Adaptation and Psychometric Evaluation of the Young Diagnostic Questionnaire (YDQ) for Parental Assessment of Adolescent Problematic Internet Use

Background and aims The surge of problematic Internet use in adolescents is a continuously growing problem across the globe. To our knowledge, to date valid questionnaire-based measurement of problematic Internet use is possible only by self-assessment. The objective for the present study was to adapt an established instrument for a parental assessment of adolescent problematic Internet use and to evaluate the psychometric properties of this questionnaire. Methods Data were collected from a representative German sample of 1,000 parents of adolescents aged between 12 and 17 years using a standardized questionnaire. To assess problematic Internet use, we adapted the established Young Diagnostic Questionnaire by rewording the items to survey a parental rating instead of a self-report (“Parental version of the Young Diagnostic Questionnaire,” PYDQ). Additionally, we assessed the Internet usage time, parental monitoring, family functioning, school performance of the adolescent, and parent–adolescent conflicts. We conducted a confirmatory factor analysis based on the 8 items of the PYDQ modeled as categorical indicators and one latent factor using a robust weighted least squares estimator. We also calculated a reliability coefficient, the acceptance of the instrument, and performed correlation analyses. Results The unidimensional model showed excellent global goodness-of-fit (χ2/df = 1.65, RMSEA = 0.03, CFI = 0.99, TLI = 0.99) and satisfactory factor loadings (standardized values ranged from 0.60 to 0.77). We observed a reliability coefficient of 0.70, a good acceptance of the instrument, and the correlation analyses indicated the construct validity of the PYDQ. Discussion and conclusion The proposed PYDQ is a suitable instrument for parental assessment of adolescent problematic Internet use

The problematic use of Information and Communication Technologies (ICT) in adolescents by the cross sectional JOITIC study

Background: The emerging field of Information and Communications Technology (ICT) has brought about new interaction styles. Its excessive use may lead to addictive behaviours. The objective is to determine the prevalence of the problematic use of ICT such as Internet, mobile phones and video games, among adolescents enrolled in mandatory Secondary Education (ESO in Spanish) and to examine associated factors. Methods: Cross sectional, multi-centric descriptive study. Population: 5538 students enrolled in years one to four of ESO at 28 schools in the Vallès Occidental region (Barcelona, Spain). Data collection: self-administered socio-demographic and ICT access questionnaire, and validated questionnaires on experiences related to the use of the Internet, mobile phones and video games (CERI, CERM, CERV). Results: Questionnaires were collected from 5,538 adolescents between the ages of 12 and 20 (77.3 % of the total response), 48.6 % were females. Problematic use of the Internet was observed in 13.6 % of the surveyed individuals; problematic use of mobile phones in 2.4 % and problematic use in video games in 6.2 %. Problematic Internet use was associated with female students, tobacco consumption, a background of binge drinking, the use of cannabis or other drugs, poor academic performance, poor family relationships and an intensive use of the computer. Factors associated with the problematic use of mobile phones were the consumption of other drugs and an intensive use of these devices. Frequent problems with video game use have been associated with male students, the consumption of other drugs, poor academic performance, poor family relationships and an intensive use of these games. Conclusions: This study offers information on the prevalence of addictive behaviours of the Internet, mobile phones and video game use. The problematic use of these ICT devices has been related to the consumption of drugs, poor academic performance and poor family relationships. This intensive use may constitute a risk marker for ICT addictio

Internet-riippuvuus teini-ikäisillä : Mitä se on ja miten sitä voi mitata

The purpose of this dissertation is to increase understanding of the nature of Internet Addiction (IA) among adolescents (aged 12 to 18 years), focusing on what IA is and how it is measured. Particular emphasis is given to the measurement of IA, and different variables are considered in order to deepen understanding of its various aspects. Accordingly, five studies have been conducted. Study I examines various Internet uses and gratifications (U&G) among adolescent Internet users by developing a valid and reliable 27-item Internet gratification scale (N = 1,914); Study II investigates the role of adolescents’ demographic, technology accessibility, unwillingness to communicate attributes, and sought Internet U&Gs in predicting their tendency to experience IA (N = 1,914); Study III examines the effect of adolescent Internet users’ background characteristics (e.g., demographics, technology accessibility, unwillingness to communicate attributes) on predicting different Internet U&Gs and heavy Internet use among adolescents (N = 1,914); Study IV investigates the psychometric properties of the Compulsive Internet Use Scale (CIUS), and the relationship between the CIUS and adolescent Internet users’ background characteristics (e.g., demographics, ICT accessibility and Problematic ICT use) (N = 2,369); and Study V focuses on the development and validation of WhatsApp (WA) addiction scales for adolescents (N = 405). Cross-sectional research and psychometric theory based analysis reveal the following findings. First, a valid and reliable Internet U&G instrument (27- item) addresses six dimensions of Internet U&G, namely information seeking, exposure, connecting, coordination, social influence, and entertainment (Study I). Second, the following are risk factors for adolescent IA: being male, lower academic performance, high daily time spent on Internet use, strict Internet parenting at home, higher approach avoidance and reward seeking, looking for more connecting, coordination and social influence seeking, and pursuing lower information seeking and exposure gratifications (Study II). Third, older females, adolescents with higher academic performance, higher reward seeking and lower daily Internet use content gratifications such as information seeking & exposure; male, adolescents seeking higher approach avoidance and reward seeking tend to seek higher social gratifications such as connecting & coordination; and higher approach avoidance and reward seeking tendencies predicted process gratifications such as social influence & entertainment (Study III). Fourth, the CIUS possesses good psychometric properties with fairly high reliability, homogeneity and validity. Male, older adolescents, those with lower academic performance, lower life satisfaction, active Internet use (including daily Internet use, excessive Internet use and overall Internet activity) and problematic Internet use significantly predicted compulsive Internet use among adolescents. The study confirmed the findings of Study II (Study IV). Fifth, three original IA scales were adjusted to access WhatsApp (WA) addiction among adolescents. The data showed that they were valid and reliable self-reporting instruments. In addition, a shorter version of each of the three adapted instruments and a 16-item unified scale were also developed and validated. All five studies (Studies I, II, III, IV, V) examined various perspectives on the conceptualization of IA with a strong focus on the measurement and development of valid and reliable instruments to measure IA To conclude, the results indicate that not all adolescents equally experience IA; rather, some are more vulnerable than others. The studies have clarified situations, attributes or behaviors that lead to IA among adolescents. Moreover, new Internet U&Gs have been identified to help to conceptualize IA. In addition, the developed and validated instruments (27-item Internet U&G, 14-item CIUS, 14-item WA addiction test, 8-item and 10-item compulsive WA use) will serve as handy tools for teachers, educational psychologists, and counsellors. By utilizing these instruments, one can easily screen compulsive Internet users from a normal population and provide vulnerable students with timely help and support. The present study confirms the findings of earlier IA literature available in the context of Internet users from a wider age group, and different cultural and demographic settings. The current studies are important, especially because the target user group is adolescent Internet users (aged 12 to 18 years) who have been overlooked in IA and Internet U&G literature. These findings also emphasize the importance of recognizing IA as a problem among adolescents, which many adolescents unknowingly are or become vulnerable to be in daily life settings. The findings are valuable in terms of education and research.Tämän tutkimuksen tarkoituksena oli lisätä ymmärrystä siitä, mitä on Internet-riippuvuus (Internet Addiction, IA) 12 -18 -vuotiailla nuorilla. Keskiösssä oli käsitteen määrittely sekä IA-ilmiön mittaaminen. Erilaisia kriteerimuuttujia käytettiin myös, jotta ilmiötä voitaisiin ymmärtää erilaisista näkökulmista. Osatutkimuksessa I tarkasteltiin teini-ikäisten Internetin käyttöä ja siihen liittyvää mielihyvää (U&G) kehittämällä validi ja luotettava 27 kysymyksen ´Internet gratification scale' (N = 1 914). Osatutkimuksessa II tutkittiin nuorten demografisten tietojen, teknologian saatavuuden, kommunikaatiohalukkuuden sekä käytön ja siihen liittyvän mielihyvän ennustearvoa Internet-riippuvuuden kokemisen suhteen (N = 1914). Osatutkimuksessa III tutkittiin teini-ikäisten Internetin käyttäjien taustamuuttujien ennustearvoa (mm. demografiset tiedot, teknologian saatavuus, haluttomuus kommunikoida) suhteessa käyttöön, mielihyvään (U&G) and intensiiviseen Internetin käyttöön teini-ikäisillä (N = 1914). Osatutkimuksessa IV tarkasteltiin mittarin 'Compulsive Internet Use Scale' (CIUS) psykometrisiä ominaisuuksia sekä CIUSin yhteyttä teini-ikäisten Internetin käyttäjien taustamuuttujiin, teknologian saatavuuteen ja ongelmalliseen teknologian käyttöön (N = 2369). Osatutkimus V keskittyi 'WhatsApp (WA) addiction scales for adolescents' -mittarin kehittämiseen ja validointiin (N = 405). Analyysit perustuivat poikkileikkausasetelmaan ja psykometriseen teoriaan. Tulokset olivat seuraavat: Ensinnäkin havaittiin, että validi and reliaabeli Internet U&G instrument käsitti kuusi Internetin käytön ja mielihyvän ulottuuvuutta: informaation hakeminen, altistuminen, yhteydenpito, koordinointi, sosiaalinen vaikuttaminen ja viihde (Osatutkimus I). Toiseksi nuorten Internet-riippuvuutta ennustivat merkitsevästi seuraavat muuttujat: sukupuoli (pojat), heikompi akateeminen suoriutuminen Internetissä käytetyn ajan määrä, tiukka Internetin valvonta koton, korkea välttämiskäyttäytyminen, alhainen palkitsemishakuisuus, runsas yhteyden hakeminen muihin, koordinoivan toiminnan ja sosiaalisen vaikuttamisen tarve, vähäisempi informaation hakeminen sekä altistuminen Internetin tuottamalle mielihyvälle (Osatutkimus II). Kolmanneksi ikä, sukupuoli (tytöt), koulussa hyvin menestyminen, korkea palkitsemishakuisuus sekä vähäisempi Internetin päivittäinen käyttö ennustivat sisällöllistä mielihyvää kuten tiedon hakua ja tiedolle altistumista. Sen sijaan sukupuoli (pojat), korkeampi välttämiskäyttäytyminen ja alhaisempi palkitsemishakuisuus olivat yhteydessä sosiaalisen mielihyvän hakuun (kuten yhteydenpito ja koordinointi). Korkeampi välttämiskäyttäytyminen ja palkitsemishakuisuus ennustivat prosessiin kohdistuvaa mielihyvää kuten sosiaalista vaikuttamista ja viihdekäyttöä (Osatutkimus III). Neljänneksi CIUSin psykometriset ominaisuudet olivat hyvät ja reliabiliteetti vähintään kohtalainen, samoin kuin validiteetti ja homogeenisuus. Pojat, vanhemmat teini-ikäiset, akateemisesti heikommin suoriutuvat, elämäänsä vähemmän tyytyväiset, aktiiviset internetin käyttäjät sekä Internetin käytön ongelmalliseksi kokevat ilmaisivat useammin myös pakonomaista Internetin käyttöä (Osatutkimus IV). Tämä tutkimus myös vahvisti toisen osatutkimuksen tulokset. Osatutkimuksessa V kolme alkuperäistä pakonomaisen Internetin käyttöä koskevaa skaalaa (summamuuttujaa) muokattiin mittaamaan WhatsAppriippuvuutta (WA) nuorilla. Tämä osoittautui reliaabeliksi itsearvioinnin mittariksi. Lisäksi kehitettiin ja validoitiin16 kysymystä käsittävä lyhyempi versio jokaisesta kolmesta instrumentista. Kaikki viisi osatutkimusta (I, II, III, IV, V) tarkastelivat eri näkökulmia Internet-riippuvuuteen ja auttoivat käsitteellistämään sitä. Tutkimuksissa painottui vahvasti Internetriippuvuutta koskevien luotettavien mittareiden kehittäminen sekä tämän ilmiön mittaaminen. Johtopäätöksenä voidaan todeta että kaikki nuoret eivät altistu Internetriippuvuudelle samalla tavalla, vaan jotkut ovat sille muita alttiimpia. Nämä tutkimukset selvensivät tilanteita, piirteitä ja käyttäytymismalleja jotka voivat johtaa Internet-riippuvuuteen teini-iässä. Lisäksi uusia Internetin käyttöön ja se tuottamaan mielihyvään liityviä tekijöitä tuli esille ja ilmiötä voidaan nyt paremmin käsitteellistää. Lisäksi tutkimuksessa kehitetyt ja validoidut mittarit (27-kysymyksen Internet U&G, 14 kysymyksen CIUS, 14 kysymyksen WA addiction test, 8 kysymyksen ja 10 kysymyksen pakonomaisen Whatappin käyttämisen mittarit) voivat toimia kätevinä työvälineinä opettajille, koulupsykologeille ja opinto-ohjaajille. Näiden mittareiden avulla saadaan helposti selville, onko Internetin käyttö pakonomaista ja poikkeaako se normaalista populaatiosta. Tällä tavalla on mahdollistaa auttaa Internet-addiktiolle mahdollisesti altistuvia oppilaita. Tämä tutkimus vahvisti aikaisempia Internet-riippuvuuteen liittyviä tutkimuksia ja auttoin yleistämään niitä laajempiin ikäryhmiin sekä uusiin kulttuureihin ja konteksteihin. Tutkimus on tärkeä, koska kohderyhmä on sellainen, jota ei aiemmin juuri ole tutkittu. Tulokset myös painottavat Internet-riippuvuuden toteamista ja tunnistamista. Kyseessä on potentiaalinen ongelma, jolle lukuisat nuoret voivat altistua jokapäiväisessä elämässään. On myös huomattava, että suurin osa nuorista kokee mielihyvää Internetin käytöstä, mutta ei osoita addiktion oireita

Young Children (0-8) and Digital Technology - A qualitative study across Europe

It only takes witnessing a few interactions within modern western families to realize how much the experience of childhood has changed. The change comes from different winds blowing on today’s families’ time but certainly, the use of digital technologies peaks out and its impacts on childhood, education, learning and safety has been at question over the last years. Since a very early age, video watching and gaming on a variety of internet-connected devices are among children's favourite activities. Parents see digital technologies as positive and unavoidable, if not necessary, but at the same time, find managing their use challenging. They perceive digital technologies as something that needs to be carefully regulated and controlled. They would appreciate advice on fostering children’s online skills and safety. The document reports on results of a cross-national analysis building on data coming from 234 family interviews with both children and parents, carried out from September 2014 until April 2017 in 21 countries. It exposes the key findings regarding first children’s usage, perceptions of the digital technologies and their digital skills in the home context but also on parents’ perceptions, attitudes, and strategies. Beside the cross-national analysis, a dedicated section provides contextualized snapshots of the study results at national level. It then takes a close up on 38 families in seven countries in which researchers came for a second interview distant of one year in which they focused on monitoring change of context, children and parents’ perceptions, attitudes, and strategies over time. Conclusion reflect on the potential benefits, risks and consequences associated with their (online) interactions with digital technologies and provide recommendations to policymakers, industry, parents and carers.JRC.E.3-Cyber and Digital Citizens' Securit

Personality traits related to problematic Facebook use

The American Psychiatric Association (APA) encouraged research in the area of Internet Gaming Disorder, by including it in the Conditions for Further Study section of the Diagnostic and Statistical Manual of Mental Disorders , 5th Edition (DSM-5; APA, 2013). The present study attempted to determine which personality traits were associated with problematic Facebook use, a subset of problematic Internet use. The Bergen Facebook Addiction Scale (BFAS), Narcissistic Personality Inventory-Sixteen (NPI-16), International Personality Item Pool (IPIP) items related to extraversion, IPIP items related to neuroticism, Internet Addiction Test (1AT), Facebook Intensity Scale (FBI), a demographic information form, and Exploratory Facebook Use Questionnaire were used to determine if specific personality traits were associated with problematic Facebook use. Participants were 295 Facebook users, recruited through social media. Participants reported more Facebook friends and the average participant age was over a decade older than in prior studies. The average number of hours spent on Facebook per day was similar to previous research. Females reported having significantly more Facebook friends and yielded significantly lower scores on personality measures than males. On the three measures of problematic Facebook use, results were mixed. Females produced lower scores than males on two measures and higher scores on a third measure. Additionally, results suggest narcissism, extraversion, and neuroticism predict problematic Facebook use in males, but not females. Higher levels of narcissism and extroversion were found to be associated with higher scores on measures of problematic Facebook use. Additionally, neuroticism and extraversion were significant positive predictors of problematic Facebook use. Positive endorsement of Exploratory Facebook Use Questions was associated with higher scores on two measures of problematic Facebook use. Lastly, participants with higher problematic Internet use also reported higher levels of problematic Facebook use. Continued research is needed to understand better the full nature of problematic Internet and/or subsets (i.e., problematic Facebook use)

Internet and Smartphone Use-Related Addiction Health Problems: Treatment, Education and Research

This Special Issue presents some of the main emerging research on technological topics of health and education approaches to Internet use-related problems, before and during the beginning of coronavirus disease 2019 (COVID-19). The objective is to provide an overview to facilitate a comprehensive and practical approach to these new trends to promote research, interventions, education, and prevention. It contains 40 papers, four reviews and thirty-five empirical papers and an editorial introducing everything in a rapid review format. Overall, the empirical ones are of a relational type, associating specific behavioral addictive problems with individual factors, and a few with contextual factors, generally in adult populations. Many have adapted scales to measure these problems, and a few cover experiments and mixed methods studies. The reviews tend to be about the concepts and measures of these problems, intervention options, and prevention. In summary, it seems that these are a global culture trend impacting health and educational domains. Internet use-related addiction problems have emerged in almost all societies, and strategies to cope with them are under development to offer solutions to these contemporary challenges, especially during the pandemic situation that has highlighted the global health problems that we have, and how to holistically tackle them

Stigma towards people with mental health problems: an individualism-collectivism cross-cultural comparison.

This study explored whether the cross-cultural value paradigm ‘individualismcollectivism’ is a useful explanatory model for mental illness stigmatisation on a cultural level. This has never before been directly investigated despite numerous clues of its potential importance in previous related literature. The paradigm asserts that in ‘collectivist’ cultures, people are more strongly interdependent with their in-groups, and are more likely to give priority to the goals of their in-groups than people from ‘individualistic’ cultures, who are instead more likely to value and desire autonomy and independence from their in-groups, and give priority to their personal goals than to their in-group goals. Three hundred and five individuals from four UK-based cultural groups (white-English, American, Greek/Greek Cypriot, and Chinese) were successfully recruited for a quantitative survey through the use of non-randomised snowball and quota sampling. Twenty-two of these individuals were later qualitatively interviewed in a one-to-one, semi-structured manner. Questions regarding where the four cultures fit within the individualism-collectivism paradigm, how acculturation affects the individualismcollectivism paradigm, what other factors explain stigmatisation, and the level of stigmatising attitudes present in these cultures, were also integrated into the methodological components in an attempt to explore these other important themes. The results partially supported the hypothesis that the paradigm can be applied to explain mental illness attitudes. Increases in the paradigm’s explanatory power corresponded with a cultures’ stigmatisation level. Specifically, the more stigmatising a culture’s mental illness attitudes are, the more likely collectivism effectively explains these attitudes. In contrast, the more positive a culture’s mental illness attitudes, the more likely individualism effectively explains attitudes. Educational level, mental illness experience, and, particularly, mental illness knowledge, were other powerful and consistent stigma explanatory factors, although the stigma affect of these and impact of other key themes were unique to each cultural group. The results also revealed that successfully acculturating to a new culture can impact on one’s cultural values including levels of individualism-collectivism. The American cultural survey group held the most positive mental illness attitudes, followed by the white English group. Both groups also scored high on levels of individualism. The Greek/Greek Cypriots and Chinese held the least positive attitudes and were also found to be generally collectivistic. None of the survey groups’ scores were wholly stigmatising, which suggests a positive shift towards more tolerant attitudes having taken place in recent years even in the Greek/Greek Cypriot and Chinese cultures. This is illuminating as these are traditionally particularly stigmatising cultures, which qualitative interviewees also argued. A number of important recommendations for policy and practice that aim to reduce stigma and highlight the importance of culture are proposed. These include anti-stigma campaigns needing to be culturally and linguistically appropriate and sensitive; using in-group, second-generation members of closed and collectivist communities/cultures to deliver of anti-stigmatising initiatives and; training practitioners to understand the impact of individualism-collectivism on mental health attitudes. Further, a consideration of the individualism-collectivism paradigm should be included in any future research aiming to provide a holistic understanding of the causes of mental illness stigma both on an individual and cultural level

Contributing to smoke-free:How can the provision and uptake of smoking cessation support be improved, including for those with mental health conditions?

Background:Smoking tobacco cigarettes is a major risk factor for cancer, chronic obstructive pulmonary disease (COPD), stroke, and heart disease. Although the United Kingdom (UK) has a comprehensive tobacco control strategy and adult smoking prevalence has reduced considerably over the past decades, from 45% in 1974 to 12.9% in 2022, smoking is still a leading preventable cause of illness and premature death in the UK and worldwide. Additionally, there are significant disparities in smoking prevalence within the population. For example, smoking prevalence is significantly higher in those with mental health conditions compared to those without, and depression and anxiety are two of the most common mental health conditions among people who smoke. Research is needed to explore how further reductions in population-level smoking prevalence can be made, including in those with mental health conditions, in order to reach national “smoke-free” or “tobacco end game” ambitions for all, which are typically defined as ≤5% adult smoking prevalence.Aim and Objectives:Aim: Contribute to the evidence base regarding how the provision and uptake of smoking cessation support options (including nicotine vaping products [NVPs]) could be improved. Objective 1: Review the evidence for the effectiveness of interventions (implementation strategies), which were implemented on a national or state-wide scale, aiming to increase the provision of smoking cessation treatment in primary care. Objective 2: Describe and characterise the extent to which NVP use has been recorded in primary care electronic health records in the UK. Objective 3: Examine interactions between health professionals and people who smoke with and without common mental health conditions (depression and/or anxiety), about smoking cessation and nicotine vaping products. Objective 4: Assess cessation aid utilisation by people who smoke with and without common mental health conditions (depression and/or anxiety) used in their last attempt to quit smoking.Methods:To achieve the four objectives, four studies were conducted. Study 1: Systematic review and narrative synthesis of findings. Study 2: Exploratory analysis of Clinical Practice Research Datalink (CPRD), 2006–2022: electronic primary care patient data from ~25% of the UK population. Study 3: Using 2018 cross-sectional International Tobacco Control Four Country Smoking and Vaping Survey data from Australia, Canada, England and the United States (US), weighted logistic regression models examined the association between self-reported current diagnosis/treatment for depression and/or anxiety and health professional interactions about smoking cessation and nicotine vaping (visiting a HP; receiving advice to quit smoking from a HP; discussing NVPs with a HP; receiving a positive recommendation to use NVPs). Study 4: Using the same survey data as in Study 3, weighted logistic regression models examined the association between self-reported current diagnosis/treatment for depression and/or anxiety and what cessation support option (any cessation support, nicotine replacement therapy [NRT], varenicline or bupropion, behavioural support, or NVPs) was used at last smoking quit attempt.Results:Study 1: The systematic review identified 49 studies. Implementation strategies which involved ‘changing infrastructure’, ‘training and educating stakeholders’, and ‘engaging consumers’ increased smoking status recording and cessation advice provision in primary care. Implementation strategies which involved ‘utilizing financial strategies’ increased smoking status recording and cessation advice provision, and smoking cessation. Implementation strategies which involved ‘training and educating stakeholders’ increased smoking status recording and cessation advice provision, and smoking cessation, but the evidence was low-quality. Study 2: Using UK primary care data, I identified seven medical codes indicating current or former vaping. Vaping documentation was very low: 150,144 unique patients out of the estimated ~16 million patients registered in CPRD had ever received a vaping medical code. The first incidence of vaping documentation was in October 2011; vaping code incidence increased from September 2013. The ‘e-cigarette or vaping product use-associated lung injury’ (EVALI) outbreak in the US (and peak media coverage in September 2019) was significantly associated with a reduction in new records of current vaping, manifested as a declining trend over a period of seven months (September 2019 to March 2020); additionally, there was an immediate increase in new records of former vaping, followed by a declining trend over the subsequent seven-month period. When patients received their first vaping code, mean age was 50.2 years, 52.4% were female, and 82.1% were White. When receiving the first vaping code, the majority of patients were either smoking or had quit smoking in the past, and &lt;2% were recorded as having never smoked. Of those recorded as currently vaping, 98.9% had records of their previous smoking status, and 55.0% had records of their smoking status over a period greater than 12 months. Over a year after being recorded as vaping, 34.2% of people who were smoking prior to being recorded as vaping were still smoking, 23.7% quit smoking, 1.7% received a ‘never smoked’ status, and there was no smoking status for 40.4%.Study 3: People with anxiety and/or depression who smoke were more likely to visit a HP than those without, but only those with depression were more likely to receive cessation advice. Among those who had visited their HP, less than half (47.9%) reported receiving advice to quit smoking. Those with both depression and anxiety were more likely to discuss NVPs, compared to those without depression/anxiety. The likelihood of receiving a positive recommendation to use NVPs did not differ by mental health condition. NVP discussions and receiving a positive recommendation to use them were rare overall.Study 4: A large proportion (40%) of respondents did not use any cessation aid in their last quit attempt and there was a high rate of unsuccessful quit attempts: 76%. At their last smoking quit attempt, those with anxiety, and both anxiety and depression were more likely to use any cessation support than those without these mental health conditions. Specifically, those with depression and anxiety were more likely to use NRT, and those with depression and/or anxiety were more likely to use behavioural support, compared to those without depression/anxiety. However, the use of NVPs and varenicline/bupropion to quit smoking was similar among adults with and without depression/anxiety.Conclusions:The rate at which health professionals deliver smoking cessation advice and support is suboptimal. I found evidence towards the effectiveness of utilizing financial strategies, and some (limited) evidence towards training and educating stakeholders, on increasing smoking cessation rates. I recommend that health professionals conduct continued professional development/training to ensure that they are up to date with the smoking cessation support options that are available, and the guidance regarding their use. I recommend that cessation support options be made available to people who smoke free of charge. Also, while not all the evidence is certain for all forms of provider incentivisation, I did find some evidence that they may increase cessation rates. I recommend that future implementation strategies attempt to better align with the existing technologies and the routine systems in place. In future research, researchers could explore if there are any ways to optimise Very Brief Advice (VBA) further, and I advise that studies assess the effectiveness of implementation strategies on both (practitioner-level) provider performance as well as (patient-level) smoking outcomes.I found that the documentation of vaping in UK primary care was low but increasing over time. Given that population-level electronic health records could be employed to investigate the long-term health effects and smoking cessation outcomes of vaping, I proposed recommendations to improve the completeness, accuracy and consistency of vaping status recording, by refining medical codes for vaping, and introducing a Quality and Outcomes Framework indicator for recording vaping status.I found that there are missed opportunities for health professionals to provide cessation advice and recommendations about using NVPs to quit smoking, and to offer cessation support. Given that a large proportion of respondents did not use any cessation aid in their last quit attempt and there was a high rate of unsuccessful quit attempts, I advise that health professionals should systematically offer ongoing cessation support to all patients, regardless of mental health status. However, in order to address the disparity in smoking prevalence between those with and without mental health conditions, health professionals need to increase the rate of smoking cessation support provision to those who smoke and have mental health conditions (above the rate of provision to people who smoke without mental health conditions). As NVPs are potentially the most effective smoking cessation support option currently available, it is important that healthcare professionals provide accurate information about and access to NVPs to people who smoke, especially for individuals with mental health conditions. To achieve this, people with mental health conditions could be specifically targeted as a priority population in some of the policy recommendations recently made in the Khan review and the initiatives recently announced by the UK government, such as the national ‘swap to stop’ programme, where people who smoke will be able to switch cigarettes for NVPs.</div

English Language Learner Teachers’ Perceptions Of Digital Games On Student Learning

This body of work contains three articles that examine the intersectionality between English Language Learner (ELL) teachers and digital games. The purpose of the study is to qualitatively explore the perception of ELL teachers’ use of digital games as educational tools and whether they realize the potential to promote language learning for ELLs. This study aims to understand the lived experiences of ELL teachers to identify their viewpoint of language learning through gaming. The work focuses particularly on the teacher in an effort to contribute empirical work that supports the need for a more holistic approach to digital games in teacher education programs. This dissertation sought to answer four main questions: 1) What is the perception and lived experiences of ELL teachers use of digital games as educational tools?; 2) What are the perceived challenges facing ELL teachers in incorporating digital games?; 3) How does ELL teacher’s perception of digital games influence their use and incorporation?; 4) How do ELL teachers define best practices for digital games in order to promote language learning? I employed qualitative case study methods with a phenomenological lens to analyze the data. I interviewed six ELL teachers in the upper Midwest of the United States. The outcome of this study has the potential to enable teachers to use digital games effectively and to ultimately improve teaching and learning. Today, almost every aspect of society requires the use of technology. Therefore, the incorporation of technology into lesson plans is aligned with the needs of society in the 21st century. By adding digital games into classroom learning, educators may be able to better prepare students for their future careers. This preparation can be achieved because digital games have the potential to increase students’ problem-solving skills, as well as spatial and logical reasoning. The upward mobility and learning opportunities in digital games for ELLs are multiplied in fun and engaging ways

Towards an Understanding of How London Turkish Cypriot Youth ‘Perform’ Their Diaspora Identities Through Emplacement and Mobility

The London Turkish Cypriot (LTC) community has been described as ‘invisible’, a community at the point of eradication (Aksoy and Robins 2001). For three generations of LTCs the process of cultural identification has seen an evolution from migration and ‘homeland’ association, to critical displacement, assimilation and different perceptions of what is ‘home’. The growing diversity in cultural identification is further reflected in enhanced access to spatial consumption, mobility and choices of emplacement for its younger generations. This PhD is driven by practice-as-research. The practice, and therefore line of reasoning, behind this research is an ongoing, organic process that has shifted throughout the course of the thesis. The documentation of the practice-as-research is included in the accompanying DVD and is integral to the findings of this thesis. The thesis asks how LTC youth ‘perform’ their identities and negotiate a diaspora identity that is in constant flux. The enquiry consists of two main lines of enquiry. First, I am exploring how young people use public spaces through mobility and a ‘mobile’ culture, using mobile initiated technology to further explore the idea of movement and flux. Second, I progress towards a greater understanding of the participating young LTCs’ concept of ‘home’ and what elements of their every day performative behaviour, their environment and relational spaciality construct and support these home-making practices. The thesis addresses complex issues arising out of auto ethnographic practice-as-research of the LTC community, conducted through applied drama practices with its youth. Issues include identifying young participants’ relationship to cultural space, place making and notions of ‘home’ as part of their identity construction process. The thesis also discusses the ‘fit’ of applied drama as a qualitative research tool within this context and the fluidity of changing technologies that can be, and are at times, used to document examples of practice