Exploring adolescents’ perceptions of graphic health warning labels: a cross-cultural qualitative study from the United Kingdom and the State of Qatar

Introduction: Despite the progress in tobacco control efforts, smoking remains the leading reason of preventable morbidity and mortality. Alarmingly, adolescents are the most prone to experiment with smoking and become addicted. As part of deterring and reducing smoking, the Framework Convention on Tobacco Control (FCTC) recommends the implementation of Graphic Health Warnings (GHWs) on cigarette packages. This thesis examines whether GHWs are perceived as an effective approach to reducing smoking among adolescents. It also investigates the under- researched area of whether fear appeal associated with GHWs increases stigma and how adolescents engage with and create meaning from GHWs. As yet, no research has specified the social and cultural dimensions that may be important factors to the effectiveness of GHWs among adolescents. Aim: The study takes a social marketing approach to examine the effectiveness of a public health policy, GHWs. The study follows an audience-centred approach to explore, through the lens of semiotics theory, the factors related to adolescents’ perception of GHWs in a cross-cultural context. This empirical study aims to offer an original contribution to the literature by establishing the communication relationship between context-specific and cross-cultural public health and social marketing communication in tobacco control. The study also explores adolescents’ suggestions for alternative messages and ways that could be more persuasive to change adolescents’ smoking attitudes. Method: The study followed a multi-site qualitative research method of focus groups and interviews among adolescents (13–18 years) in the UK and in Qatar. Twenty-six focus group discussions were conducted with adolescents in Qatar and a total of 9 focus groups and 6 individual interviews were conducted with adolescents in the UK. In total, 141 adolescents from both countries participated in the study. Interviews and focus groups were based on a semi-structured topic guide. The focus groups and interviews entailed an interactive methodological technique which is known as a projective technique. The technique involved three main activities for participants: ranking GHWs on a matrix of least to most persuasive for adolescents; designing their own understanding of a relevant and persuasive health message; and creating a mood board of the messages they perceive as persuasive to adolescents. Findings: The data were thematically analysed drawing on the theory of semiotics. Analysis of the data revealed three main themes and eight sub-themes. The study reveals that fear appeal is not always effective among adolescents and that it might create unintended consequences such as disengagement with the message, ethical considerations and reduced self-efficacy. The data suggest factors that are important message characteristics to account for during the development and evaluation of GHWs. Moreover, the study findings identify certain social and cultural factors that influence perceptions of GHWs. Adolescents in the study suggested alternative ways of communicating GHWs such as incorporating positively framed messages and other novel ways of communicating the anti-smoking message. Discussion: This thesis makes a theoretical contribution by adding concepts to the theory of semiotics, such as proximity and authenticity that can enhance the relevance and effectiveness of health messages. This contribution adds to the understanding of the meaning of signs and the dimensions deemed relevant in meaning creation. The study offers early insights into adolescents’ perceptions of GHWs in the Middle Eastern region and provides a comparative insight to adolescents’ perceptions in the UK. The thesis contributes original insights to the health communication and social marketing field, by raising awareness of the importance of specific message characteristics and social and cultural dimensions in influencing the perceptions of the target group. It also provides informed perspectives on the potential of positively framed messages and other novel approaches that could reduce unintended consequences. Furthermore, the study connects social marketing and health promotion principles to elevate a public health policy. By following an audience centred approach, the study explores the perspective of adolescents on GHWs and for the first time explores their suggestions for alternative messages and ways to communicate the antismoking message. Conclusion: The study highlights concepts and dimensions to be considered in tobacco control policy that could also be transferable to other health products. The study accentuates the importance of targeting and tailoring health communication through contextualised messages that engage the target audience. This perspective suggests a participatory approach of health communication messages

Hospital Nurses\u27 Moral Distress and Coping during COVID-19: A Pilot Study

The COVID-19 pandemic caused a wave of critically ill patients, overwhelming hospitals, and creating unprecedented conditions for hospital employees, particularly bedside nurses. Concerns about the emotional and mental well-being of nurses have already been raised prior to the pandemic and depression, anxiety, and PTSD symptoms among nurses during the pandemic have been observed. Given the increased infection and safety risks, staffing shortages, inadequate personal protective equipment and resources, and hospital restrictions causing many nurses to be patients’ only support, there is also a growing concern about how these institutional and personal restrictions to providing best care and practicing ethically have impacted nurses. Moral distress is the psychological disequilibrium that occurs when a professional knows what they need to do but is/feels unable to take that action due to perceived or actual internal and/or external constraints. Much has been researched about causes of moral distress in the last 20 years, but to date, there is limited evidence around the impact of organizational support, emotional intelligence (EI), and coping strategies. This pilot study aimed to describe and explore the relationships among EI, coping, organizational support, and moral distress, and to provide pilot data and methodological information to inform a national study. Participants were Kentucky registered nurses currently working or who have worked at an inpatient hospital facility within the last six months. Participants were recruited using non-randomized purposive and snowball sampling techniques to complete an anonymous online survey using Qualtrics. Using SPSS, descriptive statistics and regression analyses examined the relationships between the independent study variables, using the Wong and Law Emotional Intelligence Scale, COVID-19 Organizational Support, Survey of Perceived Organizational Support, and the Ways of Coping Checklist Revised, and the dependent variable, moral distress, as measured by the Measurement of Moral Distress for Healthcare Professionals. Regression analysis adjusted for hospital ethical climate, intensive care setting, and age. After data cleaning and screening, there were 544 nurse participants who completed most of the demographic questionnaire items with 271 participants completing all instruments included in the regression analysis. The sample included mostly white females with Bachelor of Science in nursing working with adult populations in non-ICU settings in central Kentucky. In support of predicted relationships, organizational support was associated with a reduction in moral distress and emotion-focused coping was positively related. However, in contrast of predicted relationships, problem-focused coping was also positively related to moral distress; and while EI had a negative relationship in correlational testing, EI resulted in a non-significant positive relationship in regression analysis. Additional regression analysis showed EI maintained a negative relationship only when entered with problem-focused coping adjusted for control variables. Future research should strive for larger, more diverse samples that would allow for mediation testing to further explore the relationship between EI, coping, and moral distress. Metadata from Qualtrics will be used to inform potential changes in the structure, length and presentation of the survey for a national study

Coping with HIV-seropositive status: a psychoneuroimmunological perspective

Twenty-seven HIV-infected homosexual men participating in an experimental drug trial were included in a psychoneuroimmunological investigation of the association between levels of short-term emotional distress, methods of coping, hopelessness, loneliness, joy, and CDS-cell counts, CD4-cell counts, and the cumulative rate of CD4-cell decline since infection. A survey of needs was included. The sample (n = 27) was significantly more depressed (p p 0.05) were found for all problem-focused coping and emotion-focusing coping scales, nor for coping by means of focusing upon and venting of emotions. Five subjects who had been infected for less than two years were excluded from analyses regarding immune functioning. For the remaining 22 subjects, no significant associations between psychosocial factors and CDS-cell counts were found (p > 0.05), nor were there any significant associations between measures of short A regression model containing the coping scales of suppression of competing activities and mental disengagement predicted 33.3 percent of cross-sectional CD4-cell counts (f = 4.737, df = 2, 19, p < 0.05). Both factors were negatively associated with CD4-cell counts. A regression model containing the coping methods of focusing upon and venting of emotions and mental disengagement predicted 29 percent of CD4- rates of decline over time (f = 3.874, df = 2, 19, p < 0.05). The venting of emotions scale was associated with slower rates of CD4-cell decline over time (r = -0.433, df = 21, p < 0.05), while mental disengagement coping was associated with faster rates of CD4-cell decline (r = + 0.314, df = 21, p = 0.16). A median-split of scores on the focusing upon and venting of emotions coping scale and CD4-rates of decline reveals that high venting scores are found in 77 percent of subjects with slow rates of decline, while low scores are evident for 78 percent of those with fast rates of cumulative CD4-cell decline since infection. It was concluded that these results are consistent with previous research concerning with the immunosuppressive effects of habitual repression of emotions and the long-term maladaptive effects of avoidance coping. -term POMS scales of emotional distress and CD4-cell counts and rates of decline over time

Cognitive behavioural treatment of chronic fatigue syndrome: an in-depth case study

Chronic Fatigue Syndrome (CFS) is a chronic disabling condition characterised by persistent physical and mental fatigue, and a variety of somatic, psychological and neurological symptoms. The aetiology of CFS is unknown and the cause of the illness remains controversial. Cognitive-behavioural therapy (CBT) is a non-pharmacological treatment approach that has been shown to be effective in treating patients with CFS. It is based on a model that hypothesises that certain maladaptive thoughts and dysfunctional beliefs may contribute to self-defeating behaviour that perpetuates symptoms and disability, and thereby impedes recovery. The main aim of this study was to critically examine the cognitive-behavioural approach of CFS outlined by Sharpe, Chalder, Palmer & Wessely (1997) by conducting three in-depth case studies. An additional aim was to present a full cognitive developmental case conceptualisation of CFS based on the theories of Leahy (1996) and Young (1994). This case study evaluated the effectiveness of a CBT treatment programme in a 48-year-old Caucasian woman diagnosed with CFS for three years. The treatment consisted of sixteen sessions of CBT and was evaluated both quantitatively and qualitatively. On the basis of this study, a set of core maladaptive schema in the area of disconnection and rejection was identified. In addition, it was found that specific compensatory schemas had developed to offset the core maladaptive schemas and that this compensatory strategy played an important role in maintaining the condition. The results also showed a significant decline in fatigue coupled with a moderate decline in functional disability and depression. A one-month follow-up interview revealed evidence of a substantial consolidation of therapeutic gains in that the improvements observed at the end of the treatment were sustained. Finally, the feasibility of incorporating a cognitive-developmental and/or schema-focused model into the standard CBT treatment model is discussed and the case study method as a research toll is evaluated in light of the findings

Care of the Sexual Self: Askesis As a Route to Sex Education

In adolescent sex education, the contemporary debate has developed into two camps: the paternalistic view and the liberal view. I argue that both sides of the camp have been too focused on actions and behavior and are assuming a heteronormative background. This dissertation argues that the way to take care of the self is through exercises, techniques, self-discipline, and self-cultivation—what the ancient Greeks called áskēsis. By applying áskēsis to sex education, students will gain the character of taking care of the sexual self and have a robust outlook of themselves via sexuality.After looking at countless syllabi, I reduce three different moral foundations that underlie existing sex education programs. The first are paternalistic sex education programs. However, empirical research shows that gender discrepancies andheteronormativity are presented as inevitable.The second model is what I call liberal-consequentialist sex education, which emphasizes avoiding negative consequences such as unwanted pregnancies and STIs. This model is an improvement since it empowers students with essential knowledge such as anatomy and sexual mechanics. But this model is still limited because it fails to discuss many forms of sexuality and gender while embracing heteronormativity.The third model is what I call liberal-deontological sex education, which teaches sexual consent. While this model definitely improves on the previous two models, there is still something lacking. Most importantly, this model fails to address the gender inequality at the root of the problematic power dynamics. For example, if to receive consent is to garner a yes, then all men have to do is manipulate woman to get that yes.These three models focus on a person’s behavior, but sexuality is much deeper. Therefore, we need another model that implements áskēsis. For simplicity, I analyze áskēsis to three components: the sexual emotions, the sexual mind, and the sexual body. A comprehensive sex education program helps students train the moral sexual character by disciplining whether those components are coming from their authentic character, or if these ideas were simply societal expectations. This model, thereby, helps students question their own social mores and help formulate their sexual subjectivity

A Bicultural Service Member/Civilian Identity and Motivations-Based Assessment of Moral Injury in U.S. Military and Veteran Populations from America’s Longest Wars

Experiences in war are often traumatic in nature. Over the past thirty years, research has resulted in increased understanding of these experiences and the unique trajectory that values-based, as opposed to fear-based, traumas can cause. This study investigates these values-based traumas and the mental health outcomes that may result in a syndrome known as moral injury. The current research examined the relationship between potentially morally injurious event exposure and mental health symptomology. Event exposure was conceptualized both as objective occurrences and as the subjective experience of events, with notable distinctions in significance of outcomes. After attempting to replicate previous research findings for the relationship between these potentially morally injurious events and symptomology, including with meaning-making hypothesized as a key variable, two new variables of bicultural identity integration and motivations to enlist were introduced into the research analyses. It was hypothesized that bicultural identity integration would have statistically significant and negative correlations with all mental health outcomes and that bicultural identity integration would mediate the relationship between perceived moral violations and overall mental health outcomes, and these hypothesized relationships were supported. Hypotheses that intrinsic motivations to enlist would be negatively correlated with mental health outcomes and extrinsic motivations would be positively correlated with negative mental health outcomes were partially supported. This paper ends with discussion of the study results, including clinical implications, study limitations, and suggestions for future research

An investigation into the influence that social and physical anti-smoking threat appeals have upon adolescent behavioural responses

The application of social marketing is rising due to its ability to promote behavioural change. This has catalysed the implementation of threat appeals across the health domain. The prominence of including physical threats that aim to elicit a fearful response has prevailed throughout threat appeal research. This over reliance and limited research has provided an opportunity to explore how other content influence attitudes and intentions towards behaviour. To the best of my knowledge, no research has systematically compared the differences between adolescents’ responses to social and physical threat appeals, specifically with those aged 11-13 who are the most vulnerable to starting to smoke. With theory suggesting that preventing adolescent smoking initiation holds the greatest reward; a conceptual model has been developed to evaluate how coping response is elicited to threat appeals. The model provides an interesting theoretical approach to evaluate responses that aim to reduce adolescent smoking initiation. Identified as one of the greatest failures in public health, marketing has been recommended to conquer adolescent initiation. The thesis provides innovative results, comparing responses between smoking classifications that provides practical findings. Attitudinal and intentional responses towards smoking was shown to be significantly different between samples depending on threat witnessed, thus identifying the need to segment campaigns. The development of the coping response classification provides a tool to assess whether the observer accepts the threat or disregards it. Specifically the research addresses three areas: 1) To investigate the differences between adolescent non-smokers’ and smokers’ responses to threat appeals; 2) To compare how social threats and physical threats influence post exposure responses; and 3) To develop a coping response classification to evaluate and estimate attitudinal and intentional responses between samples for each threat appeal to better understand responses to social marketing campaigns

Spoon-feeding or self-feeding? The infant’s first experience of solid food

Since 2002, the minimum recommended age worldwide for the introduction of solid foods has been six months, an age when most infants are able to bring food to their mouth and chew it, without assistance. Despite this, the practice of spoon feeding with purées remains prevalent and most research to date has examined the introduction of solid foods from the adult’s perspective rather than the infant’s. As a result, factors that may impact on the food preferences of infants, such as the appearance, smell and haptic qualities of food, have not been investigated, nor has the routine use of puréed foods been challenged. Similarly, while differences have been well documented between the processes of breastfeeding and bottle feeding, the possibility that there may be pertinent differences between spoon feeding and self-feeding has not been explored. Overall, the introduction of solid foods has been researched in nutritional terms, rather than in relation to the infant’s experience and his wider learning and development. This study appears to be the first to explore the introduction of solid food from the infant’s perspective. Ten infants were offered a single food, both as a graspable piece and as a spoon-fed purée. The experience was audio/video-recorded and analysed in depth using a combination of quantitative and qualitative methods. Two interviews were conducted with the mother of each infant, during which they were asked to eat the same food, in the same formats, as their infant, and to comment on the audio/video-recording. The findings indicate that spoon feeding and self-feeding are two contrasting experiences. Self-feeding was seen to be characterised by exploratory behaviour, while spoon feeding showed more evidence of avoidant behaviour by the infant and controlling behaviour by the mother. Possible implications for parental and professional guidance and for future research are discussed