"Older people will die of old age. I'll die of climate change": engaging children and young people in climate decision making for public health.

BACKGROUND: The climate crisis is a significant risk to the health and wellbeing of children, young people, and future generations. While there are calls for children and young people's engagement in climate decision making, current power structures limit their participation. This paper aimed to understand children's perspectives about the impact of the climate crisis on their futures, their ability to influence climate decisions, and strategies and mechanisms to facilitate their greater engagement in decisions made about the climate crisis. METHODS: Online in-depth interviews were conducted with n = 28 children (aged 12-16 years) across Australia. Photo elicitation techniques were used to prompt discussion about how the climate crisis impacted their futures, their ability to influence climate decisions, and strategies and mechanisms to engage them in climate decision making. A reflexive approach to thematic analysis was used to construct three themes from data. Images were analysed for ascribed meanings. RESULTS: First, participants stated that they and future generations will inherit the climate crisis from older generations, specifically decision makers. Second, they described a need to address a range of age-related barriers that limit children and young people's engagement in climate decision making, including perceptions about their capabilities. Finally, they discussed strategies and mechanisms to embed children and young people's perspectives within climate decision making, including at civic and political levels. CONCLUSIONS: Children and young people have the right to be involved in decisions made about the climate crisis which significantly impact their futures, including their health and wellbeing. They argue for structural changes to embed their views in climate decision making, and describe a range of engagement strategies and mechanisms to structure their perspectives and knowledge with decision making processes. Furthermore, genuine involvement of children and young people in climate discussions must avoid youthwashing and tokenistic participation. The public health community can help address barriers to youth participation in climate action and should actively engage and collaborate with children and young people to facilitate their political and democratic influence over the climate crisis. This involves making room and creating an accessible seat at the decision making table to ensure their perspectives are embedded in climate decisions.

"It's changing our lives, not for the better. It's important that we have a say". The role of young people in informing public health and policy decisions about gambling marketing.

BACKGROUND: Marketing has a significant impact on the normalisation of gambling for youth across the globe. This has included shaping positive attitudes towards gambling, as well as increasing the social and cultural acceptance of gambling - particularly aligned with valued activities such as sport. Because of this, public health experts argue that gambling marketing poses a significant risk to the health and wellbeing of youth. While young people are increasingly exposed to, and impacted by marketing for gambling products, they are rarely consulted about policy issues and options. This study aimed to explore young Australians' perceptions of current policy responses to gambling advertising, whether they thought young people should be involved in discussions and decisions about gambling marketing regulations, and their perceptions of the duty of governments to protect young people from gambling industry marketing strategies. METHODS: Qualitative focus groups (n = 22) were held with n = 64, 12-17 year olds in the Australian states of Victoria and New South Wales. Participants were asked to reflect on current gambling policies, particularly relating to marketing, what they thought should be done about gambling marketing, and if and how young people should be included in public health responses to gambling. An interpretivist 'Big Q' approach to reflexive thematic analysis was used. RESULTS: Young people highlighted the need for more effective regulations around the content and frequency of gambling marketing. They also wanted to see more realistic representations of the negative impacts of gambling to counter persistent positive commercial marketing messages. Most thought that young people should be given an opportunity to have a say about responses to gambling due to their unique experiences. Participants identified mechanisms to increase young people's engagement in decision making, such as direct lines of communication to different levels of government, involvement in research, and diversifying ways of engagement. Specific recommendations included more regulatory action such as bans on gambling advertising. CONCLUSIONS: Creating formal structures that facilitate the inclusion of young people's perspectives in decisions made about gambling can result in more innovative and effective strategies to prevent the harms from gambling industry products, promotions, and practices.

The role of alcohol consumption in the lives of older Australian women: qualitative insights and an agenda for further research, policy and practice.

BACKGROUND: Alcohol consumption presents a threat to the health and wellbeing of women. The alcohol industry often pushes back at global efforts to prioritise the prevention of alcohol harms to women. Qualitative researchers have investigated how younger and midlife women conceptualise their alcohol consumption, but there is very limited research relating to older women (those 60 years and over). METHODS: Using data collected from an online qualitative survey, this paper explored the factors that influence how older Australian women drinkers (n = 144. 60-88 years) conceptualised the role of alcohol in their lives. The study used a 'Big Q' reflexive approach to thematic analysis, drawing upon sociological theories of risk and symbolic interactionism to construct four themes from the data. RESULTS: First, alcohol consumption was viewed by participants as an accepted and normalised social activity, that was part of Australian culture. Second, alcohol played a role for some participants as a way to cope with life changes (such as retirement), as well as managing stressful or challenging life circumstances (such as loneliness). Third, alcohol was part of the routines and rituals of everyday life for some women. For example, women discussed the consumption of wine with their evening meal as an important part of the structure of their day. Fourth, participants had clear personal expectancies about what it meant to be a 'responsible drinker'. They had clear narratives about personal control and moral obligation, which in some cases created a reduced perception of their own risk of alcohol-caused harm. CONCLUSIONS: This research provides a starting point for future public health research examining the factors that may shape older women's alcohol consumption beliefs and practices. Public health activities should consider the unique needs and potential vulnerabilities of older women drinkers, and how these may be potentially exploited by the alcohol industry.

Children, young people and the Commercial Determinants of Health.

The commercial determinants of health (CDoH) have a significant impact on the health and well-being of children and young people (subsequently referred to as young people). While most research has focused on the influence of harmful industry marketing on young people, more recent CDoH frameworks have emphasized that a range of commercial systems and practices may influence health and well-being. Focusing on the impact of traditional and digital media, contemporary marketing strategies and corporate production and consumption processes, the following article outlines the impact of the CDoH on the health and wellbeing of young people. The article also provides evidence about how young people conceptualize the impact of corporate actors on health, and their involvement in advocacy strategies to respond. The article recommends that when collaborating with young people to understand the impacts of and responses to the CDoH, we should seek to diversify investigations towards the impact of a range of corporate tactics, systems and structures, rather than simply focusing on the impacts of advertising. This should include considering areas and priorities that young people identify as areas for action and understanding why some young people are more vulnerable to commercial tactics than others. Youth are powerful allies in responding to the CDoH. Public health and health promotion stakeholders could do more to champion the voices of young people and allow them to be active participants in the decisions that are made about harmful commercial practices and health.

'You can't really separate these risks, our environment, our animals and us': Australian children's perceptions of the risks of the climate crisis.

Perceptions of the risks associated with the climate crisis are shaped by a range of social and political contexts and information sources. While some have expressed concerns about the impact of the spread of climate misinformation through social media platforms on young people, others have shown that the youth climate movement has played a key role in countering misinformation. Despite this, there has been very limited research with children about how they conceptualize the risks associated with the climate crisis, how they receive climate information, and how they understand and apply this to their own and others' lives. The following qualitative study used photo-elicitation techniques and in-depth interviews with Australian children to address this gap. A total of n = 28 children (12-16 years) participated, with four themes constructed from the data using a reflexive approach to thematic analysis. Children were concerned about how the climate crisis would continue to harm their futures and the health of planet and people. They recognized that some groups and countries would experience more risks associated with the climate crisis as compared to others. While they received information from a range of different sources (school, family, social media), they mostly used social media to seek out climate information. They recognized that social media sites could be a source of climate misinformation, and argued that a range of strategies were needed to identify and counter false information about the climate crisis. Children's perspectives must be harnessed to improve information about climate risks and action.

Methodological and practical guidance for designing and conducting online qualitative surveys in public health.

Online qualitative surveys-those surveys that prioritise qualitative questions and interpretivist values-have rich potential for researchers, particularly in new or emerging areas of public health. However, there is limited discussion about the practical development and methodological implications of such surveys, particularly for public health researchers. This poses challenges for researchers, funders, ethics committees, and peer reviewers in assessing the rigour and robustness of such research, and in deciding the appropriateness of the method for answering different research questions. Drawing and extending on the work of other researchers, as well as our own experiences of conducting online qualitative surveys with young people and adults, we describe the processes associated with developing and implementing online qualitative surveys and writing up online qualitative survey data. We provide practical examples and lessons learned about question development, the importance of rigorous piloting strategies, use of novel techniques to prompt detailed responses from participants, and decisions that are made about data preparation and interpretation. We consider reviewer comments, and some ethical considerations of this type of qualitative research for both participants and researchers. We provide a range of practical strategies to improve trustworthiness in decision-making and data interpretation-including the importance of using theory. Rigorous online qualitative surveys that are grounded in qualitative interpretivist values offer a range of unique benefits for public health researchers, knowledge users, and research participants.

Australian young people's perspectives about the political determinants of the climate crisis.

ISSUE ADDRESSED: There has been little focus on young people's views about the political determinants of the climate crisis. As young people are likely to be the group most impacted by political decisions relating to the climate crisis, it is essential to understand their views about government decision-making. METHODS: A qualitatively-led online survey of n = 500 young Australians aged 15-24 years. Open text questions sought young people's views about current government climate policies, perceptions about policy effectiveness, and how governments could improve their climate responses. Reflexive thematic analysis was used to interpret and construct themes from the data. RESULTS: Young people perceived that governments were not taking serious action on the climate crisis. They stated that climate policies were largely influenced by economic imperatives, rather than concern for the wellbeing of current and future generations. They perceived that governments had a duty of care to protect them from the climate crisis, and needed to engage young people in climate discussions and decision-making. CONCLUSIONS: Young people's perspectives about the political determinants of the climate crisis provides information about their understanding of government policies and their recommendations for action. There is a need for collaboration between young people and decision-makers to urgently develop effective climate policies. SO WHAT?: Young people understand key issues relating to the political determinants of the climate crisis. The health promotion community has a role in advocating for structural changes in policymaking processes to ensure young people have a seat at the decision-making table.

Australian young people's perceptions of the commercial determinants of the climate crisis.

There is increasing public health focus on how corporate practices impact population health and well-being. While the commercial determinants of the climate crisis pose serious threats to human and planetary health, governments largely seek to balance climate action with economic imperatives. Global stakeholders recognize that young people have important voices in influencing climate responses. However, few studies have investigated young people's perceptions of the commercial determinants of the climate crisis. A qualitatively led online survey of n = 500 young Australians (15-24 years) investigated their understanding of corporate responses to the climate crisis, factors that influenced these responses and strategies to respond. A reflexive approach to thematic analysis was used. Three themes were constructed from the data. First, young people perceived that corporate responses to the climate crisis focussed on soft options and lacked meaningful action. Second, they stated that these responses were largely influenced by economic imperatives rather than planetary health, with policy levers needed to implement environmentally responsible corporate practices. Third, young people perceived that systems needed change to create demand for a cleaner environment, leading to improved practices. Young people have a clear understanding of the commercial determinants of the climate crisis and associated threats to population health. They recognize that corporate practices (and consumer demand) will not change without significant policy and structural change. Public health and health promotion stakeholders should work alongside young people to influence decision-makers to address harmful corporate behaviours.

The symbolic consumption processes associated with 'low-calorie' and 'low-sugar' alcohol products and Australian women.

The influence of commercial actors, practices and processes on the health and wellbeing of women is still not well understood. The alcohol industry has developed a range of products to appeal to new 'health conscious' markets, such as 'low-calorie' and 'low-sugar' products. While these products may have specific appeal for women, there has been little in-depth research that has sought to understand how women conceptualize these products and the range of symbolic meanings that women associate with these products. An online qualitatively led survey was conducted with n = 497 Australian women who had consumed alcohol in the last year. Questions related to the reasons for and influences on alcohol use, the purchasing of 'low-calorie' or 'low-sugar' products and the influence that these products might have on women's alcohol use. Data were interpreted using reflexive thematic analysis. Women consumed alcohol to relax, cope with everyday stressors and because of the alignment with social practices and social connection. Women perceived that these products provided a healthier alternative to traditional alcohol products and that they aligned with women's values relating to weight and the thin ideal. Some women were concerned that these products could increase alcohol consumption by reducing the perceptions of risk associated with alcohol. Policy consideration is needed to address how product claims and attributes may influence population groups' interpretations of the risks and benefits of these alcohol products, including the illusion that these products have protective potential and are better for overall health and wellbeing.

Unhealthy and health promoting sponsorship of male and female professional sporting teams in Australia.

ISSUE ADDRESSED: There are concerns that unhealthy industries may use sponsorships to align their brands with the increased popularity of professional women's sporting events. This study aimed to identify and compare the sponsors of Australian male and female professional sporting teams in relation to unhealthy industries (alcohol, gambling, discretionary food and drink, and venues) and health-promoting companies and organisations (charities, government departments, and educational institutions). METHODS: A web-based scan was conducted from July to October 2021 to identify team and uniform sponsors, with descriptive statistics used to identify and compare results. RESULTS: About one tenth of sponsors (team n = 269; 10.9%; uniform n = 62; 10.6%) were for unhealthy industries. Men's teams had a greater number of these sponsors as compared to women's teams. Just under 10% of sponsors were for health-promoting organisations (team n = 210; 8.5%; uniform n = 44; 7.5%), with women's teams more likely to have these sponsors as compared to men's teams. CONCLUSIONS: Professional sport provides an important opportunity to facilitate health-promoting rather than -harming sponsors. Health-promoting sponsors are more prominent in women's sport, but as women's professional sport continues to grow in popularity, there is a need for policy, funding, and support to prevent engagement with unhealthy industry sponsorship and create a level playing field with men's sport. SO WHAT?: Mechanisms should be developed to help sporting codes, particularly women's sport, to adopt business models that are not reliant on industries that cause harm. Establishing strong relationships with health-promoting organisations may provide alternative sponsorship opportunities for sporting teams.

Young people in Australia discuss strategies for preventing the normalisation of gambling and reducing gambling harm.

BACKGROUND: The normalisation of gambling for young people has received considerable recent attention in the public health literature, particularly given the proliferation of gambling marketing aligned with sport. A range of studies and reports into the health and wellbeing of young people have recommended that they should be consulted and engaged in developing public health policy and prevention strategies. There are, however, very few opportunities for young people to have a say about gambling issues, with little consideration of their voices in public health recommendations related to gambling. This study aimed to address this gap by documenting young people's perceptions about strategies that could be used to counter the normalisation of gambling and prevent gambling related harm. METHODS: This study took a critical qualitative inquiry approach, which acknowledges the role of power and social injustice in health issues. Qualitative interviews, using a constructivist approach, were conducted with 54 young people (11-17 years) in Australia. Reflexive thematic analysis was used to interpret the data. RESULTS: Five overall strategies were constructed from the data. 1) Reducing the accessibility and availability of gambling products; 2) Changing gambling infrastructure to help reduce the risks associated with gambling engagement; 3) Untangling the relationship between gambling and sport; 4) Restrictions on advertising; and 5) Counter-framing in commercial messages about gambling. CONCLUSIONS: This study demonstrates that young people have important insights and provide recommendations for addressing factors that may contribute to the normalisation of gambling, including strategies to prevent gambling related harm. Young people hold similar views to public health experts about strategies aimed at de-normalising gambling in their local communities and have strong opinions about the need for gambling to be removed from sport.

Australian youth perspectives on the role of social media in climate action.

OBJECTIVE: The climate crisis poses a significant public health threat to current and future generations. Limited research has examined young people's perspectives about the role of social media for climate awareness, action, and policy change. METHODS: Qualitatively led online survey of n=500 young Australians (aged 15-24). Questions focused on the effectiveness of social media platforms in communicating the need for climate action, with TikTok videos used to prompt about appeal strategies and campaigns. Data were analysed using a reflexive approach to thematic analysis. RESULTS: Participants perceived that social media platforms were a powerful and inclusive communication mechanism for climate action. Social media had the ability to reach diverse audiences and connect young people globally. Limitations included influencing key decision makers and risks associated with misinformation and disinformation. Participants supported messages that highlighted the urgent need for action, trusted celebrity and youth voices, and practical information to engage in action. CONCLUSIONS: Social media presents a powerful opportunity for engaging young people in discussions and decisions made about the climate crisis. IMPLICATIONS FOR PUBLIC HEALTH: The public health community should be guided by young people in developing a range of social media mechanisms to empower them to have a seat at the table in public health responses to climate.

"It shows we are serious": Young people in Australia discuss climate justice protests as a mechanism for climate change advocacy and action.

OBJECTIVE: This article aims to understand young Australians' perspectives of climate justice protests as a mechanism for climate change advocacy and action. METHOD: A qualitatively led online survey was conducted with n=511 young Australians (15-24 years). Open-text questions prompted for young people's perceptions of the appeal, accessibility, and effectiveness of climate justice protests in climate change action. A reflexive thematic analysis was conducted to construct themes from the data. RESULTS: Participants perceived that protests were an important mechanism for young people to draw attention to the need for climate action. However, they also stated that the clear messages that were sent to governments via protests did not necessarily lead to government action. Young people perceived that there were some structural issues that prevented them from taking part in these types of activities, including living far away from protests, not being accessible for young people with disabilities, and limited support from family members and/or friends to participate. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH: Climate justice activities engage young people and give them hope. The public health community has a role to play in supporting access to these activities and championing young people as genuine political actors in addressing the climate crisis.