervention versus standard education (SE) program for the prevention of alcohol and commercial tobacco use among urban Native American youth. DESIGN: The study employed a 2-condition quasi-experimental design and utilized convenience and snowball sampling methods for recruiting 100 urban Native American youth participants in two urban Native American community program locations in Florida. Study participants were randomized by their urban Native American community program location to one of the 2-conditions. These included the standard education (SE) program used within United States school systems (drug abuse resistance education) and the Urban Talking Circle (UTC) intervention, culturally tailored and developed for urban Native American youth from the culturally based Talking Circle Intervention for rural Native American Youth. The Native American Alcohol Measure for Youth (NAAMY) and Native Reliance Questionnaire were utilized to collect participants' data. Participants' data was analyzed using multivariate analysis of variance to determine differences between the scores on all measures at pre/post-intervention for the 2-conditions. RESULTS: Study findings indicate that a culturally based intervention was more effective for the reduction of commercial tobacco and alcohol use than a non-culturally based intervention for urban Native American youth. CONCLUSION: The study findings emphasized that the utilization of the culturally tailored UTC intervention reduced involvement associated with alcohol and commercial tobacco use.

Art Therapy Interventions for Syrian Child and Adolescent Refugees: Enhancing Mental Well-being and Resilience.

PURPOSE OF REVIEW: This critical review primarily aims to conduct a comprehensive assessment of recent studies conducted within the past 3 years, with a specific focus on the use of art therapy within Syrian child and adolescent refugee populations. The central objective of this inquiry is to explore the impact of art therapy interventions and provide critical insights into their effectiveness in enhancing the mental well-being and resilience of these young refugees. RECENT FINDINGS: Recent research conducted within the past 3 years highlights the effectiveness of art therapy as an intervention strategy within Syrian child and adolescent refugee populations. These studies emphasize that art therapy offers a safe and supportive space for these young refugees to express emotions, process trauma, and improve their psychological well-being. It has shown promise in mitigating trauma-related challenges and fostering resilience among this group of refugee populations. Furthermore, art therapy plays a crucial role in preserving cultural identities and has proven to be versatile and adaptable to various artistic modalities. These findings underscore the potential of art therapy as a valuable tool for supporting the mental well-being and resilience of Syrian children and adolescent refugees, warranting further exploration and integration into their care and support programs. Recent studies on the use of art therapy within Syrian child and adolescent refugee communities reveal its potential as a powerful intervention strategy for enhancing mental well-being and resilience in this vulnerable population. The review identifies six key themes, highlighting the therapeutic benefits and versatility of art therapy. As we move forward, these findings offer promising future directions for research and practice in art therapy with this specific group of refugees, emphasizing the need for continued exploration and integration of this approach in supporting Syrian child and adolescent refugees.

Outcomes of LGBTQ culturally sensitive training among civilian and military healthcare personnel.

BACKGROUND: Lesbian, gay, bisexual, transgender, or queer (LGBTQ) military servicemembers are at higher risk of developing health problems compared to heterosexual peers. To improve outcomes and address negative attitudes, previous literature has recommended education of healthcare personnel. The purpose of our study was to evaluate the knowledge and skill outcomes of an LGBTQ cultural sensitivity training program. METHODS: We used a pretest/posttest design. Participants completed the Ally Identity Measure (AIM) to assess three subscales: knowledge and skills, openness and support, and oppression awareness. Participants included both military and civilian healthcare personnel from multiple disciplines. Descriptive statistics and pairwise analyses were used. RESULTS: A total of 101 participants answered both pretest and posttest. Across all AIM subscales, posttest scores demonstrated statistically significant (P < 0.001) increases from mean pretest scores. Completion rates for the pretest and posttest were 99% and 93%, respectively. The majority of participants were female (75%) and non-Hispanic (87%), composed of Caucasians (39%) and Asians (33%). Over one-third (39%) of participants were aged 30-39. Fifty percent were active-duty military and more than half (58%) of all participants did not have prior training in LGBTQ patient care. Statistically significant differences were found between the pretest and posttest scores for the knowledge and skills subscale (M = 2.64-3.70). The most significant increases were observed in Item 12 and Item 15 (M = 2.72-3.70) regarding awareness of theories and skill development to provide proper support, respectively. CONCLUSION: These significant findings contribute to the currently limited research exploring LGBTQ cultural sensitivity training in both civilian and military settings. To our knowledge, this is the first time a cultural sensitivity training of this depth has been provided to active-duty servicemembers. Further research and development of similar educational programs integrating interactive participation can potentially aid in the delivery of improved care and military readiness for all servicemembers.

Associations among migration risk factors, cultural identity conflict, and psychological symptoms among Syrian emerging adults with refugee backgrounds in the Netherlands.

OBJECTIVES: In the present study, we examined relations between premigration, perimigration, and postmigration risk factors (i.e., potentially traumatic events [PTEs], postmigration living problems [PMLPs], stressful life events) and psychological symptoms (i.e., anxiety/depression, posttraumatic stress) in Syrian emerging adults with refugee backgrounds; we also tested cultural identity conflict as a possible mediator of these relations. We expected that greater exposure to migration risk factors was associated with more psychological symptoms and that higher cultural identity conflict would contribute to these associations. METHODS: We used data from the first wave of Karakter, a longitudinal study of 158 Syrians with refugee backgrounds (69.0% men, age range 18-35). Participants completed a questionnaire assessing PTEs, PMLPs, stressful life events, cultural identity conflict, and symptoms of anxiety/depression and posttraumatic stress. RESULTS: Correlational analyses indicated that more PTEs and stressful life events were related to higher levels of cultural identity conflict and more psychological symptoms. Furthermore, greater cultural identity conflict was associated with more psychological symptoms. We did not observe indirect effects of cultural identity conflict in the mediation analyses. CONCLUSIONS: Results suggest that postmigration stressors and cultural identity conflict are associated with psychological symptoms among Syrian emerging adults who have resettled in the Netherlands.

Cultural Identity Configurations: A Latent Profile Analysis of Ethnic/Racial and U.S. Identity Process and Content.

Cultural identity, which represents the degree to which individuals define themselves with the cultural groups to which they belong, is a particularly salient developmental task for ethnic/racial minoritized youth. Two important identity domains of cultural identity, ethnic-racial and U.S. identity, have been consistently associated with psychological and academic adjustment. That said, the majority of this research has been variable centered, limiting the capacity to understand the specific developmental configurations of ethnic/racial and U.S. identity. Addressing this gap, the current study utilized latent profile analysis (LPA) to identify unique profiles of ethnic/racial identity and U.S. identity across process and content dimensions among a sample of 376 Hispanic/Latinx college students (Mage = 20.58, SD = 2.69) and examine the separate and joint links between ethnic/racial and U.S. identity profile membership and adjustment. The LPA identified three similar profiles for ethnic/racial identity (i.e., Diffused/Negative, Diffused/Neutral, and Developed/Positive), U.S. identity (Diffused/Negative, Diffused/Positive, and Developed/Positive), and ethnic/racial and U.S. identity (i.e., Diffused/Negative, Diffused/Neutral, and Bicultural), highlighting that ethnic/racial and U.S. identity not only share parallel dimensionality but manifest themselves remarkably similar in their configuration across process and content dimensions. Separately, individuals classified in a Developed/Positive profile reported the highest levels of adjustment. Jointly, individuals classified as Bicultural (60.49%) exhibited the highest levels of adjustment. The findings highlight the benefit of a positive bicultural identity that embraces both domains of cultural identity.

Does "who I am" influence "how I feel"? Cultural identity and mental health among Hong Kong Chinese adolescents.

Securing a clear sense of identity is a critical issue in adolescence, yet the role that cultural identity plays in the well-being of youths remains unclear. This study aims to examine the relationship between cultural identity and mental health among three groups of adolescents in Hong Kong with different residential backgrounds. Data came from a cross-sectional survey with 2180 4th-9th grade students in Hong Kong. Cultural identity was assessed by whether the youths identify themselves as local Hong Kong people, mainland Chinese, both Hong Kong and mainland Chinese, or confused about which group to belong to. Mental health was assessed by self-esteem, mental well-being, happiness, social anxiety, and depression. Multiple linear regression was performed to examine the relationship between cultural identity and mental health, adjusting for sociodemographic variables. The regression results suggested adolescents with confused cultural identity scored lower in all positive indicators of mental health compared with those with a clear cultural identification. No significant association was found between cultural identity and social anxiety/depression. Uncertainty in cultural identification may be detrimental for the mental health of adolescents living in a multicultural society. Interventions may consider cultivating clear cultural identities among adolescents to promote their mental health.

Cultural identity affiliation and alcohol use and related consequences among American Indian and White adolescents: A latent profile analysis.

BACKGROUND: Adolescent alcohol use is a significant public health concern and rates of alcohol use are higher among American Indian (AI) adolescents than national samples of non-AI youth. A potential factor in understanding AI alcohol use is cultural identity, which can vary widely based on experiences of historical trauma. We used latent class analysis to examine cultural identity in AI and White adolescents and their alcohol use outcomes in relation to the latent class solutions. METHODS: The samples included 3189 AI adolescents (Mage  = 14.76, 48.9% female) and 1579 White adolescents (Mage  = 15.56, 48.7% female) living on or near a reservation. Participants completed self-report measures of AI and White cultural identity affiliation, alcohol use, and alcohol-related problems. We examined (1) the best-fitting latent class solution with respect to American Indian (AI) and White cultural identity; (2) equivalence of the latent class solution; and (3) alcohol use outcomes across the optimal latent class solution. RESULTS: Latent profile analyses indicated an optimal 3-class solution in both the AI and White samples, which differed by level of affiliation with AI and White cultural identity. While the optimal number of classes were similar across racial groups (configural profile similarity), the nature of the classes differed (structural profile dissimilarity). The three classes represented low overall scores on AI and White cultural identity (Marginalized), a mixture of high and low scores on AI and White cultural identity (Third Culture), and overall high scores on AI and White cultural identity (Bicultural). Alcohol-related problems predicted membership in the Third Culture class compared with the Marginalized class and the Bicultural class. Specifically, youth in the Third Culture class reported significantly fewer alcohol-related problems than youth in the Marginalized and Bicultural classes. Alcohol use did not predict latent class membership. CONCLUSIONS: The future-oriented nature of the Third Culture class may provide protection against adverse alcohol-related outcomes. Research is needed to test interventions that target greater future orientation and future plans to integrate culture into adolescents' lives.

Psychosocial Experiences That Support Positive Self-Concept in Children with Cleft Lip and Palate Adopted From China.

OBJECTIVE: Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population. DESIGN: Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis. SETTING: Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit. PATIENTS, PARTICIPANTS: Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents. RESULTS: Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme. CONCLUSIONS: Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.

ICIRAS: Research and reconciliation with indigenous peoples in rural health journals.

AIM: We aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications. CONTEXT: This is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals-the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health-recognised that Indigenous peoples' identity could be embedded in authorship details. APPROACH: An environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is 'nothing about Indigenous people, without Indigenous people' in rural health research publications. CONCLUSION: Improving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call-to-action for research journals and institutions to rigorously improve publication governance that signals "Editing with IndigenUs and for IndigenUs".

Indigenous Cultural Identity of Research Authors Standard: research and reconciliation with Indigenous Peoples in rural health journals.

The Indigenous Cultural Identity of Research Authors Standard (ICIRAS) is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously recognised in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination. Reflecting on these broader movements, the editorial teams of three rural health journals - Rural and Remote Health, the Australian Journal of Rural Health, and the Canadian Journal of Rural Medicine - adopted a policy of 'Nothing about Indigenous Peoples, without Indigenous Peoples'. This meant changing practices so that Indigenous Peoples' identity could be embedded in authorship credentials - such as in the byline. An environmental scan of literature about the inclusion of Indigenous Peoples in research revealed many ways in which editorial boards of journals could improve their process to signal to readers that Indigenous voices are included in rural health research publication governance. Improving the health and wellbeing of Indigenous peoples worldwide requires high-quality research evidence. This quality benchmark needs to explicitly signal the inclusion of Indigenous authors. The ICIRAS is a call to action for research journals and institutions to rigorously improve research governance and leadership to amplify the cultural identity of Indigenous peoples in rural health research.

Improving immunization uptake rates among Gypsies, Roma and Travellers: a qualitative study of the views of service providers.

BACKGROUND: Gypsies, Roma and Travellers are at risk of low uptake of routine immunizations. Interventions to improve uptake in these communities are seldom evaluated. As part of a qualitative study exploring barriers and facilitators to immunization uptake in Travellers, we report service provider (SP) perspectives. METHODS: We interviewed immunization SPs working with six Traveller communities across four UK cities. Participants included frontline staff and those with strategic or commissioning roles. Semi-structured interviews explored perceived attitudes of Travellers to vaccinations, local service delivery, and opportunities and challenges to improving uptake. Audio-recordings were transcribed, analyzed thematically and mapped to a socio-ecological model of health. RESULTS: 39 SPs participated. Four overarching themes were identified: building trusting relationships between SPs and Travellers; facilitating attendance at appointments; improving record keeping and monitoring and responding to local and national policy change. Travellers were perceived as largely supportive of immunizations, though system and organizational processes were recognized barriers to accessing services. CONCLUSIONS: Findings were broadly consistent across Traveller groups and settings. The barriers identified could often be addressed within existing infrastructure, though require system or policy change. Development of a culturally competent system appears important to enable equity in access to immunizations for Travellers.

Maintaining cultural identity: A systematic mixed studies review of cultural influences on the self-care of African immigrants living with non-communicable disease.

AIM: To understand and identify cultural factors influencing the self-care practices of African immigrants living with chronic illness in countries outside Africa. BACKGROUND: The influence of cultural factors on self-care is relatively unexplored in African immigrants with non-communicable diseases (NCDs). DESIGN: Systematic Mixed Studies review. DATA SOURCES: PubMed, Psych Info, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus and Sociological Abstract computerized databases. No limit was placed on publication date. REVIEW METHODS: Results-based convergent design was used. The Mixed Method Appraisal Tool was used to evaluate the studies. Quantitative studies were synthesized narratively while qualitative studies were synthesized using thematic synthesis. RESULTS: We identified 251 articles and nine fulfilled our inclusion criteria. The studies were published between 2006 and 2019, with six qualitative and three quantitative studies. Studies were conducted in the United States, Australia, Sweden, the Netherlands and the United Kingdom. Most studies examined the influence of culture on self-care of diabetes (n = 6), while the rest focused on hypertension (n = 3). Findings highlight that cultural norms and practices, non-Western approaches to interpreting and managing illness, cultural connotations of health behaviours and structural challenges influencing self-care. Cultural food preferences made adherence to prescribed diets challenging. Family support facilitated self-care. Maintaining cultural identity was both a driver and constraint to engaging in self-care. CONCLUSION: The complex interplay of cultural and structural factors influences the willingness of Africans who have immigrated to a developed country to follow recommended self-care practices. Considering these cultural norms and structural barriers can help to explain the self-care behaviours of African immigrant populations. IMPACT: Clinicians and policymakers who account for structural factors and integrate cultural factors into care facilities, treatment protocols and policy can be influential in promoting self-care in African immigrant populations.

[Ethnicity and immigration status: How are they associated with work and depressive symptoms?] / Ethnicité et statut d'immigrant : quelle association avec le travail et les symptômes dépressifs ?

BACKGROUND: The purpose of this research is to determine whether, in the Canadian workforce, cultural identity traits, particularly ethnicity and immigrant status, might modify the association of work with depressive symptoms. METHOD: Data were derived from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 6477 workers, multilevel regression models were brought into being. Analyses were adjusted for family-related factors, non-work social support, and personal characteristics. RESULTS: After accounting for potential confounders, ethnicity and work-related factors were distinctly and directly associated with depressive symptoms. Workers belonging to visible minorities had significantly fewer depressive symptoms than their Caucasian counterparts. Unlike Caucasians, they were more often overqualified, less in a position to use their skills, and largely without decision-making authority. On the other hand, all analyses having to do with immigrant status led to inconclusive results. CONCLUSION: Ethnicity seems to have some bearing on the association of work with depressive symptoms among members of the Canadian workforce. It might be beneficial to carry out targeted interventions aimed at improving working conditions according to ethnicity and situations involving professional overqualification.

Directional Effects in Cultural Identity: A Family Systems Approach for Immigrant Latinx Families.

Although there is a substantial body of work focusing on the processes underlying cultural identity in general, less is known regarding how these processes might operate within the context of Latinx families. Moreover, among the limited research that has included the adolescent and caregiver cultural identity, most of the research has primarily focused on how caregivers influence their adolescent's cultural identity. In the present study, the directional pathways between recently immigrated adolescents' and caregivers' ethnic and U.S. identity belonging were examined using data from a longitudinal study of acculturation and identity development among recently arrived Latinx immigrant families. The sample consisted of 302 primary caregivers (Mage = 41.09, SD = 7.13 at baseline; 67.5% mothers) and their adolescents (Mage = 14.51, SD = 0.88 at baseline; 46.7% female). The results indicated that caregivers' ethnic identity belonging significantly predicted adolescents' ethnic identity belonging over time. At the same time, adolescents' ethnic identity negatively predicted caregivers' ethnic identity belonging over time, whereas adolescents' U.S. identity belonging positively predicted caregivers' later ethnic identity belonging. The findings indicate that immigrant caregivers may retain their native culture to direct and respond to their children's changing cultural identifications.

Indigenous youth reconnect with cultural identity: The evaluation of a community- and school-based traditional music program.

Reconnecting Indigenous youth with their cultural traditions has been identified as an essential part of healing the intergenerational effects of forced assimilation policies. Past work suggests that learning the music of one's culture can foster cultural identity and community bonding, which may serve as protective factors for well-being. An 8-week traditional song and dance program was implemented in a school setting for Indigenous youth. An evaluation was conducted using a mixed-method design to determine the impact of the program on 35 youth in the community. A triangulation of qualitative and quantitative data revealed several important themes, including personal development, cultural development, social development, student engagement in school-based programming, and perpetuating cultural knowledge. The program provided students with an opportunity to connect with their cultural traditions through activities that encouraged self and cultural expression. Community responses suggested that this type of programming is highly valued among Indigenous communities.

'Where and how do you buy medicines?' A pilot survey of consumption strategies among the public in Sweden.

BACKGROUND: Substandard and falsified (SF) medical products are a major danger to public health. They affect every region of the world, and have been identified in all major therapeutic categories. Studies from medicine, pharmacology, law and public health dominate this research area with a focus on the supply side. However, the spread of SF medical products cannot be fully understood without information about the demand side or a sociocultural perspective on market formation. The aim of this short report is to present findings from a pilot study that examines the attitudes of the Swedish public regarding consumption of medicines. METHODS: We conducted a pilot survey in 2016 'Where and how do you buy medicines?' using LimeSurvey, an open-source online survey software. In total 155 respondents completed the survey. RESULTS: The majority of respondents turn to doctors within healthcare for prescription-only medicines (POM). Simultaneously, some respondents would consider buying POMs without prior contact with experts even if medicines may come from unsafe sources. CONCLUSIONS: There is a tendency that people move away from formal healthcare towards an unregulated market. In parallel, people's approach to doctors becomes more personalized and pragmatic than in former patriarchal relationships. Risk becomes a negotiable concept.