Intoxication,harm and pleasure: an analysis of the Australian National Alcohol Strategy

This article contrasts two understandings of intoxication. The first, found in public health discourse, constructs intoxication as a harm produced by risky alcohol consumption and highlights its many negative consequences for individual and social well-being. The model of intoxication as a harm dominates the new Australian National Alcohol Strategy, which includes the reduction of intoxication as one of four priority areas. The second understanding, based on the everyday experiences of drinkers as well as popular discourse, approaches intoxication as a positive and enhanced state: a form of bodily pleasure. The article argues that while the understanding of intoxication as a harm is epidemiologically incontrovertible, the gap between the public health and everyday understandings of intoxication is a problem for campaigns that aim to alter drinking practices. This is particularly the case when, as recent research suggests, young people's drinking is part of a wide-ranging culture of hedonistic consumption. A clearer picture of the varied uses of alcohol and cultures of drinking, including controlled intoxication among young people, would enhance public health understandings of alcohol consumption and its risks and pleasures.     

Friendship,sexual intimacy and young people’s negotiations of sexual health

Abstract

This paper examines how young people’s friendships influence safer sexual practices. Through a thematic discourse analysis, interviews with Sydney-based young people (aged 18–25 years) and Australian-based sexual health websites for young people are considered. Interview data illustrate how friendships can support young people's sexual experiences, concerns and safeties beyond the practice of ‘safe sex’ (condom use). This is evident in friends’ practices of sex and relationship advice, open dialogue, trust and sharing experiential knowledge, as well as friend-based sex. Meanwhile, friendship discourse from selected Australian sexual health websites fails to engage with the support offered by friendship, or its value to a sexual health agenda. Foucault’s account of friendship as a space of self-invention is considered in light of these data, along with his argument that friendship poses a threat to formal systems of knowing and regulating sex. Whether sexual or not, many close friendships are sexually intimate given the knowledge, support and influence these offer to one’s sexual practices and relations. This paper argues that greater attention to friendship among sexual health promoters and researchers would improve professional engagements with young people’s contemporary sexual cultures, and better inform their attempts to engage young people through social media.     

Neither ‘foolish’ nor ‘finished’: identity control among older adults with HIV in rural Malawi

Prevalence of HIV after age 50 is considerable, especially in southern Africa. Negative social constructions of HIV in older age, and the health consequences of ageing with the virus, mean that having HIV presents a challenge for many people's roles and social memberships, threatening to disrupt their sense of self. Using constructivist grounded theory and qualitative data from rural Malawi, this paper describes how older men and women deal with these identity challenges. Drawing on a symbolic interactionist framework, it uses identity control theory to explore how the study's participants presented their post‐diagnosis behaviours in ways that maintained their most significant pre‐diagnosis identities as ‘adults’, a label they gave to the core identity of being a person who belongs in the social world. Considering the processes through which older people with HIV navigated challenges to their identities in light of the intersectional influences of HIV and age‐related stigma and illness, provides insight into how older people might experience HIV, as well as informing theoretical understandings of identity formation and maintenance in light of chronic and/or stigmatising illness more broadly.     

A focus on pleasure? Desire and disgust in group work with young men

There are a number of persuasive arguments as to why sexual pleasure should be included in sexual health work with young people, including the suggestion that this would provide young people with accounts of gender and sexuality that are more critical and holistic than those presented in the popular media, pornography and current sex education curricula. This paper considers the possibilities for engaging young men in critical group work about sexual pleasure in research and education contexts, drawing on a mixed-methods study of young people's understandings and experiences of ‘good sex’. The paper provides a reflexive account of one focus group conducted with a group of heterosexual young men and two youth educators. It explores some of the challenges to building relationships with young men and creating ‘safe spaces’ in which to engage in critical sexuality education in socially unequal contexts. In this case study, adult-led discussion elicits rebellious, ‘hyper-masculine’ performances that close down opportunities for critical or reflective discussion. Although there are some opportunities for critical work that move beyond limited public health or school-based sex education agendas, there is also space for collusion and the reinforcement of oppressive social norms. The paper concludes by imagining possibilities for future research and practice.     

Ideology and resistance in young people's experiences of health under the ‘imperative of enjoyment’

This article explores upper secondary school students’ understandings and experiences of health in Denmark, where public health promotions appeal to pleasure. Health promotion thereby taps into capitalist society's ‘imperative of enjoyment’, which reproduces ideological fantasies about the fulfilment of desires through the consumption of health. Based on qualitative empirical material produced through participatory and visual methods during fieldwork conducted in 2012, the analysis shows that relations between healthiness and pleasure are conflated and paradoxical: the students try to fit into society not only by being healthy, but also by enjoying healthiness; but if they fail pleasure, they fail healthiness and experience a loss of individual social value. Although the ‘enjoyment society’ has the potential to produce individualisation and marginalisation, the students in this study actively attempt to subvert its double bind by insisting that collective experiences with peers constitutes the foundation of enjoyable healthiness. Nevertheless, public health promotions that reproduce enjoyment as an imperative, even in the pursuit of health, risk reinforcing young people's resistance towards health.     

Sexting: Young Women's and Men's Views on Its Nature and Origins

PurposeThis study addresses a gap in evidence regarding the nature and origins of the phenomenon of sexting from the perspective of young people.MethodsA qualitative methodology was used, involving individual semistructured interviews with 33 young people aged 15–20 years. Participants were sourced via youth health, recreational, and educational settings using purposive snowball sampling. Results were organized using NVivo, and themes were generated.ResultsInterviews with 15 males and 18 females exposed a number of themes, including the gendered nature of sexting, which is the focus of this article. Of particular concern is the theme of pressure experienced by both young women and young men to be involved in the behavior.ConclusionsFindings highlight important implications for the design of strategies to prevent the potential harmful consequences of sexting. For prevention approaches to be effective, they must consider the underlying origins of the behavior and the online sociocultural context within which young people live.     

Through the tablet glass: transcendent parenting in an era of mobile media and cloud computing

Abstract

In many urban societies, mobile media and cloud computing that offer always-on, always-available information and communication services are increasingly pervasive. These services shape the communication practices and media consumption habits of families, influencing how parents guide children’s media use, and how parents and children connect with one another. In this paper, I explain how the growing prevalence of mobile media and cloud computing has different implications at each stage of young people’s development. I then argue that the advent of pervasive, ubiquitous media has engendered the practice of “transcendent parenting” which goes beyond traditional, physical concepts of parenting, to incorporate virtual and online parenting and how these all intersect. In this emergent form of parenting, parents must transcend every media consumption environment that the child may enter, their children’s offline and online social interaction milieu and “timeless time” as experienced in the apparent ceaselessness of parenting duties.     

Crisis and Emergency Risk Messaging in Mass Media News Stories: Is the Public Getting the Information They Need to Protect Their Health?

The mass media provide an important channel for delivering crisis and emergency risk information to the public. We conducted a content analysis of 369 newspaper and television broadcast stories covering natural disaster and foodborne outbreak events and coded for seven best practices in crisis and emergency risk messaging. On average, slightly less than two (1.86) of the seven best practices were included in each story. The proportion of stories including individual best practices ranged from 4.6% for “expressing empathy” to 83.7% for “explaining what is known” about the event’s impact to human health. Each of the other five best practices appeared in less than 25% of stories. These results suggest much of the risk messaging the public receives via mass media does not follow best practices for effective crisis and emergency communication, potentially compromising public understanding and actions in response to events.     

From risky behaviour to sexy adventures: reconceptualising young people’s online sexual activities

Western discourses about young people and sexuality centre around the concept of risk. Anxieties have been fuelled by the increasing popularity of social media and practices such as ‘sexting’ and watching ‘sexually explicit’ materials online. Research has shown however that such risk discourses mainly serve to moralise about, pathologise and police particular behaviours and children. In order to counter such paternalism, researchers advocated a reconceptualisation of youth not as passive victims, but as active agents who actively negotiate sexual experiences and discourses. In this paper, which is based on ethnographic fieldwork among young people in The Netherlands, I argue that we need a reconceptualisation not only of youth, but also of their sexual practices, especially their online sexual practices. Mobilising an interdisciplinary interaction between critical socio-cultural studies of risk, feminist theory and adventure studies, I propose to reconceptualise these practices as ‘adventures’ rather than ‘risky behaviour’. This opens up possibilities for a more reasoned analysis that acknowledges: (1) the distinction between risks and outcomes of an activity; (2) the constructive potential of risk; and (3) the subjective, dynamic character of risk and pleasure.     

Gender and class differences in young people's sexuality and HIV/AIDS risk‐taking behaviours in Thailand

This study examines gender and class differences in young people's beliefs about sexuality and HIV/AIDS risk‐taking behaviours in Thailand. Sixty young people aged 15–19, divided equally by gender and socioeconomic background, participated in focus groups and in‐depth interviews. Four topics were explored: the differences between ‘good’ and ‘bad’ girls/boys; young people's perceptions of sexuality; social class variations in young people's knowledge of HIV/AIDS and perceptions of risk; and the most influential institutions shaping young people's sexual attitudes. Results showed that young people screened potential sexual partners utilizing an image of ‘good girls/boys' as potential HIV/AIDS‐free partners; young people defined sexuality in terms of love/sexual relationships, premarital sex, promiscuity, and virginity; and HIV/AIDS awareness varied according to class. Young people of all classes failed to demonstrate an in‐depth understanding of how they can contract AIDS. They neither viewed themselves as being in an at‐risk group, nor considered their sexual behaviours to be at‐risk behaviours. Finally, family, friends, and mass media were reported to be among the most influential institutions shaping young people's sexual attitudes. In the struggle against HIV/AIDS, these institutions together with health education not only protect but also can empower young people in Thailand.     

“Judging a Body by Its Cover”: Young Lebanese-Canadian Women’s Discursive Constructions of the “Healthy” Body and “Health” Practices

Our interest stems from the dramatic increase in the number of obesity studies, which expose Canadian women to a huge amount of information that links health to weight. Using feminist poststructuralist and postcolonial lenses, this paper investigates young Lebanese-Canadian women’s constructions of the body and “health” practices within the context of the dominant obesity discourse. Participant-centered conversations were held with 20 young Christian Lebanese-Canadian women. A thematic analysis was first conducted and was followed by a poststructuralist discourse analysis to further our understanding of how the participants construct themselves as subjects within various discourses surrounding health, obesity, and the body. Our findings reveal that most participants conflate the “healthy” body and the “ideal” body, both of which they ultimately portray as thin. The young women construct the “healthy”/“ideal” body as a solely individual responsibility, thus reinforcing the idea of “docile bodies.” The majority of participants report their frequent involvement in disciplinary practices such as rigorous physical activity and dietary restrictions, and a few young women mention the use of other extreme forms of bodily monitoring such as detoxes, dieting pills, and compulsive exercise. We discuss the language employed by participants to construct their multiple and shifting subjectivities. For instance, many of these Lebanese-Canadian women use the term “us” to dissociate themselves from Lebanese women (“them”), whom they portray as overly focused on thinness and beauty and engaged in physical activity and other bodily practices for “superficial” purposes. The participants also use the “us/them” trope to distance themselves from “Canadian” women (read: white Euro-Canadian women), whom they portray as very physically active for purposes beyond the improvement of the physical appearance of the body. We discuss the impacts of the young Christian Lebanese-Canadian women’s hybrid cultural identities and diasporic spaces on their discursive constructions of the body and “health” practices. Finally, we examine the participants’ fluid subject-positions: On one hand, they construct themselves as neoliberal subjects re-citing elements of dominant neoliberal discourses (self-responsibility for health, traditional femininity, and obesity) but, on the other hand, they at times construct themselves as “timid” poststructuralist subjects expressing awareness of, and “micro-resistance” to such discourses.     

A risky business? Health and physical activity from the perspectives of urban Australian Indigenous young people

Being Aboriginal or Torres Strait Islander in contemporary Australia is often discursively constructed in health literature as equating with risks of many kinds. This article explores the ways in which a group of urban Australian Indigenous young people perceive, navigate and articulate the so-called ‘risks' pertaining to issues surrounding their health and physical activity. Eight girls and six boys aged 11–13 years were recruited from an urban school in a major Australian city. Each young person was interviewed up to eight times, using multi-modal tools, over two and a half years, to explore the ways in which they engaged with discourses about health, risk and physical activity. Data were analysed both thematically and through a process of critical discourse analysis. The young people in this study did not perceive themselves as ‘at-risk’ of ill-health despite the recognition of ‘unhealthy’ choices or a family history of chronic illness. They appeared to negotiate risk based on both their knowledge of public health messages and their trust in themselves and those around them. The young people's narratives offer an alternate view to the pathologised, statistical ‘stories’ often representing Indigenous Australians in scientific and popular literature and the media.     

Children’s Experiences and Awareness about Impact of Digital Media on Health

Previous research has focused on the associations between technology use and children’s health, using mainly quantitative designs. This qualitative study describes technology’s impact on physical and mental health from children’s perspectives. The differences between children’s experiences and awareness of the health-related consequences associated with digital media use were examined. Focus groups and interviews were conducted with children between the ages of 9 and 16 in nine European countries (N = 368). Results of this study indicate that children’s experiences of health-related technology impacts are different from their awareness of these impacts. Children’s direct experiences with media were less extreme in contrast to their awareness of health problems, which typically involved extreme examples of possible consequences, such as killing people, kidnapping, blindness, and developing learning or psychological disorders. The results are discussed in the context of the “media panic” and “third person effect” theories.     

An integrative review on family caregivers’ involvement in care of home‐dwelling elderly

Often family members provide care‐giving, which allows older adults to remain in their homes. With declining health and increasing frailty, care‐giving of elderly people becomes a task of family caregivers (FC) in conjunction with home care nurses. It has been shown in both acute care settings and long‐term care facilities that family members prefer to be involved in decision‐making and care planning for their next of kin. Therefore, an integrative review was conducted to explore the body of knowledge of FCs’ involvement in home‐care settings from the FCs’ perspective. CINAHL, PubMed, and Cochrane databases was searched with the terms family caregiver, involvement, home care, and community dwelling. Studies written in German or English between 1996 and 2017 focusing on FCs’ caring for home‐dwelling older adults together with home care nurses were included and critically appraised. The extracted findings were analysed with concept analysis method. Twenty‐six studies were included and five themes were identified. Four themes formed the basis of assistance towards family caregivers by nurses and included “relationship building with professionals,” “negotiating with professional care,” “being professionally supported,” and “managing role expectations and knowledge sharing”. The fifth theme, “working together” described the mutual care for the care recipient. Although the first four themes were consistent with a pre‐existing conceptual model by Sims‐Gould and Marin‐Matthews (2010), the fifth required an expansion of the model with an additional contribution “collaborative practice”. The findings illustrate that involvement in care is an interactional process, which provides the basis for collaborative practices with the home care nurses for family caregivers. Family members often want to be part of the healthcare team, and nurses need contextual factors that allow providing their full range of skills and knowledge to involve family caregivers accordingly.     

“Keeping Control”: A user‐led exploratory study of mental health service user experiences of targeted violence and abuse in the context of adult safeguarding in England

The situation for people with mental health problems as a group of disabled people who experience targeted violence and abuse is a complex one. Disabled people, particularly those with mental health problems, are at higher risk of targeted violence and hostility with few effective evidence‐based prevention and protection strategies. Achieving effective safeguarding for adults with mental health problems is characterised by differential attitudes to and understandings of abuse by safeguarding practitioners, as well as systemic issues arising from multi‐agency working. “Keeping Control” was a 16‐month user‐led, co‐produced exploratory qualitative study into service user experiences of targeted violence and abuse that was examined in the context of Care Act 2014 adult safeguarding reforms in England. User‐controlled interviews of mental health service users (N = 23) explored their experiences and concepts of targeted violence and abuse, prevention and protection. Preliminary findings from these interviews were discussed in adult safeguarding and mental health stakeholder and practitioner focus groups (N = 46). The data were also discussed via two facilitated Twitter chats (responses N = 585 and N = 139). Mental health service users’ experiences and concepts of risk from others, vulnerability and neglect can be different to those of practitioners but should be central to adult safeguarding. Histories of trauma, multi‐factorial abuse; living with fear and stigma as well as mental distress; the effects of “psychiatric disqualification” and individual blaming should be addressed in adult safeguarding in mental health. Fragmented responses from services can mean a person becomes “lost in the process”. Staff can feel disempowered, afraid or lacking in confidence to “speak up” for individuals in complex service systems with poor communication and lines of accountability. Adult safeguarding practitioners and stakeholders need to be confident, accessible and respond quickly to service users reporting incidents of targeted violence and abuse particularly in closed environments such as wards or supported housing.     

Sharing “Sex Secrets” on Facebook: A Content Analysis of Youth Peer Communication and Advice Exchange on Social Media about Sexual Health and Intimate Relations

Social media present opportunities and challenges for sexual health communication among young people. This study is one of the first to examine the actual use of Facebook for peer communication of sexual health and intimate relations. Content analysis of 2186 anonymous posts in a “sex secrets” Facebook page unofficially affiliated with a Hong Kong University shows gender balance among posters, inclusiveness of sexual minorities, and frequent sharing of personal experiences in storytelling or advice seeking. The findings illuminate young people’s health concerns regarding condom use, avoiding pain, birth control, sexually transmitted infections, and body appearance. Relational concerns found entailed sexual practices, expectations, and needs—predominantly within dating relationships and include not wanting to have sex. Supportive communication among users was prevalent. A majority of posts involved advice solicitation in the form of request for opinion or information (30.38%), request for advice (13.68%), situation comparison (5.40%), or problem disclosure (9.97%). Comments to the advice-seeking posts were mostly supportive (69.49%); nonsupportive responses (unsolicited messages and gratuitous humor) were concentrated with ambiguous advice solicitations. These findings hold implications for understanding self-disclosure of intimate concerns within social networks, and attuning sexual health intervention on social media to young people’s actual needs and advice preferences.     

“Is It Really Confidential?” A Content Analysis of Online Information About Sexual and Reproductive Health Services for Adolescents

PurposeMany young people are not aware of their rights to confidential sexual and reproductive health (SRH) care. Given that online health information seeking is common among adolescents, we examined how health education Web content about SRH for young people addresses confidentiality.MethodsIn Spring 2017, we conducted Google keyword searches (e.g., “teens” and “sex education”) to identify health promotion Web sites operated by public health/medical organizations in the United States and providing original content about SRH for adolescents/young adults. Thirty-two Web sites met inclusion criteria. We uploaded Web site PDFs to qualitative analysis software to identify confidentiality-related content and conduct thematic analysis of the 29 Web sites with confidentiality content.ResultsSexually transmitted infection testing and contraception were the SRH services most commonly described as confidential. Clear and comprehensive definitions of confidentiality were lacking; Web sites typically described confidentiality in relation to legal rights to receive care without parental consent or notification. Few mentioned the importance of time alone with a medical provider. Only half of the Web sites described potential inadvertent breaches of confidentiality associated with billing and even fewer described other restrictions to confidentiality practices (e.g., mandatory reporting laws). Although many Web sites recommended that adolescents verify confidentiality, guidance for doing so was not routinely provided. Information about confidentiality often encouraged adolescents to communicate with parents.ConclusionsThere is a need to provide comprehensive information, assurances, and resources about confidentiality practices while also addressing limitations to confidentiality in a way that does not create an undue burden on adolescents or reinforce and exacerbate confidentiality concerns.     

Cultural Beliefs Underlying Medication Adherence in People of Chinese Descent in the United States

This article examines the meanings, practices, and cultural beliefs underlying medication adherence in people of Chinese descent living in the United States. The narratives were analyzed using interpretive phenomenology, resulting in the following themes that influenced the communication and behaviors around medication adherence of the participants: (a) cultural concepts of yin yang balance and “qi,” (b) understandings of Western and Chinese medicine’s efficacy profiles, (c) importance of family and social support, and (d) level of acculturation. This article discusses the influence of these themes on medication adherence and proposes that health communication campaigns, interventions, and doctor–patient communication about increasing medication adherence with people of Chinese descent should engage these understandings.     

Believing the Unbelievable: Understanding Young People's Information Literacy Beliefs and Practices in the United States

Young people are increasingly turning to the Internet more than to traditional media and information sources to find information. Yet, research demonstrates suboptimal online information literacy among youth today, suggesting potential shortcomings in young people's information consumption behaviors. To assess this, this study investigates several predictors of young people's success in online information evaluation, including their awareness of credibility problems associated with digital information, their use of specific information evaluation practices, and their accuracy in credibility assessment. Results from a study of 2,747 11–18-year-old Internet users indicate both expected and surprising influences of young people's cognitive development, decision-making style, demographic background, and digital information literacy training on their information evaluation awareness, skills, and practices. Theoretical implications and those for redesigning online information literacy interventions are discussed.