Digital alcohol marketing and gender: A narrative synthesis.

ISSUES: Alcohol marketing on social media platforms is pervasive and effective, reaching wide audiences and allowing interaction with users. We know little about the gendered nature of digital alcohol marketing, including how women and men are portrayed, how different genders respond and implications for gender relations. This review aimed to identify how males, females and other genders are targeted and represented in digital alcohol marketing, and how they are encouraged to engage with digital alcohol marketing content. APPROACH: A narrative synthesis approach was employed. Academic literature and research reports were searched for studies on digital alcohol marketing published within the previous 10 years with a range of methods and designs. We reviewed the studies, extracted data relevant to gender and synthesised findings thematically. KEY FINDINGS: The review included 17 articles and 7 reports with a range of designs and methods, including content analyses of digital material, interviews, focus groups and surveys. Our analysis identified three conceptual themes that captured many of the gendered results, namely: (i) leveraging a diversity of idealised femininities; (ii) amplifying hegemonic masculinity; and (iii) infiltrating everyday gendered life. IMPLICATIONS AND CONCLUSION: Alcohol marketing on social media is highly gendered and is designed to embed itself into everyday life in agile ways that reinforce traditional and evolving gendered stereotypes, activities, lifestyles and roles. Gendered engagement strategies are widely used to link alcohol to everyday gendered activities and identities to encourage alcohol purchase and consumption. This marketing normalises alcohol consumption and reproduces harmful gender norms and stereotypes.

Exposure to digital vape marketing among young people in Aotearoa New Zealand.

AIMS: Little is known about the exposure of young people in Aotearoa New Zealand to marketing of vape products on social media. This study investigated vaping behaviour and the extent of vape marketing exposure and engagement that young people (14-20 years) report on social media and examined differences across socio-demographic groups. METHODS: An online survey was conducted with 3,698 participants aged between 14-20 years (M=17.1; SD=1.8). A range of genders (55.7% females, 38.3% males and 6% another gender), ethnicities (25.6% Maori, 46.7% Pakeha or NZ European, 6.5% Pasifika and 21.2% another ethnicity) and social classes took part. RESULTS: Half (50.8%; n=1,110) of the respondents (N=2,185) reported that they had vaped at least once; vaping history was positively related to exposure to and engagement with digital vape marketing. Half (50.3%; n=1,119) of the respondents (N=2,224) reported seeing vape marketing on at least one social media platform. Binary logistic regressions showed that younger respondents were more likely to report seeing vape marketing than older respondents, and Maori and Pasifika more likely than other ethnicities. Over a quarter (26%; n=563) of respondents (N=2,148) reported engaging with vape marketing online, with Maori and Pasifika respondents more likely to engage than other ethnicity groups, and similarly for respondents of lower compared to higher socio-economic status. No interaction effects were found. CONCLUSIONS: Many young people, including a subset under the legal age for purchase, reported seeing vape product marketing on social media platforms. Patterns of exposure to vape product marketing on social media mirror the inequitable marketing exposure of harmful commodities in physical environments. Improved transparency and regulation of social media marketing is required.

Embodied decisions unfolding over time: a meta-ethnography systematic review of people with cancer's reasons for delaying or declining end-of-life care.

BACKGROUND: Barriers to accessing hospice and palliative care have been well studied. An important yet less researched area is why people approaching the end-of-life decline a referral when they are offered services. This review focused on synthesising literature on patients in the last months of life due to a cancer diagnosis who have declined a referral to end-of-life care. METHODS: Six academic databases were systematically searched for qualitative literature published between 2007 and 2021. Two researchers independently reviewed and critically appraised the studies. Using meta-ethnographic methods of translation and synthesis, we set out to identify and develop a new overarching model of the reasons patients decline end-of-life care and the factors contributing to this decision. RESULTS: The search yielded 2060 articles, and nine articles were identified that met the review inclusion criteria. The included studies can be reconceptualised with the key concept of 'embodied decisions unfolding over time'. It emphasises the iterative, dynamic, situational, contextual and relational nature of decisions about end-of-life care that are grounded in people's physical experiences. The primary influences on how that decision unfolded for patients were (1) the communication they received about end-of-life care; (2) uncertainty around their prognosis, and (3) the evolving situations in which the patient and family found themselves. Our review identified contextual, person and medical factors that helped to shape the decision-making process. CONCLUSIONS: Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients' end-of-life care decision-making, in particular estimating how much time one has left and patients' embodied knowing about when the right time for end-of-life care is. The multiple and intersecting domains of health that inform decision-making, namely physical, mental, social, and existential/spiritual as well as emotions/affect need further exploration. The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients.

Home drinking practices among middle-class adults in midlife during the COVID-19 pandemic: Material ubiquity, automatic routines and embodied states.

INTRODUCTION: Harmful drinking is increasing among mid-life adults. Using social practice theory, this research investigated the knowledge, actions, materials, places and temporalities that comprise home drinking practices among middle-class adults (40-65 years) in Aotearoa New Zealand during 2021-2022 and post the COVID-19 pandemic lockdowns. METHODS: Nine friendship groups (N = 45; 26 females, 19 males from various life stages and ethnicities) discussed their drinking practices. A subset of 10 participants (8 female, 2 male) shared digital content (photos, screenshots) about alcohol and drinking over 2 weeks, which they subsequently discussed in an individual interview. Group and interview transcripts were thematically analysed using the digital content to inform the analysis. RESULTS: Three themes were identified around home drinking practices, namely: (i) alcohol objects as everywhere, embedded throughout spaces and places in the home; (ii) drinking practices as habitual, automatic and conditioned to mundane everyday domestic chores, routines and times; and (iii) drinking practices intentionally used by participants to achieve desired embodied states to manage feelings linked to domestic and everyday routines. DISCUSSION AND CONCLUSIONS: Alcohol was normalised and everywhere within the homes of these midlife adults. Alcohol-related objects and products had their own agency, being entangled with domestic routines and activities, affecting drinking in both automatic and intentional ways. Developing alcohol policy that would change its ubiquitous and ordinary status, and the 'automatic' nature of many drinking practices, is needed. This includes restricting marketing and availability to disrupt the acceptability and normalisation of alcohol in the everyday domestic lives of adults at midlife.

Women, alcohol consumption and health promotion: the value of a critical realist approach.

Research on women's drinking occurs in largely disparate disciplines-including public health, health promotion, psychology, sociology, and cultural studies-and draws on differing philosophical understandings and theoretical frameworks. Tensions between the aims and paradigmatic underpinnings of this research (across and within disciplines) have meant that knowledge and insight can be frequently disciplinary-specific and somewhat siloed. However, in line with the social and economic determinants of the health model, alcohol research needs approaches that can explore how multiple gender-related factors-biological, psycho-social, material, and socio-cultural-combine to produce certain drinking behaviours, pleasures and potential harms. We argue that critical realism as a philosophical underpinning to research can accommodate this broader conceptualization, enabling researchers to draw on multiple perspectives to better understand women's drinking. We illustrate the benefit of this approach by presenting a critical realist theoretical framework for understanding women's drinking that outlines interrelationships between the psychoactive properties of alcohol, the role of embodied individual characteristics and the material, institutional and socio-cultural contexts in which women live. This approach can underpin and foster inter-disciplinary research collaboration to inform more nuanced health promotion practices and policies to reduce alcohol-related harm in a wide range of women across societies.

Research has shown that over the last few decades women's alcohol consumption has increased alongside rising rates of alcohol-related harm. A range of different research approaches explores women's drinking. However, many researchers have worked within their own disciplines with little input from other alternative, and sometimes inconsistent, approaches. In this paper, we argue that critical realism is an approach that can enable researchers to draw on a variety of research perspectives to provide greater insight and understanding of women's drinking. We illustrate how this can benefit knowledge of women's drinking by exploring the interrelationships between the properties of alcohol as a psychoactive substance, the role of individual characteristics and experiences, and the realities of women's lives. Critical realism is also able to incorporate the social and economic determinants of health model that critically considers the role of individual aspects, living and working conditions, and social and cultural factors on health behaviours. By contributing to an understanding of diverse drinking practices, this approach can assist health promotion policy and practice seeking to prevent and reduce alcohol-related harm in a wide range of women across societies.

Alcohol and drinking within the lives of midlife women: A meta-study systematic review.

BACKGROUND: A range of societal changes have created positive and encouraging environments for women's alcohol use. Within this context, in Western countries there is evidence of rising rates of alcohol consumption and related harms among midlife and older women. It is timely and important to explore the role of alcohol in the lives of midlife women to better understand observed data trends and to develop cohort specific policy responses. Focussing on Western countries and those with similar mixed market systems for alcohol regulation, this review aimed to identify 1) how women at midlife make sense of and account for their consumption of alcohol; 2) factors that play a role; and 3) the trends in theoretical underpinnings of qualitative research that explores women's drinking at midlife. METHODS: A meta-study approach was undertaken. The review process involved extracting and analysing the data findings of eligible research, as well as reviewing the contextual factors and theoretical framing that actively shape research and findings. RESULTS: Social meanings of alcohol were interwoven with alcohol's psycho-active qualities to create strong localised embodied experiences of pleasure, sociability, and respite from complicated lives and stressful circumstances in midlife women. Drinking was shaped by multiple and diverse aspects of social identity, such as sexuality, family status, membership of social and cultural groups, and associated responsibilities, underpinned by the social and material realities of their lives, societal and policy discourses around drinking, and how they physically experienced alcohol in the short and longer term. CONCLUSION: For harm reduction strategies to be successful, further research effort should be undertaken to understand alcohol's diverse meanings and functions in women's lives and the individual, material, and socio-cultural factors that feed into these understandings. As well as broad policies that reduce overall consumption and "de-normalise" drinking in society, policy-makers could usefully work with cohorts of women to develop interventions that address the functional role of alcohol in their lives, as well as policies that address permissive regulatory environments and the overall social and economic position of women.

'A little bubble of utopia': constructions of a primary care-based pilot clinic providing gender affirming hormone therapy.

The provision of gender affirming hormone therapy for transgender and non-binary people is a rapidly developing area of gender affirming healthcare. While research indicates the benefits of providing gender affirming hormone therapy through interdisciplinary primary care-based models, less is known about how service users and providers construct their understandings of affirmative approaches. In this paper, we present findings from a discourse analysis of four service users' and four healthcare professionals' talk about a primary care-based pilot clinic providing gender affirming hormone therapy in Aotearoa New Zealand. Participants employed notions of pathologisation, time, and agency in their talk to construct the clinic as a personal setting which gave service users time to make their own health decisions, while constructing hospitals as impersonal with lengthy wait times. The assessment-driven nature of best practice guidelines that governed clinicians' decision-making was constructed as constraining users' agency. Findings highlight the ongoing importance of aligning gender affirming hormone therapy with other non-disease types of healthcare, and suggest new ways for achieving this through affirmative approaches to healthcare.

Embodying health behaviours in everyday life: the social and gendered practices of female senior managers.

Objective: This article extends current theorising around health behaviours using insights from a study with women working in senior management positions in Switzerland. The study aimed to explore the meanings they attached to their everyday activities and examine implications for health and wellbeing by drawing on 1) social practices theory, 2) a socio-constructionist approach to gender, and 3) conceptualisations of embodiment.Design: Twenty female senior managers were interviewed at two time points six months apart: the first interview elicited highly-detailed, descriptive accounts of activities during the previous day, while in the second interview participants reflected on their previous accounts and discussed the meanings they ascribed to their activities. A thematic and narrative analysis of both sets of transcripts was conducted.Results: Three main themes captured the ways female senior managers talked about their everyday behaviours, all focused around their bodies: 'Functional bodies: Being on-the-go and meeting responsibilities'; 'Limiting bodies: Threats to everyday activities'; and 'Intentional bodies: Activities for wellbeing'.Conclusions: Results are considered in terms of contemporary postfeminist/neoliberal discourses in Western societies, how these are shaping and affecting everyday practices and subjectivities, and their consequences for women's health and wellbeing at work.

Providing gender-affirming hormone therapy through primary care: service users.

INTRODUCTION Primary health care providers are playing an increasingly important role in providing gender-affirming health care for gender diverse people. This article explores the experiences of a primary care-based pilot clinic providing gender-affirming hormone therapy in Wellington, New Zealand. AIM To evaluate service users' and health professionals' experiences of a pilot clinic at Mauri Ora (Victoria University of Wellington's Student Health and Counselling Service) that provided gender-affirming hormones through primary care. METHODS In-depth interviews were conducted with four (out of six) service users and four health professionals about their perspectives on the clinic. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Three themes were identified in service users' interviews, who discussed receiving affirming care due to the clinic's accessibility, relationship-centred care and timeliness. Three themes were identified in the health professionals' interviews, who described how the clinic involves partnership, affirms users' gender and agency, and is adaptable to other primary care settings. Both service users and health professionals discussed concerns about the lack of adequate funding for primary care services and the tensions between addressing mental health needs and accessing timely care. DISCUSSION The experiences of service users and health professionals confirm the value of providing gender-affirming hormone therapy in primary care. Models based in primary care are likely to increase accessibility, depathologise gender diversity and reduce wait times.

An objective methodology capturing online commodity marketing and other harms.

Increasingly life is lived online, yet little is known about the actual nature and extent of online content that people view due to the difficulty of recording real time exposure. This includes people's exposure to harmful commodity marketing. This study aimed to develop a methodology to assess the nature and extent of exposure to, and engagement with, unhealthy commodity marketing and other public health harms online, particularly children's exposure. A convenience sample of 16 young adult participants (aged 21-29) recorded their device usage for 2 days using Zoom software. Data were coded and analysed to assess the nature and extent of marketing for alcohol, gambling, junk food and smoking products. Four focus groups were conducted with participants to explore their data collection and coding experiences, and results assessed using thematic analysis. The study found that, with some modifications, this method was feasible for gathering real-time objective data from the online world that can be analysed for a range of public health harms, including marketing of unhealthy commodities. Larger studies are recommended to build global evidence for public health action in the online world.

The role of alcohol in constructing gender & class identities among young women in the age of social media.

Research suggests young women view drinking as a pleasurable aspect of their social lives but that they face challenges in engaging in a traditionally 'masculine' behaviour whilst maintaining a desirable 'femininity'. Social network sites such as Facebook make socialising visible to a wide audience. This paper explores how young people discuss young women's drinking practices, and how young women construct their identities through alcohol consumption and its display on social media. We conducted 21 friendship-based focus groups (both mixed and single sex) with young adults aged 18-29 years and 13 individual interviews with a subset of focus group respondents centred on their Facebook practices. We recruited a purposive sample in Glasgow, Scotland (UK) which included 'middle class' (defined as students and those in professional jobs) and 'working class' respondents (employed in manual/service sector jobs), who participated in a range of venues in the night time economy. Young women's discussions revealed a difficult 'balancing act' between demonstrating an 'up for it' sexy (but not too sexy) femininity through their drinking and appearance, while still retaining control and respectability. This 'balancing act' was particularly precarious for working class women, who appeared to be judged more harshly than middle class women both online and offline. While a gendered double standard around appearance and alcohol consumption is not new, a wider online audience can now observe and comment on how women look and behave. Social structures such as gender and social class remain central to the construction of identity both online and offline.

Critical health psychology in New Zealand: Developments, directions and reflections.

We examine how critical health psychology developed in New Zealand, taking an historical perspective to document important influences. We discuss how academic appointments created a confluence of critical researchers at Massey University, how interest in health psychology arose and expanded, how the critical turn eventuated and how connections, both local and international, were important in building and sustaining these developments. We discuss the evolution of teaching a critical health psychology training programme, describe the research agendas and professional activities of academic staff involved and how this sustains the critical agenda. We close with some reflections on progress and attainment.

'Part of me already knew': the experiences of partners of people going through a gender transition process.

Research has shown that the gender transition of one partner in a relationship can have a significant impact on the non-transitioning partner. This paper explores the experiences of former and current cisgender partners of people making a gender transition. Six participants were recruited via snowball sampling and took part in semi-structured interviews, which were transcribed and analysed using interpretative phenomenological analysis. Three superordinate themes were identified, namely: (1) the shared and ongoing process of learning about a partner's transgender identity; (2) changes in relationships; and (3) impact on self and identity. Findings highlight the constructed nature of gender and sexual identities, and the fluidity with which partners experienced these aspects of their lives. Future research could usefully explore the support needs of partners of transitioning people and the best ways to access and distribute this support.

Opioid Substitution Treatment Planning in a Disaster Context: Perspectives from Emergency Management and Health Professionals in Aotearoa/New Zealand.

Opioid Substitution Treatment (OST) is a harm reduction strategy enabling opiate consumers to avoid withdrawal symptoms and maintain health and wellbeing. Some research shows that within a disaster context service disruptions and infrastructure damage affect OST services, including problems with accessibility, dosing, and scripts. Currently little is known about planning for OST in the reduction and response phases of a disaster. This study aimed to identify the views of three professional groups working in Aotearoa/New Zealand about OST provision following a disaster. In-depth, semi-structured interviews were conducted with 17 service workers, health professionals, and emergency managers in OST and disaster planning fields. Thematic analysis of transcripts identified three key themes, namely "health and wellbeing", "developing an emergency management plan", and "stock, dose verification, and scripts" which led to an overarching concept of "service continuity in OST preparedness planning". Participants viewed service continuity as essential for reducing physical and psychological distress for OST clients, their families, and wider communities. Alcohol and drug and OST health professionals understood the specific needs of clients, while emergency managers discussed the need for sufficient preparedness planning to minimise harm. It is concluded that OST preparedness planning must be multidisciplinary, flexible, and inclusive.

The Future of Qualitative Research in Psychology: Accentuating the Positive.

In this paper we reflect on current trends and anticipate future prospects regarding qualitative research in Psychology. We highlight various institutional and disciplinary obstacles to qualitative research diversity, complexity and quality. At the same time, we note some causes for optimism, including publication breakthroughs and vitality within the field. The paper is structured into three main sections which consider: 1) the positioning of qualitative research within Psychology; 2) celebrating the different kinds of knowledge produced by qualitative research; and 3) implementing high quality qualitative research. In general we accentuate the positive, recognising and illustrating innovative qualitative research practices which generate new insights and propel the field forward. We conclude by emphasising the importance of research training: for qualitative research to flourish within Psychology (and beyond), students and early career researchers require more sophisticated, in-depth instruction than is currently offered.

Social networking and young adults' drinking practices: innovative qualitative methods for health behavior research.

OBJECTIVES: Understandings of health behaviors can be enriched by using innovative qualitative research designs. We illustrate this with a project that used multiple qualitative methods to explore the confluence of young adults' drinking behaviors and social networking practices in Aotearoa, New Zealand. METHOD: Participants were 18-25 year old males and females from diverse ethnic, class, and occupational backgrounds. In Stage 1, 34 friendship focus group discussions were video-recorded with 141 young adults who talked about their drinking and social networking practices. In Stage 2, 23 individual interviews were conducted using screen-capture software and video to record participants showing and discussing their Facebook pages. In Stage 3, a database of Web-based material regarding drinking and alcohol was developed and analyzed. RESULTS: In friendship group data, young adults co-constructed accounts of drinking practices and networking about drinking via Facebook as intensely social and pleasurable. However, this pleasure was less prominent in individual interviews, where there was greater explication of unpleasant or problematic experiences and practices. The pleasure derived from drinking and social networking practices was also differentiated by ethnicity, gender, and social class. Juxtaposing the Web-based data with participants' talk about their drinking and social media use showed the deep penetration of online alcohol marketing into young people's social worlds. CONCLUSIONS: Multiple qualitative methods, generating multimodal datasets, allowed valuable nuanced insights into young adults' drinking practices and social networking behaviors. This knowledge can usefully inform health policy, health promotion strategies, and targeted health interventions.

Transformation and time-out: the role of alcohol in identity construction among Scottish women in early midlife.

Despite the increase in drinking by women in early midlife, little alcohol research has focused on this group. We explore how alcohol is associated with the construction of gender identities among women aged 30-50 years in the west of Scotland, United Kingdom. We draw on qualitative data from 11 focus groups (five all-female, six mixed-sex) with pre-existing groups of friends and work colleagues in which women and men discuss their drinking behaviours. Analysis demonstrated how alcohol represented a time and space away from paid and unpaid work for women in a range of domestic circumstances, allowing them to relax and unwind. While women used alcohol to construct a range of identities, traditional notions of femininity remained salient (e.g. attention to appearance, drinking 'girly' drinks). Drinking enabled women to assert their identity beyond the roles and responsibilities often associated with being a woman in early midlife. For example, some respondents with young children described the transformative effects of excessive drinking which allowed them to return temporarily to a younger, carefree version of themselves. Thus, our data suggest that women's drinking in early midlife revolves around notions of 'idealised' femininity but simultaneously represents a way of achieving 'time out' from traditional female responsibilities such as caring for others. We consider these findings within a broader social and cultural context including alcohol marketing, domestic roles and motherhood and their implications for health promotion.

Conceptualizing mind, body, spirit interconnections through, and beyond, spiritual healing practices.

CONTEXT: Although research is increasingly exploring the concept of the mind, body, spirit (MBS) and its relevance to health and well-being, it remains difficult to precisely define it. OBJECTIVE: This research aims to explore indigenous and non-indigenous spiritual healers' conceptualizations of MBS and consider implications for theory and practice. DESIGN AND SETTING: A total of 12 spiritual healers from Aotearoa/New Zealand participated in a semi-structured interview about their healing practices. INTERVENTION: The research interview asked participants to discuss how they conceptualized the mind, body, spirit in their work. MAIN OUTCOME MEASURES: The data were analyzed using interpretative data analysis. RESULTS: Transcripts of the interviews were analyzed using interpretative phenomenological analysis, which led to the identification of three major themes: MBS interconnections of healing, impacts on the mind and the body, and spiritual aspects of healing. These results are discussed in terms of their implications for concepts of healing and conceptualizations of MBS.

'See it doesn't look pretty does it?' Young adults' airbrushed drinking practices on Facebook.

A range of negative health outcomes are associated with young adults' drinking practices. One key arena where images of, and interaction about, drinking practices occurs is social networking sites, particularly Facebook. This study investigated the ways in which young adults' talked about and understood their uses of Facebook within their drinking practices. Face-to-face, semi-structured interviews were conducted with seven New Zealand young adults as they displayed, navigated and talked about their Facebook pages and drinking behaviours. Our social constructionist thematic analysis identified three major themes, namely 'friendship group belonging', 'balanced self-display' and 'absences in positive photos'. Drinking photos reinforced friendship group relationships but time and effort was required to limit drunken photo displays to maintain an overall attractive online identity. Positive photos prompted discussion of negative drinking events which were not explicitly represented. Together these understandings of drinking photos function to delimit socially appropriate online drinking displays, effectively 'airbrushing' these visual depictions of young adults' drinking as always pleasurable and without negative consequences. We consider the implications of these findings for ways alcohol health initiatives may intervene to reframe 'airbrushed' drinking representations on Facebook and provoke a deeper awareness among young people of drinking practices and their online displays.