Thirty Years of Implementing the Photovoice Method: Insights From a Review of Reviews.

As the use of the photovoice method has proliferated over the past three decades, several literature reviews have been conducted about implementing the method in the context of health promotion research and practice. Challenges emerged from the literature frequently enough to be reported in several reviews. As such, the purpose of this "review of reviews" was to identify and describe the various challenges to implementing photovoice as reported in published literature reviews. Taken together, the sum of the reviews' critiques about photovoice may be of particular use for developing solutions regarding challenges that limit the utility and outcomes of the method. The literature reviews included in this study were identified using PubMed, CINAHL, Google Scholar, and backward/forward chaining. The final 15 review articles included in the study were analyzed for the challenges of implementing photovoice described in each review. Four major themes emerged from the reviews: (1) inconsistent adherence to the photovoice method, (2) inconsistent evaluation of photovoice outcomes and impacts, (3) implementation challenges with specific populations, and (4) inconsistent reporting and adherence to ethical procedures. For those conducting photovoice projects in the future, the implications of the findings include maximizing participant engagement in the project from start to finish, evaluating photovoice projects for effectiveness in producing community change, and reporting ethical procedures.

Cartoon Images on E-juice Labels: A Descriptive Analysis.

INTRODUCTION: Although previous studies have found cartoons in electronic cigarette (e-cigarette) advertisements, social media posts, and a small sample of labels, there has yet to be an analysis of cartoons located on the labels attached to bottles of e-juice (the solution that contains nicotine and other chemicals). As such, the objective of this study was to analyze the prevalence and types of cartoons on e-juice labels. METHODS: Two researchers independently analyzed the presence and types of cartoons on the labels of e-juice flavors available on eliquid.com. Based on the Master Settlement Agreement's definition of a cartoon, the cartoons were placed into five categories: (1) comically exaggerated people, (2) comically exaggerated animals, (3) comically exaggerated creatures, (4) anthropomorphic creatures, or (5) extra-human creatures. RESULTS: There was a total of 1587 brands that offered 7135 e-juice products. Of those, 311 brands (19%) offered 1359 products (19%) that contained cartoons on the e-juice labels. From the labels that contained cartoons, 790 (58%) were of comically exaggerated people, 247 (18%) were of anthropomorphic creatures, 212 (16%) were of comically exaggerated animals, 73 (5%) were of comically exaggerated creatures, and 37 (3%) were of extra-human creatures. CONCLUSIONS: Given the previous success of Joe Camel on youth tobacco use, the prevalence of cartoon images found in this study is noteworthy. In addition, the number of brands that had cartoons on e-juice labels indicates that this issue is pervasive among businesses that sell e-juice. IMPLICATIONS: This study adds to the body of knowledge on this topic by describing a concerning number of cartoons located on e-juice labels, indicating a need for policy that prohibits the use of cartoon images in e-cigarette packaging.

using photovoice to foster a student vision for natural spaces on a college campus in the Pacific Northwest United States.

Undergraduate students face a host of stressors and may be particularly susceptible to encountering health-related challenges throughout college life. Seventy-two (N = 72) undergraduate students enrolled at a newly developed university campus located in the pacific northwest United States used the photovoice research method in crafting a vision for how natural spaces on campus might be maintained and minimally developed to promote student health. Five student-created themes emerged: 1) mental and physical health, 2) developing community spaces, 3) sustainable infrastructure design, 4) preserving natural habitat and history of the region, and 5) addressing issues related to homelessness. Initial evidence suggests that many aspects of the student vision may be incorporated into future campus environmental planning efforts. Additional research is needed in determining whether community-based greenspace planning on college campuses can positively impact the extent to which students access natural spaces for the purposes of alleviating stress and promoting health.

Student Experiences With Community-Based Enforcement of a Smoke-Free University.

A common approach to enforcing a university smoke-free policy is through "community-based" enforcement, in which the entire campus community is responsible for asking smokers in violation to abide by the policy. The purpose of the study was to explore university students' experiences with this strategy of enforcing a smoke-free policy. A total of 43 undergraduate students were interviewed regarding their experiences and opinions of community enforcement. The interviews were transcribed and analyzed using phenomenological methods, in which six major themes emerged from the data: Fear (alarm that smokers might respond with verbal insults or physical violence), Situational (enforcing the policy depended on violators' distance, group settings, strangers vs. peers), Protect Image (not wanting to be viewed as annoying, judgmental, or offensive), Lack of Authority (feeling a lack of authority to enforce the smoking policy), Compassion (empathy that violators smoke due to physical/emotional needs), and Enforcer (willingness to confront a policy violator). These findings reflected previous studies regarding people's fear to ask a smoker to extinguish a cigarette, feelings of a lack of authority, and so on. The study demonstrated that using only a community-based approach to enforcement may not be a realistic responsibility to impose on an entire campus community.

Universities' communication of COVID-19 cases through online dashboards.

Objective: This study's purpose was to explore universities' online dashboards that communicate information about COVID-19 cases to campus communities, and if dashboards adhere to American College Health Association (ACHA) recommendations. Methods: The websites of all four-year, public universities with an enrollment of at least 10,000 students were analyzed for the presence of COVID-19 dashboards, if dashboards contained recommended case features (eg, number of cases, tests, and people in quarantine/isolation), as well as other helpful features (eg, epidemiological curve, cluster information). Results: Of the 263 universities included in the study, 76% had a dashboard, but only 15% contained all recommended features. Most (62%) had an epidemiological curve, but few (3%) reported information related to clusters. Conclusion: Dashboards display case information and encourage behavior change; however, there is a need for improved adherence to the ACHA's recommendations for COVID-19 dashboards to maximize their potential impact on campus communities.

E-cigarette sharing behavior among college students: An exploratory study.

INTRODUCTION: The purpose of this study was to explore sharing behavior among college students who use e-cigarettes. METHODS: A convenience sample of current e-cigarette users answered questionnaire items regarding sharing behavior (e.g., the number of people that have shared e-cigarettes, the settings that sharing takes place, reasons for sharing). RESULTS: Of the 121 participants, 24% shared e-cigarettes every day and 76% shared some days. The most common setting (91%) for sharing was at social gatherings, and participants shared most often (52%) with one or two people, which happened most often (99%) with friends. The top reason (80%) for sharing e-cigarettes was to feel the effects of nicotine. CONCLUSIONS: The finds support the need to address sharing behavior in youth e-cigarette use and the need for more stringent e-cigarette policies and cessation resources.

Country Participation in the WHO Framework Convention on Tobacco Control Health Warnings Database.

BACKGROUND: The World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) Health Warnings Database is an online, publicly available resource created for countries to upload and share pictorial health warnings for tobacco packaging. The purpose of this study was to evaluate the extent to which the database is used by countries for the sharing of pictorial warnings. METHODS: The study's sample included parties to the FCTC who required graphic health warning labels on cigarette packaging from. Those countries were categorized as having a low, middle, and high Socio-Demographic Index (SDI). The Health Warnings Database was then analyzed for those countries' unique pictorial images, as well as the number of pictorials that were shared between countries. RESULTS: Of the 110 countries that required pictorial warnings on cigarette packaging, only 53 (48%) voluntarily contributed pictorials to the database, with most of those (53%) being high SDI-level countries. There were 342 unique pictorials on the database, with 62 images posted by seven countries that were used by 13 other countries. CONCLUSION: While sharing was evident from the database, there remains a need for more countries to upload the pictorials to the database. There is also a need to expand the database to include alternative tobacco products, such as waterpipe tobacco and e-cigarettes.

Quitline Information Included on Cigarette Packaging: An Assessment of Country Adherence to WHO FCTC Guidelines, 2007 to 2018.

The purpose of this study is to evaluate country adherence to the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) guidelines in terms of including quitline information on cigarette packaging. Data were gathered from the WHO's Global Health Observatory database. The study included countries that were signatories to the FCTC, had a toll-free quitline, and required health warnings on cigarette packaging. Countries were then classified by income level according to the World Bank. From 2007 to 2018, the number of countries that established a quitline increased from 34 to 60. During the same timeframe among those countries, the number of countries that included information about the quitline on cigarette packaging increased from 5 to 37, with a larger proportion (79%) of high-income countries promoting their quitlines on cigarette packaging compared to middle-income (45%) countries. Although there was an increase in adherence to the WHO FCTC guidelines, there is still a need for several countries to include quitline information on cigarette packaging.

The use of tobacco in online trailers of top-grossing movies.

INTRODUCTION: Images of tobacco use in movies have been studied extensively, showing that smoking in movies can cause the initiation of smoking among young people. Tobacco use in movie trailers, however, has not been monitored to the extent of full-length films. As such, the purpose of this study was to assess how many online trailers from top-grossing movies contain images of tobacco use, and to estimate audience exposure to those depictions. METHODS: A total of 964 trailers from the top-grossing movies of 2010-16 were located on YouTube and analyzed for the number of tobacco 'incidents' (tobacco went off screen and on screen, a different actor had tobacco, or a new scene contained tobacco). Audience exposure was measured through 'impressions', by multiplying each trailer's number of incidents by the number of times the trailer was viewed. RESULTS: From 2010 to 2016, the trailers from top-grossing movies increased in: total per cent of tobacco incidents (16% in 2010 vs 21% in 2016), total number of incidents (69 in 2010 vs 102 in 2016), and tobacco impressions (89 million in 2010 vs 725 million in 2016). CONCLUSIONS: A considerable number of online movie trailers contain incidents of tobacco use, with a noteworthy exposure to those incidents. As such, tobacco use in movie trailers should be monitored to the same extent as full-length movies, and public health professionals should advocate for age-verification restrictions to movie trailers that contain tobacco incidents and that anti-smoking advertisements be shown before trailers containing any incidents.

Burn injuries caused by e-cigarette explosions: A systematic review of published cases.

INTRODUCTION: E-cigarettes have the potential to cause burns from batteries that explode. Although e-cigarette explosion burns have been reported by the media (e.g. local online news, blogs), there is a need for a comprehensive review of published medical case reports regarding these injuries. METHODS: CINAHL and PubMed were systematically searched using common terms regarding e-cigarettes (electronic cigarette, e-cigarette, vape, vaping, electronic nicotine delivery systems) in every combination with the term 'explosion'. Peer-reviewed articles were included if they: were written in English, described case reports of burn injuries caused by e-cigarette explosions, and were published in any year. Cases were categorized by demographics, location of the e-cigarette explosion, burned body areas, types of burns, total body surface area of burns, the need for skin grafting, and the length of hospital stay. RESULTS: Thirty-one articles were included in the review and described 164 cases. Most patients (90%) were male and between 20 to 29 years old. In the majority of cases (65%), e-cigarettes exploded in pockets, compared to exploding in the face or hand. Common burned areas included the thigh, hand, genitals, and face. Burn severity was typically second-degree burns (35%) or a combination of second-degree and third-degree burns (20%). In all, 48 patients required skin grafting, with 19 reporting a median hospital stay of 5 days. CONCLUSIONS: This review has several implications, including the need for regulation of batteries, education regarding battery safety, and leveraging images of the severity of e-cigarette explosion burns to discourage the use of e-cigarettes.

Student, Faculty, and Staff Approval of University Smoke/Tobacco-Free Policies: An Analysis of Campus Newspaper Articles.

OBJECTIVE: To provide a nontraditional source of data to university policymakers regarding student, faculty, and staff approval of university smoke/tobacco-free policies, as published through campus newspaper articles. METHODS: From January to April 2016, a total of 2523 articles were retrieved concerning campus smoking/tobacco at 4-year, public universities. Of these, 54 articles met the inclusion factors, which described 30 surveys about campus approval of tobacco-free policies and 24 surveys about smoke-free policies. RESULTS: In all, the surveys included more than 130 000 respondents. With the exception of 4 surveys, all reported that the most of the respondents approved a tobacco/smoke-free campus policy. CONCLUSIONS: Although the study had several limitations, the findings provide a synthesis from a nontraditional data source that is consistent with findings from the peer-reviewed literature, in which most of the students, faculty, and staff on university campuses approve of smoke/tobacco-free campus policies.

Enforcing a tobacco-free campus through an ambassador-based program: a phenomenology.

OBJECTIVE: This phenomenology explored the experiences of those involved in a campus-based Ambassador program that enforced a tobacco-free policy at a public university in Montana. PARTICIPANTS: During the program's initial implementation (spring 2014), researchers observed and interviewed 21 Ambassadors and 19 policy violators. METHODS: Researchers observed and recorded field notes of Ambassadors promoting the policy to the campus community and interacting with policy violators. Researchers invited Ambassadors and violators to be interviewed regarding their experiences with the program. RESULTS: Although Ambassadors enjoyed promoting the policy and sensed an increase in recognition by others, they also felt uncomfortable and had mixed feelings regarding their level of authority. Violators also felt uncomfortable, yet the majority described the experience with the program as positive. CONCLUSIONS: The findings from the study can be used to inform those considering the implementation of an Ambassador program on their campus.

Coverage of adolescent substance use prevention in state frameworks for health education: 10-year follow-up.

BACKGROUND: The use of alcohol, tobacco, and other drugs (ATOD) by adolescents is a national health issue. One way in which the United States approaches the prevention of substance use among adolescents is by teaching high school students about ATOD at school. The curriculum for health education courses is based upon each state's framework. The purpose of this study was to conduct a 10-year follow-up to a study that analyzed state frameworks for key mediators of adolescent substance use. METHODS: Researchers performed an extensive content analysis of all 50 states' curriculum frameworks for high school health education to identify if, and to what degree, key mediators of adolescent substance use were included in each state's curriculum framework. After training, inter-rater agreement was greater than 95%. RESULTS: Mediators identified most often in the 50-state curriculum frameworks for high school health education were beliefs about consequences, decision making, social skills, assistance skills, and goal setting. Twenty-two of 50-state curriculum frameworks for high school health education had dedicated sections for ATOD. CONCLUSION: There were modest improvements since 2001 in the inclusion of mediators of adolescent substance use within state curriculum frameworks. There still exists many opportunities to more effectively use curriculum frameworks to improve classroom health instruction.

Quantifying littered cigarette butts to measure effectiveness of smoking bans to building perimeters.

OBJECTIVE: The authors estimated the number of violations of a university policy that prohibited smoking within 25 ft of all campus buildings. PARTICIPANTS: The project was conducted by 13 student researchers from the university and a member of the local public health department. METHODS: Students quantified cigarette butts that were littered in a 30-day period inside the prohibited smoking area of 7 campus buildings (large residential hall, small residential hall, administrative building, 2 academic buildings, campus cafeteria, and student union). RESULTS: Investigators found a total of 7,861 cigarette butts (large residential hall: 1,198; small residential hall: 344; administrative building: 107; 2 academic buildings: 1,123 and 806; campus cafeteria: 2,651; and student union: 1,632). CONCLUSIONS: Findings suggest that there is low compliance with the university's smoking policy. The described project may be repeated by students at other universities as a method to advocate for policy change.

Using the photovoice method to advocate for change to a campus smoking policy.

OBJECTIVE: The authors used the photovoice method as a strategy for empowering students to advocate for change of a campus smoking policy. PARTICIPANTS: Participants included 49 college students and 160 photo-exhibit attendees during spring 2011. METHODS: Students were trained in the use of the photovoice method and a public exhibit was used to educate the campus community and advocate for change. RESULTS: The photovoice initiative resulted in an effective platform for students to successfully advocate for the relocation of ashtrays that were in violation of the policy and for the elicitation of future advocacy targets. CONCLUSIONS: The photovoice project provided a platform for students to have their views heard by campus community members and policymakers. The project served as a useful tool for grassroots student advocacy. Those interested in addressing campus health policy issues may want to consider conducting a photovoice project similar to the one described in this article.