Two Essays on the Consumer Acculturation Process – A Need for and Development of a Consumer Acculturation Measure

The United States is becoming increasingly multi-cultural and there are various new immigrant consumer groups that businesses try to reach through ethnic-based segmentation and targeting. Often, businesses offer accommodation strategies to their ethnic consumer groups through language or other cultural accommodation tactics. There are inconsistencies in the literature for the efficacy of ethnic-based targeting and accommodation strategies: often these do not have the desired results and there is evidence that ethnic identification may be fading over time for many immigrant groups. There is evidence that acculturation may be a better predictor of consumer behavior such as preferences for brand, services, and/or marketing communications. Acculturation is the adoption by a person or group of the culture of another social group, or the process leading to acculturation, and assimilation is the complete adoption so that a person has left behind their former culture. There are various existing measurement tools to identify an individual’s level of acculturation; however, there are concerns with the existing tools. All but one measurement tool treat acculturation as a reflective scale, all view acculturation as a one-time event, and the tools have been largely developed for specific contexts such as mental healthcare. Also, many scales lump all ethnicities into one group such as the Suinn-Lew Asian Acculturation Measurement Scale, and this presents theoretical cultural concerns. The difficulty is that the acculturation process involves both formative and reflective components, and it is a process which can change over time. Through conducting two qualitative studies with 57 participants on both the east and west coasts of the country (Virginia, New York, and California), we found that in order to effectively examine acculturation, there must first be a desire or propensity to assimilate and then that propensity in turn will influence actual acculturation behaviors. Through two separate studies we then developed (N=222) and validated (N=248) a parsimonious propensity to assimilate index. Testing it in a nomological net (N=504), we found that the index causally influences subsequent acculturation behaviors, cultural orientations, and brand preferences. To develop the index, we used Diamantopoulos and Winklhofer’s (2001) index-development protocols. We also adapted existing Asian context acculturation measures using the Churchilll (1979) scale-development ptotocols (N=222 for the EFA and N=504 for the CFA). In order to eliminate cultural confounding effects, we kept our sample to the Chinese culture and used only Chinese immigrants and first- and second-generation Chinese Americans. All data was collected by Qualtrics panels and included strong quality control measures. The index and scale were developed, refined, and tested in a nomological net, and the index was reduced to three items and the scale was refined to ten items. Antecedents to someone’s propensity to assimilate are cosmopolitanism, age, and generational status. Through testing in structural equation modeling in AMOS, we show that the index influences an individual’s acculturation behaviors, brand preferences, and cultural orientations. Additionally, strength of ethnic identity is a moderator in the theoretical model with stronger ethnic identity weakening the relationship between an individual’s propensity to assimilate and their acculturation behaviors. We found that the higher an individual’s propensity to assimilate, the more likely they are to prefer American-made brands. The insights from this research will help marketing managers better understand, segment, and target their consumers’ propensity to assimilate and subsequent acculturation behaviors. Future research may examine the predictive capacity of the propensity to assimilate index vs. the acculturation behavior scale; explore the acculturation behavior segmentation categories; examine other outcomes such as purchase intentions; and conduct experiments on the index’s ability to predict consumer’s preferences for advertisements, sales personnel, products, and desired aspects of services encounters

Determining Patient Satisfaction and Well-being in Dental Healthcare: Expanding Theoretical Models through Grounded-Theory Methods

This research involves examining the antecedents of patient satisfaction in dental healthcare while utilizing a grounded theory approach. We created a model of dental care patient satisfaction and well-being and found that past experiences, expectations, desires, emotions, sensations, co-creation behaviors, relational factors, level of involvement, and level of patient engagement impacts patient satisfaction, which subsequently impacts patient well-being. These findings contribute a theoretical model incorporating extant research on customer and healthcare satisfaction while also providing practical implications for dental service providers to implement in their practices. Future research can expand this study to include the point of view of dental providers and develop a measure for dental patient satisfaction

How “tweet” tones can explain consumer beliefs in CSR

This research examines what can be learned about consumers’ opinions tweeted out about them over social media. The valence and tweet character with the type of CSR/CSR related fraud is specifically examined in order to understand consumers’ beliefs about firm CSR use as well as firm confidence. This was conducted via an experimental design manipulating the type of CSR used and related fraud, and then participants responded to the events via simulated tweets and responded to questions about their beliefs in firms engaging in CSR as well as their overall confidence in a firm. Through applying how individuals assess moral judgements via ethical philosophies (idealism vs. relativism) and how those apply to the types of “tweets” made (emotional vs. rational), it was found that the valence and character of a tweet coupled with the CSR type and the related CSR fraud can be used to understand CSR beliefs and confidence in the firm. Additionally, it was found that tweet valence (positive or negative) moderated by the tweet character (emotional vs. rational) impacts the beliefs that firms should engage in CSR. Therefore, after a fraud and related negative buzz, it is recommended that firms withhold broadcasting their CSR activities

How Political Ideology Impacts Political Brand Image: Analysis of the 2016, 2018, and 2020 Elections

The U.S. presidential elections of 2016 and 2020 have both been characterized as “An Election like No Other” (Goodman 2020; Smith 2016) unparalleled to previous ones. The 2016 election saw an outsider, not an established politician, win the support of a major political party and eventually the presidency. The 2020 election was influenced by a once in a century pandemic that diminished all traditional election issues and greatly affected the nature of campaigning. This research examines whether political ideology played an invariant and stable role in shaping the brand image of the presidential election candidates. Analysis of 2016, 2018, and 2020 data sets identifies ten aspects of political ideology, finds that they are a significant determinant of the brand image of candidates in both elections, and concludes which aspects are stable versus unstable. The findings will help political marketers and researchers to create the strong brand image of political candidates, providing insights into the future U.S. presidential as well as overall election strategies

Breast cancer risk and imprinting methylation in blood

Date of Acceptance: 17/08/2015 Acknowledgements This study was supported by the Breast Cancer Campaign (2008MayPR46) and Fraserburgh Moonlight Prowl Breast Cancer Charity. PH, GH and GWH acknowledge the support of the Scottish Government. We would like to thank Val Bain and Michela Donnarumma for help with the data and sample collection.Peer reviewedPublisher PD

Moral distress among clinicians working in US safety net practices during the COVID-19 pandemic: a mixed methods study

Objective To explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19 pandemic. Design Cross-sectional survey in late 2020, employing quantitative and qualitative analyses. Setting Safety net practices in 20 US states. Participants 2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes. Measures Ordinally scaled degree of moral distress experienced during the pandemic, and open-ended response descriptions of issues that caused most moral distress. Results Weighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported ‘mild’ or ‘uncomfortable’ levels and 26.8% characterised their moral distress as ‘distressing’, ‘intense’ or ‘worst possible’. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress. Conclusions During the pandemic’s first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-quarter was this significantly distressing. As reported for hospital-based clinicians during the pandemic, this study’s clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians’ moral distress from witnessing inequities and other injustices for their patients and communities

Adenosine has two faces: Regionally dichotomous adenosine tone in a model of epilepsy with comorbid sleep disorders

Objective: Adenosine participates in maintaining the excitatory/inhibitory balance in neuronal circuits. Studies indicate that adenosine levels in the cortex and hippocampus increase and exert sleep pressure in sleep-deprived and control animals, whereas in epilepsy reduced adenosine tone promotes hyperexcitability. To date, the role of adenosine in pathological conditions that result in both seizures and sleep disorders is unknown. Here, we determined adenosine tone in sleep and seizure regulating brain regions of Kv1.1 knockout (KO) mice, a model of temporal epilepsy with comorbid sleep disorders. Methods: 1) Reverse phase-high performance liquid chromatography (RP-HPLC) was performed on brain tissue to determine levels of adenosine and adenine nucleotides. 2) Multi-electrode array extracellular electrophysiology was used to determine adenosine tone in the hippocampal CA1 region and the lateral hypothalamus (LH). Results: RP-HPLC indicated a non-significant decrease in adenosine (~50%, p = 0.23) in whole brain homogenates of KO mice. Regional examination of relative levels of adenine nucleotides indicated decreased ATP and increased AMP in the cortex and hippocampus and increased adenosine in cortical tissue. Using electrophysiological and pharmacological techniques, estimated adenosine levels were ~35% lower in the KO hippocampal CA1 region, and 1–2 fold higher in the KO LH. Moreover, the increased adenosine in KO LH contributed to lower spontaneous firing rates of putative wake-promoting orexin/hypocretin neurons. Interpretation: This is the first study to demonstrate a direct correlation of regionally distinct dichotomous adenosine levels in a single model with both epilepsy and comorbid sleep disorders. The weaker inhibitory tone in the dorsal hippocampus is consistent with lower seizure threshold, whereas increased adenosine in the LH is consistent with chronic partial sleep deprivation. This work furthers our understanding of how adenosine may contribute to pathological conditions that underlie sleep disorders within the epileptic brain

Making Every Contact Count with seldom-heard groups? A qualitative evaluation of voluntary and community sector (VCS) implementation of a public health behaviour change programme in England

Making Every Contact Count (MECC) is a national, long-term public health strategy in England. It supports public-facing workers to use opportunities during routine contacts to enable healthy lifestyle changes. This paper reports the findings from an external evaluation of voluntary and community sector (VCS) delivery of MECC in the North East of England, which focused on engaging under-represented client groups. The study aimed to (a) Establish if (and how) MECC had impacted the workforce, including changes to staff knowledge, confidence and behaviour; (b) Identify benefits, challenges and unintended consequences; and (c) Explore outcomes for service users. A multi-stage qualitative design focused on understanding both process and outcomes. The study utilised three data collection methods, including a journey mapping workshop (n = 20), semi-structured interviews with delivery leads, VCS workers and volunteers who had accessed MECC training (n = 11), and focus group discussions with clients (n = 22). The findings illustrated positive early outcomes, including improvements in self-reported staff knowledge and confidence as well as emerging examples of organisational culture shift and individual behaviour change. Alongside this, the data provided a rich picture of barriers and challenges which are examined at different levels—national programme, local programme, VCS sector, partner organisation, worker and client. The research highlights clear successes of the VCS delivery model. However, it is presented as a ‘double-edged sword,’ in light of associated challenges such as sector-level funding uncertainty and accessibility of MECC resources to diverse client groups. The discussion considers issues related to the measurement and attribution of behaviour change outcomes for brief interventions, as well as fidelity, legacy and long-term sustainability challenges. The recommendations call for system-level analysis and comparison of different MECC implementation models, to improve our understanding of challenges, opportunities and programme reach for behaviour change intervention programmes—particularly in relation to seldom-heard client groups

Moral distress among clinicians working in US safety net practices during the COVID-19 pandemic: a mixed methods study

Objective To explore the causes and levels of moral distress experienced by clinicians caring for the low-income patients of safety net practices in the USA during the COVID-19 pandemic. Design Cross-sectional survey in late 2020, employing quantitative and qualitative analyses. Setting Safety net practices in 20 US states. Participants 2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes. EMPAVELI® (pegcetacoplan) - Official Physician Website See Prescribing Info & Boxed Warning. Read What to Know Before Prescribing EMPAVELI. empavelihcp.com Measures Ordinally scaled degree of moral distress experienced during the pandemic, and open-ended response descriptions of issues that caused most moral distress. Results Weighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported ‘mild’ or ‘uncomfortable’ levels and 26.8% characterised their moral distress as ‘distressing’, ‘intense’ or ‘worst possible’. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress. Conclusions During the pandemic’s first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-quarter was this significantly distressing. As reported for hospital-based clinicians during the pandemic, this study’s clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians’ moral distress from witnessing inequities and other injustices for their patients and communities

Archaeal glycolipid adjuvanted vaccines induce strong influenza-specific immune responses through direct immunization in young and aged mice or through passive maternal immunization.

Vaccine induced responses are often weaker in those individuals most susceptible to infection, namely the very young and the elderly, highlighting the need for safe and effective vaccine adjuvants. Herein we evaluated different archaeosome formulations as an adjuvant to the H1N1 influenza hemagglutinin protein and compared immune responses (anti-HA IgG and hemagglutination inhibition assay titers) as well as protection to an influenza A virus (strain A/Puerto Rico/8/1934 H1N1) homologous challenge to those generated using a squalene-based oil-in-water nano-emulsion, AddaVax™ in a murine model. The impact of age (young adult vs aged) on vaccine induced immune responses as well as the protection in pups due to the transfer of maternal antibodies was measured. Overall, we show that archaeal lipid based adjuvants can induce potent anti-HA responses in young and aged mice that can also be passed from vaccinated mothers to pups. Furthermore, young and aged mice immunized with archaeal lipid adjuvants as well as pups from immunized mothers were protected from challenge with influenza. In addition, we show that a simple admixed archaeosome formulation composed of a single sulfated glycolipid namely sulfated lactosylarchaeol (SLA; 6′-sulfate-β-D-Galp-(1,4)-β-D-Glcp-(1,1)-archaeol) can give equal or better protection compared to AddaVax™ or the traditional antigen-encapsulated archaeosome formulations