Healthism online: 'What I eat in a day' vlogs before and during COVID-19 restrictions.

Objective and setting: The COVID-19 pandemic and its restrictions coincide with an increase in body weight and changes in health-related habits worldwide. This study focusses on the way health-related habits are portrayed online in digital food cultures. The study aims to investigate if and how the content of high-profile Dutch 'What I eat in a day' vlogs has changed during the first period of COVID-19 restrictions. We approach changes in digital food culture through the concept of 'healthism' and see vloggers as cultural intermediaries. Design and participants: We collected the most watched vlogs of almost all high-profile Dutch influencers pre-post corona and analyzed these in a mixed method approach by using summative and thematic content analysis. Results: Pre-COVID vlogs highlight an explicit consciousness of energy balance-related behavior, focusing on calorie counting, avoidance of unhealthy food and the use of tracking apps. In vlogs uploaded in 2020, these themes are less present. Instead, intuitive eating and listening to one's body are more central themes within the vlogs. Conclusions: We consider the shift towards intuitive eating as another variant of "wellness diets" rather than a shift away from dieting, furthered by COVID-19 restrictions. The core values of health and self-regulation are upheld within the shift towards intuitive eating. Yet, we nuance the broad claims of healthism in biopolitics and point to relevant cultural changes within foodscapes.

Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects.

The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.

Overweight and obesity prevention for and with adolescents: The "Confronting obesity: Co-creating policy with youth" (CO-CREATE) project.

The CO-CREATE project focuses on the need for research on obesity prevention in adolescents to move away from studies of single interventions, toward the investigation of systems-based research incorporating youth involvement. This paper provides an overview of the project, presenting the objectives, design, and novel methodologies applied, as well as findings to date and anticipated outcomes. Adolescents (16-18 years old) in five European countries participated. Methods applied in the project include monitoring and benchmarking of policies, systematic literature reviews, epidemiological surveillance, linking observed overweight and obesity trends to observed policy landscapes, group model building to identify perceived drivers of obesity, alliance building with adolescents, dialog with stakeholders, and system dynamics modelling to explore the potential impact of policy options. Outcomes include tools for developing policy ideas and investigation of prevention strategies with adolescents, including policy databases, system maps of drivers of obesity, protocols for organizing youth alliances, an intergenerational policy dialog tool, and system dynamic models exploring the impacts of cocreated policy ideas. These outcomes make an important contribution to building a pan-European infrastructure for designing and evaluating policies and for providing youth with the opportunity to make their voices heard in the development and implementation of obesity prevention measures.

Recruiting and engaging adolescents in creating overweight and obesity prevention policies: The CO-CREATE project.

The CO-CREATE project aims to collaborate with adolescents across Europe in developing policy ideas that contribute to overweight and obesity prevention. In this paper, we present the theoretical basis and methodological approach to recruitment and engagement in the project. The principles of youth-led participatory action research were employed to design Youth Alliances in which adolescents and adults could collaborate. These Alliances should serve to promote and support adolescent participation and to develop policy ideas that would contribute to obesity prevention. Alliance members were recruited in two local geographical areas per country with a focus on reaching out to underrepresented youth. We started with fieldwork to assess locally relevant forms of inclusion and exclusion. The methodology entailed a handbook combining existing tools which could be used flexibly, a collaborative organization, and budgets for the alliances. Engagement started in local organizations, that is, schools and scouts, and with peers. Health- and overweight-related challenges were addressed in their immediate surroundings and supported the inclusion of experiential knowledge. Adolescents were then supported to address the wider obesogenic system when designing policy ideas. The CO-CREATE Alliances provide a concrete example of how to engage youth in public health, in a manner that strives to be participatory, transformative, and inquiry based.

Assessing adolescents' readiness for action and attitudes toward obesity prevention: Instrument development and psychometric properties.

Engaging adolescents in obesity prevention is a main objective of the CO-CREATE project. This paper presents the development of a questionnaire to assess readiness for action and attitudes toward obesity prevention among adolescents. The questionnaire was developed based on literature searches and internal discussions with experts in the CO-CREATE consortium. The questionnaire was translated, back translated, and pretested for time and comprehensiveness by adolescents from five countries (the Netherlands, Norway, Poland, Portugal, and the United Kingdom). Exploratory factor analysis was performed, and internal reliability of the resulting factors was determined using baseline data from Poland and Norway. Furthermore, test-retest reliability was assessed in a sample of Norwegian adolescents. The exploratory factor analysis on readiness for action identified four factors. Analysis on attitudes toward obesity prevention identified four factors on responsibility and five factors on drivers of behavior. Six of the factors had a Cronbach's alpha value above 0.70, five factors had a value between 0.60-0.70, whereas the remaining two factors were below 0.60. The test-retest correlation ranged from 0.46 to 0.87. The exploratory factor analyzes on readiness for action identified the same factors as hypothesized in the development of the questionnaire, whereas attitudes toward obesity prevention identified more factors than initially assumed. The questionnaire is considered reliable as a tool for measuring adolescents' readiness for action and attitudes toward obesity prevention.

Ethical considerations in engaging young people in European obesity prevention research: The CO-CREATE experience.

Engaging youth in obesity prevention research and policy action is essential to develop strategies that are relevant and sensitive to their needs. Research with young people requires critical reflection to safeguard their rights, dignity, and well-being. The CO-CREATE project used various methods to engage approximately 300 European youth aged 15-19 years in the development of policies to prevent adolescent obesity. This paper discusses ethical considerations made in the project pertaining to the youth's voluntary participation, their protection from obesity stigma, respect for their time, data privacy and confidentiality, power balance, and equality of opportunity to participate in the research. We describe measures implemented to prevent or limit the emergence of ethical challenges in our interaction with youth and discuss their relevance based on our experience with implementation. While some challenges seemingly were prevented, others arose related to the youth's voluntary participation, time burdens on them, and the sustainability of participation under the Covid-19 pandemic. Concrete and ongoing ethical guidance may be useful in projects aiming to interact and build collaborative relationships with youth for long periods of time.

Agency through medicalization: Ghanaian children navigating illness, medicine and adult resistance.

Medicalization in the Global North assumes that bottom-up medicalization is driven by increasing consumer power, risk avoidance among professionals, or emancipation. Building on ethnographic work of the first author, this article aimed to explore the existence and conditions of a different and novel mechanism and found children manifesting agency through self-medicalization. We look at how Ghanaian children pragmatically deal with everyday health concerns and argue children are agents of medicalization and medicalization enables agency in children. Through interpretive and collaborative content analysis of structured ethnographic observations of 105 children from different class backgrounds (between June 2016 and December 2017) we found children in Northern Ghana framed situations of feeling ill in markedly biomedical terms and persisted in biomedical treatment even with opposition from adults. We observed that children intentionally navigated opposition from adults, mobilized support through networks, exploited power differences between adults, and organized treatment among themselves if necessary. While girls had an even harder time to muster recognition from adults, we also discovered children from a lower socioeconomic background, with more experience on the street had more leeway in navigating lack of support. So far, children's agency in health and illness has only been discussed in instances where children had already received a professional diagnosis. In our case where children had not yet received a professional diagnosis, we find that agency is enabled through bodily awareness, experience, interactions with peers, family, and the media; all working as tools for children to self-diagnose and to deal with illness in a postcolonial setting.

Medicalization and manhood: Is an ADHD diagnosis emerging for allegedly troublesome boys in Accra, Ghana?

Although mental health diagnoses and treatments are spreading across the globe, most medicalization research originates from the Global North, where diagnosis and treatment are well institutionalized. In this article, we examine the earliest possible emergence of ADHD diagnosis and treatment in the context of Ghanaian boys' transition towards manhood. Based on ethnographic fieldwork among boys from different class backgrounds in Accra in 2017, we identify how interactional troubles arising at the tricky transition to manhood provide a fertile or inhibiting context for medicalization. Torn between norms of obedience, autonomy and striving for societal achievements, boys face obstacles on the road towards manhood that are not yet medicalized. We demonstrate that boys and adults use specific idioms (in Ghanaian local language Twi) to describe issues around overactivity and inattention, but do not refer to medical categories. Instead, we witness an emerging shift towards psychological counselling, potentially supported by global mental health actions, and Pentecostalism. This psychologizing might constitute an intermediate step towards medicalization of troubling interactions. However, the colonial stigma of psychiatric labels and the limited reach of psycho-medical institutions in Ghana make medicalization unlikely. At the same time, there is a possibility for medicalization at the intersection of interactional problems, inequality, the global spread of psychiatry and transition to manhood. Medical labels and potentially ADHD might shift the blame from family to "disease". The incipient introduction of diagnosis and treatment might engender a creolized notion of ADHD with disrespect being a core problem.

Negotiating ADHD: Pragmatic medicalization and creolization in urban India.

Although a growing number of studies have demonstrated differences in responses to ADHD-like behaviours, very few studies have focused on theorizing diversity in the way ADHD is framed and approached globally. To contribute to the study of medicalization in a global context, this study examines the discursive field in which care professionals explain and treat ADHD among children in metropolitan India and addresses the need for an analytic framework to grasp the variations in the way ADHD is understood and approached. Building on the concepts of pragmatic medicalization and creolization, we study ADHD discourses in India asking 'What is at stake' and 'What matters most'? In this mixed methods study, 64 care professionals regularly involved in assessing ADHD-like behaviour completed an online Q-sort, and 21 professionals participated in face-to-face interviews. The Q-data were subjected to factor analysis. The interviews were analyzed using qualitative content analyses. Our study identified six distinct ADHD discourses, which showed that care professionals combine explanatory and treatment models. Professionals adapt their explanations and treatments of ADHD to parents' worries regarding academic performance, family prestige, stigma and side effects of allopathic medicine. Our findings indicate that an awareness of local concerns and adjustments to structural opportunities can diversify how ADHD-like behaviour is framed and responded to. This study demonstrates that medicalization operates between the emerging institutions of care and the everyday concerns of families and care professionals and reveals the need to examine conflicting stakes as drivers of diverse responses to ADHD diagnosis and treatment in India and the rest of the world.

From Danger to Uncertainty: Changing Health Care Practices, Everyday Experiences, and Temporalities in Dealing With COVID-19 Policies in the Netherlands.

Based on ongoing longitudinal research in families with young children, we investigate parents' changing everyday experiences and health care practices of dealing with COVID-19 policies in the Netherlands from March to June 2020. We identify four key themes developing over time. In relation to evolving COVID-19 prevention policies, (a) the lockdown interrupted life and experiences of temporality. (b) Following the lockdown, risk management changed from fear to insecurities and (c) simultaneously, emotion management transitioned from solidarity to fragmentation. (d) Increasingly, pragmatic considerations allowed parents to tackle uncertainties and created room to normalize everyday life. We studied "change" by using a novel conceptual model for temporality and found distinct temporalities in parents' accounts. In sum, we interpret this as a shift from danger to uncertainty, induced by policy shifts and pragmatically translating those to the lifeworld.

Family health competence: Attachment, detachment and health practices in the early years of parenthood.

During the first years of a baby's life, parents develop ways of caring that affect the child's health later in life. In this paper, we focus on eating and sleeping, as social practices that mediate between socioeconomic and cultural conditions and health outcomes, such as weight status. We argue for an analysis of what we call 'family health competence', meaning emerging know-hows and resources relevant to healthy living produced, embodied and shared by household members, to understand the development of health practices of first-time parents and their children. In an ethnographic panel study in the Netherlands, we follow households pre-birth until the first child turns age four. Our analysis suggests that across different families, competences develop enabling parents to balance a) attaching and b) detaching in particular ways. Parents learn how to observe and interpret their new-borns, bracket doubt, build trust, manage time pressures and mobilize support networks. These competences are partly class and gender-specific while there is also significant diversity within class and gender. The competence to balance attachment and detachment can be understood as the effect of contradictory social norms and institutional (labour market and care) provisions typical for late-modern welfare states.

Sadness or depression: Making sense of low mood and the medicalization of everyday life.

This research focusses on low mood as a generic category in everyday social interactions, outside the clinical realm and among non-patients. We examine if and how a clinical depression label and treatment are employed when low mood occurs in everyday life, which enables us to analyze the extent and content of medicalization and brings to the fore the interactional mechanisms and cultural concerns that potentially drive medicalization. The analysis is based on 316 observations of everyday life in the Netherlands. We observed and recorded interactions in which low mood was spontaneously expressed. Our paper shows that the clinical depression label resonates widely even if low mood is not fully medicalized. People de-medicalize low mood, and low mood can be un-medicalized. Our analysis thus suggests that dominance is not achieved, which nuances Horwitz and Wakefield's claim that the clinical category of depression has come to encompass all forms of low mood. Moreover, uncertainties about the meaning of low mood and about the depression label remain pragmatic concerns of everyday life. The cultural norm of happiness and active citizenship are very prominent in everyday life across medicalized and un-medicalized interactions. These norms thus seem to be a necessary but insufficient condition for medicalization. While pragmatic concerns do not seem to trigger medicalization either, one specific type of concern is consistently related to medicalization: relational conflicts. In sum, the cultural construction of low mood is not dominated by a single medical approach; however, it mirrors the diversity and uncertainties within and around the medical field.

Neurobiology in public and private discourse: the case of adults with ADHD.

How do people describe their health? How do their descriptions relate to public definitions? This article focuses on adult attention deficit hyperactivity disorder (ADHD). We look at Dutch adults who adopt the ADHD label and ask: which discourses structure their descriptions of ADHD? How do these relate to the dominant public discourse on ADHD? Do people use, for example, neurobiological explanations of ADHD? The research makes use of Q-methodology, which combines a discursive relational approach with factor analysis. We examine five different personal discourses that partly differ from the public discourse. People borrow neurobiological, psychological, sociological and even holistic arguments from public discourse to come up with a distinct set of discourses. Neurobiology resonates among adults with ADHD but does not dominate their thinking. Contrary to our expectation, this supports reflexivity instead of discipline theory.

Policy discourse, people's internal frames, and declared aircraft noise annoyance: an application of Q-methodology.

Aircraft noise annoyance is studied extensively, but often without an explicit theoretical framework. In this article, a social approach for noise annoyance is proposed. The idea that aircraft noise is meaningful to people within a socially produced discourse is assumed and tested. More particularly, it is expected that the noise policy discourse influences people's assessment of aircraft noise. To this end, Q-methodology is used, which, to the best of the authors' knowledge, has not been used for aircraft noise annoyance so far. Through factor analysis five distinct frames are revealed: "Long live aviation!," "aviation: an ecological threat," "aviation and the environment: a solvable problem," "aircraft noise: not a problem," and "aviation: a local problem." It is shown that the former three frames are clearly related to the policy discourse. Based on this observation it is argued that policy making is a possible mechanism through which the sound of aircraft is turned into annoyance. In addition, it is concluded that the experience of aircraft noise and, in particular, noise annoyance is part of coherent frames of mind, which consist of mutually reinforcing positions and include non-acoustical factors.

Apprehensive parents: a qualitative study of parents seeking immediate primary care for their children.

BACKGROUND: Children are more frequent users of out-of-hours primary care than other age groups, although their medical problems are less urgent. AIM: To gain insight into the health-seeking behaviour of parents who ask for immediate medical attention for their children. DESIGN OF STUDY: Qualitative analysis of interviews and telephone calls. SETTING: A general practice out-of-hours cooperative that caters for approximately 300,000 people in The Netherlands. METHOD: A semi-structured interview was conducted with 27 parents who had consulted their own GP or an out-of-hours facility for primary care because they wanted urgent medical attention for their child who was sick. Forty-four telephone calls from parents seeking medical care for a child were analysed. RESULTS: Recognising symptoms in a child started with the observation of a deviation from the child's normal appearance or behaviour. Parents decided to contact medical services when they felt they lost control of the situation. Most parents consulted because they wanted to rule out or prevent serious disease, not because of the condition itself; not wanting to take a risk with their child was an important motivation. In an attempt to rule out serious disease at home, parents also attempted diagnostic procedures they had copied from professionals. CONCLUSION: Worry of parents and their health-seeking behaviour can be seen as an expression of the central role of risk regulation in modern society. Doctors need to realise their own contribution to the way parents want to rule out serious disease in their children. Improving parents' knowledge will not solve the problem of inappropriate use of out-of-hours facilities.