The role of the media in shaping young people’s drinking cultures, practices and related identity making: studies of multiple media platforms

This PhD submission presents a series of peer-reviewed journal articles (and other supporting publications) that synthesise an original programme of research that examined the ways in which the media platforms (magazines, television, marketing, Social Network Sites (SNS)) young people (11-21 years) engage with portrayed alcohol, it’s use and related practice. Young people’s own perspectives, interpretations and experiences were also explored, in order to better understand the role of the media in shaping young people’s drinking cultures, practices and related identity making, in ways that are gendered. The underlying theory is presented, the methodological approach employed critically reviewed, and researcher positionality considered. Published findings are then presented that highlight how entertainment media, marketing and peer content on SNS act as important sources of information through which young people learn what is socially acceptable and normative drinking practice for men and women, and how to ‘do’ and perform gender through alcohol-related practice. The research found that although mediated gendered norms around alcohol are reflected and reproduced in young people’s attitudes, beliefs, and behaviours, young people also appropriated and rejected alcohol-related messages within their own identity making. The use of the media and social media platforms (e.g. SNS) in disseminating health messages on alcohol to young people and young people’s acceptability of such approaches is also addressed. How the research has contributed to knowledge and the implications of the research for public health, gender studies and policy are also considered. The articles presented in this PhD, supporting documents, conference presentations and public engagement, provide a coherent, significant and novel multi-disciplinary contribution to knowledge on the role of the alcohol, media, and alcohol marketing in young people’s drinking cultures, and practices, and in shaping their identities. All the research conducted for the publications was undertaken during employment at the Public Health Institute, Liverpool John Moores University

'If I don't look good, it just doesn't go up': A qualitative study of young women's drinking cultures and practices on Social Network Site.

BACKGROUND: Young women in the UK often partake in a culture of intoxication in the pursuit of pleasure and friendship fun. Experiences of intoxication and drinking spaces remain highly gendered and relative to men, women continue to find their behaviours in drinking spaces more constrained and scrutinised. Simultaneously, young women now express themselves via Social Network Sites (SNS), where they display drinking experiences and where they perform, negotiate and display contemporary femininities. METHODS: The research explored young women's experiences of drinking and intoxication, the use of SNS in their drinking cultures and the display of drinking practices on SNS through group interviews (n=12) with women (n=37) aged 16-21 from one city in the North-West of England, UK. RESULTS: The practice of uploading drinking photographs to SNS played an important role in displaying young women's popularity, enhancing friendship fun and belonging, and in positioning the hyper-sexual feminine look as the norm in drinking spaces. Both intoxication and the hyper-sexual and feminine look challenged traditional notions of respectable femininity, while the highly groomed feminine look itself was threatened by drunkenness. As such, young women invested much work and effort in self-surveillance and in managing the display of their drinking behaviours on SNS. CONCLUSION: The dilemmas in contemporary femininity created by the juxtaposition of hyper-sexual femininity and the culture of intoxication are reproduced on SNS. Controlling and restricting certain content on SNS with the aim of achieving the 'right' feminine self-presentation resulted in a narrowly set of body oriented and behavioural feminine attributes being presented as the norm, and an overly positive online representation of young women's drinking experiences

'We are still obsessed by this idea of abstinence': A critical analysis of UK news media representations of proposals to introduce drug consumption rooms in Glasgow, UK.

BACKGROUND: Drug consumptions rooms (DCRs) are a well-established and evidence-based harm reduction response to drug use. Recently, a consortium led by health services in Glasgow, United Kingdom (UK), proposed piloting a DCR. In this article, we examine how the proposals were represented in news media reporting, and the possible effects of such reporting. METHODS: A quantitative content and qualitative thematic analysis of UK news media (n = 174 articles) representations of the proposals to introduce DCRs in the city of Glasgow, UK, was conducted. Analysis was informed by Bacchi's (2009, 2012, 2017) approach to policy analysis, 'What's the problem represented to be?' FINDINGS: Competing representations of the 'problem' of injecting drug use (IDU) were contested by a range of actors with different political visions. The applicability of the 'evidence base', potential benefits of DCRs to both users and the public, and the associated economic costs, were presented in differing ways depending on the underlying assumptions and presumptions of the arguments constructed (e.g. harm reduction vs recovery). As a result, a number of conflicting subject positions were presented that may have implications for the way that people who inject drugs (PWID) see themselves, and how they are viewed and treated by society. Whilst proponents positioned DCRs within a discourse of public health, an underlying rhetoric of abstinence and recovery underpinned the arguments against DCRs. It was this latter discourse that underpinned the UK Government's rejection of the proposals, which the Scottish Government were prevented from overruling within the political constraints of their devolved powers, with the lived effect of people who use drugs (PWUD) being denied access to public health services that mitigate harm. CONCLUSION: We conclude that attempts to introduce and gain public and political support for harm reduction responses such as DCRs through the news media face challenges within the historical and political context of prohibitionist UK drugs policy

Velocity unwrap for high resolution slice-selective Fourier Velocity Encoding using spiral SENSE

Quantification of peak velocity is important in the assessment of stenotic flow jets. It is possible to measure peak velocity accurately using Fourier Velocity Encoding (FVE). In this study, a fast, high-resolution slice-selective FVE sequence was developed with the use of spiral trajectories, parallel-imaging, partial-Fourier in the velocity-dimension and a novel velocity-unwrap technique. The resulting sequence was acquired within a short breath-hold. Peak velocities were compared from Doppler ultrasound (US), phase-contrast MR (PCMR) and FVE. Experiments carried out in-vitro and in-vivo showed that PCMR tended to underestimate peak velocity compared to Doppler US, whereas FVE agreed well with Doppler US

Anabolic-Androgenic Steroid Use in the Eastern Mediterranean Region: a Scoping Review of Extant Empirical Literature

The use of image- and performance-enhancing drugs particularly anabolic-androgenic steroids (AAS) is not a new phenomenon. AAS use is not limited to athletes, with mainstream populations using these drugs for aesthetic purposes. Prevalence has been predominantly in Western countries, with some recent studies indicating a rise in popularity in the Eastern Mediterranean region. A scoping review of extant empirical literature from the Eastern Mediterranean region described and mapped what is known about the extent of AAS in the region. Four themes emerged from the review: (1) profile of AAS users; (2) AAS within gymnasium practice; (3) AAS regimes of use; and (4) knowledge and understanding of the AAS concept and related adverse effects. The review highlights a relatively new phenomenon of AAS use in the Eastern Mediterranean. The review underscores the need to carry out further research, particularly qualitative and quantitative studies with both genders, and cognisant of the complexities of culture and religiosity

D-optimal designs for multiarm trials with dropouts.

Multiarm trials with follow-up on participants are commonly implemented to assess treatment effects on a population over the course of the studies. Dropout is an unavoidable issue especially when the duration of the multiarm study is long. Its impact is often ignored at the design stage, which may lead to less accurate statistical conclusions. We develop an optimal design framework for trials with repeated measurements, which takes potential dropouts into account, and we provide designs for linear mixed models where the presence of dropouts is noninformative and dependent on design variables. Our framework is illustrated through redesigning a clinical trial on Alzheimer's disease, whereby the benefits of our designs compared with standard designs are demonstrated through simulations.Grant codes MR∕N028171∕ and MC_UP_1302∕

‘Isn’t it mostly girls that do pre-drinks really?’ Young men and women’s accounts of pre-loading in the UK

Aims: Pre-loading, the consumption of off-sale alcohol within private settings before socialising in licenced premises, is common among young people. The research explored young people’s accounts of pre-loading within their experience of wider peer group drinking occasions in the UK. Methods: Fourteen semi-structured focus group interviews were conducted with peer groups of young people (N = 70, 16–21 years) and analysed using thematic analysis. Results: Pre-loading with friends prior to a ‘night out’ drinking in public spaces was a common sequential practice within their collective drinking experiences. Although traditionally conceptualised within policy, academic and media discourse as drinking in the domestic sphere before entering licenced premises, young people also considered drinking within the home prior to attending private parties (e.g. house parties) as pre-loading. Price was represented as a key, yet not sole, motivating factor and pre-drinking alcohol held importance in reaching a desired state of intoxication that enhanced shared fun and pleasure among both young men and women. However, the social (e.g. chatting with friends, taking photographs) and preparatory activities (e.g. ‘getting ready’) at play during pre-loading appeared to hold more importance to young women, in promoting group bonding and in the creation and management of heterosexual feminine identities both on- and off-line. Conclusions: Although price is important, there is a wider social and cultural significance of pre-loading as a gendered phenomenon. Young people apply a wider definition of pre-loading that incorporated the consumption of off-sale alcohol prior to parties within private settings

Neo-liberal discourse of substance use in the UK reality TV show, The Jeremy Kyle Show

This article presents findings of a content and thematic analysis of representations of substance use and users in the UK Reality Television programme, The Jeremy Kyle Show. It provides evidence that substance use and users were problematised through the process of ‘othering’ which contributed to a reductionist drugs discourse. We argue that such discourse can be understood within the wider socio-economic political context of neoliberalism. Four intertwined themes revealed underlying neo-liberal notions that reduced substance use and users to a number of characteristics and associated issues, and provided a narrow and skewed representation of use and users. Through framing substance use as a rational choice, users were held fully responsible and blamed for their substance use, resulting problems, and failure of treatment. Substance use was associated with unemployment and dependency on state welfare, with those claiming welfare being deemed accountable for their lack of employment and shamed for their failure to meet the neoliberal notion of the productive citizen. Structural causes of substance use and inequality were silenced, and an emphasis on individual responsibility prioritised, which may lead to the reinforcement of stigma, and societal and institutional interventions being overlooked. Users were also encouraged to repair a ‘lost’ sense of self through abstinence within private inpatient treatment, endorsing the neo-liberal notion of private health care and prioritising abstinence-based responses and individual responsibility in treatment success. Implications for public perceptions of substance use, users and suitable responses, and substance users’ perceptions of themselves, are considere

Radiomics-Based Texture Analysis of Ga-68-DOTATATE Positron Emission Tomography and Computed Tomography Images as a Prognostic Biomarker in Adults With Neuroendocrine Cancers Treated With Lu-177-DOTATATE

Purpose: Neuroendocrine tumors (NET) are rare cancers with variable behavior. A better understanding of prognosis would aid individualized management. The aim of this hypothesis-generating pilot study was to investigate the prognostic potential of tumor heterogeneity and tracer avidity in NET using texture analysis (TA) of 68Ga-DOTATATE positron emission tomography (PET) and non-enhanced computed tomography (CT) performed at baseline in patients treated with 177Lu-DOTATATE. It aims to justify a larger-scale study to evaluate its clinical value. Methods: The pretherapy 68Ga-DOTATATE PET-CT scans of 44 patients with metastatic NET (carcinoid, pancreatic, thyroid, head and neck, catecholamine-secreting, and unknown primary NET) treated with 177Lu-DOTATATE were analyzed retrospectively using commercially available texture analysis research software. Image filtration extracted and enhanced objects of different sizes (fine, medium, coarse), then quantified heterogeneity by statistical and histogram-based parameters (mean intensity, standard deviation, entropy, mean of positive pixels, skewness, and kurtosis). Regions of interest were manually drawn around up to five of the most 68Ga-DOTATATE avid lesions for each patient. 68Gallium uptake on PET was quantified as SUVmax and SUVmean. Associations between imaging and clinical markers with progression-free (PFS) and overall survival (OS) were assessed using univariate Kaplan-Meier analysis. Independence of the significant univariate markers of survival was tested using multivariate Cox regression analysis. Results: Measures of heterogeneity (higher kurtosis, higher entropy, and lower skewness) on coarse-texture scale CT and unfiltered PET images predicted shorter PFS (CT coarse kurtosis: p=0.05, PET entropy: p=0.01, PET skewness: p=0.03) and shorter OS (CT coarse kurtosis: p=0.05, PET entropy: p=0.01, PET skewness p=0.02). Conventional PET parameters such as SUVmax and SUVmean showed trends towards predicting outcome but were not statistically significant. Multivariate analysis identified that CT-TA (coarse kurtosis: HR=2.57, 95% CI=1.22–5.38, p=0.013) independently predicted PFS, and PET-TA (unfiltered skewness: HR=9.05, 95% CI=1.19–68.91, p=0.033) independently predicted OS. Conclusion: These preliminary data generate a hypothesis that radiomic analysis of neuroendocrine cancer on 68Ga-DOTATATE PET-CT may be of prognostic value and a valuable addition to the assessment of patients

‘You’re in the alcohol Matrix, then you unplug from it, and you’re like ‘Wow’’’: exploring sober women’s management, negotiation and countering of alcohol marketing in the UK

Background: Alcohol marketing influences drinking practices, and this helps shape how gender identities are constructed. This paper presents research exploring how women who are sober manage and negotiate their non-drinking and sober identities in neo-liberal contexts that market alcohol productsand consumption as a defining feature of feminine identities. Methods: Semi-structured in-depth interviews (n ¼ 15) and online content produced by sober women active in the positive sobriety community on the social media platform Instagram were analysed using thematic analysis. Findings: Women negotiated marketing messages within their everyday experiences of sobriety, with associations between drinking and motherhood, female friendship and empowerment, discussed as impacting their drinking, lived experience and sense of self. They negotiated such messages, and created alternative ways of ‘doing femininity’ as sober women, through distancing themselves from their previous drinking identities; rejecting, reworking and countering marketing that links alcohol use to femininity; and alternative consumption practices. Conclusion: Instagram allowed women to publicly critique and counter marketing messages in ways that unlinked alcohol use, but not consumption more generally, from femininity, in traditional and news ways. Marketing regulation should consider how those experiencing problematic alcohol use may be particularly vulnerable to marketing messages, in ways that are gendered