"It's Not Too Aggressive": Key Features of Social Branding Anti-Tobacco Interventions for High-Risk Young Adults.

Purpose. Peer crowd-targeted campaigns are a novel approach to engage high-risk young adults in tobacco use prevention and cessation. We elicited the perspectives of young adult key informants to understand how and why two social branding interventions were effective: (1) "COMMUNE," designed for "Hipsters" as a movement of artists and musicians against Big Tobacco, and (2) "HAVOC," designed for "Partiers" as an exclusive, smoke-free clubbing experience. Design. Qualitative study (27 semistructured qualitative phone interviews). Setting. Intervention events held in bars in multiple U.S. cities. Participants: Twenty-seven key informants involved in COMMUNE or HAVOC as organizers (e.g., musicians, event coordinators) or event attendees. Measures. We conducted semistructured, in-depth interviews. Participants described intervention events and features that worked or did not work well. Analysis. We used an inductive-deductive approach to thematically code interview transcripts, integrating concepts from intervention design literature and emergent themes. Results: Participants emphasized the importance of fun, interactive, social environments that encouraged a sense of belonging. Anti-tobacco messaging was subtle and nonjudgmental and resonated with their interests, values, and aesthetics. Young adults who represented the intervention were admired and influential among peers, and intervention promotional materials encouraged brand recognition and social status. Conclusion. Anti-tobacco interventions for high-risk young adults should encourage fun experiences; resonate with their interests, values, and aesthetics; and use subtle, nonjudgmental messaging

Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing

Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals' everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients' space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants' everyday lives. We found that participants' everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants' everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off ‘ripple effects’ within participants' space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de-centre everyday human behaviour. Opportunities to support renal patients in managing illness and experiencing wellbeing outside the clinical setting lie in a space-time re-design of chronic care servicesThis research was conducted with financial support from University of New South Wales, a National Cancer Institute Training Grant 2T32 CA113710-11, and recruitment assistance from Ms Patricia Johnson and The Canberra Hospital

A geographically explicit ecological momentary assessment (GEMA) mixed method for understanding substance use.

Tobacco use is increasingly concentrated within marginalized groups, including LGBTQ+ young adults. Developing tailored interventions to reduce tobacco-related health disparities requires understanding the mechanisms linking individual and contextual factors associated with tobacco use to behavior. This paper presents an in-depth exploration of three cases from a novel mixed method study designed to identify the situational factors and place-based practices of substance use among high-risk individuals. We combined geographically explicit ecological momentary assessment (GEMA) with an adapted travel diary-interview method. Participants (young adult bisexual smokers, ages 18-26) reported on non-smoking and smoking situations for 30 days with a smartphone app. GEMA surveys captured internal and external situational factors (e.g., craving intensity, location type, seeing others smoking). Continuous locational data was collected via smartphone GPS. Subsequently, participants completed in-depth interviews reviewing maps of their own GEMA data. GEMA data and transcripts were analyzed separately and integrated at the case level in a matrix. Using GEMA maps to guide the interview grounded discussion in participants' everyday smoking situations and routines. Interviews clarified participant interpretation of GEMA measures and revealed experiences and meanings of smoking locations and practices. The GEMA method identified the most frequent smoking locations/times for each participant (e.g., afternoons at university). Interviews provided description of associated situational factors and perceptions of smoking contexts (e.g., peer rejection of bisexual identity) and the roles of smoking therein (e.g., physically escape uncomfortable environments). In conclusion, this mixed method contributes to advancing qualitative GIS and other hypothesis-generating approaches working to reveal the richness of individuals' experiences of the everyday contexts of health behavior, while also providing reliable measures of situational predictors of behaviors of interest, such as substance use. Limitations of and future directions for the method are discussed

Purposeful play: exploring a bar-based, anti-tobacco intervention for young adults

Social smoking is increasingly prevalent among young Americans and often takes place in nightlife social settings. Yet, few smoking interventions are embedded in these settings. This paper focuses on space, embodiment, and practice to explore young adults’ experiences of COMMUNE, a bar-based anti-tobacco intervention for ‘Hipster’ young adults; a group with shared aesthetics and interests, and high smoking rates. We conducted in-depth interviews (n = 21) with young adults involved with COMMUNE (event organizers, artists/brand ambassadors, event attendees) and observed two COMMUNE events. We analyzed the data thematically and identified three prominent affective registers: (1) ‘Fun and flow’—Messaging did not disrupt essential elements of nightlife assemblages; (2) ‘Openness and receptivity’—Playful bar settings encouraged openness and receptivity, allowing event attendees to learn about COMMUNE without feeling taught or patronized; and (3) ‘Belonging and purpose’—Events focused on an external adversary (Big Tobacco) rather than individual smoking behavior and offered a role in supporting community. This anti-tobacco intervention leveraged the capacity-enhancing elements of nightlife settings where social smoking often takes place and emphasized access to a desired experience rather than the loss of smoking. More playful, capacity-enhancing approaches can engage with smoking and other health-related behaviors.Highlights Young adult social smoking is often practiced in nightlife settings Few smoking interventions are embedded in nightlife settings We explored young adults’ experiences of a bar-based, anti-tobacco intervention Fun, flow, openness, receptivity, belonging, and purpose were prominent Smoking interventions can offer playful, capacity-enhancing experiences.This research was supported by the National Cancer Institute grants T32 CA113710, P60MD006902, and U01 CA154240, the California Tobacco Related Disease Research Program grant T29FT0436, and the Oklahoma Tobacco Settlement Endowment Trust (TSET) Grant R21-02

"It's Not Too Aggressive": Key Features of Social Branding Anti-Tobacco Interventions for High-Risk Young Adults.

Purpose. Peer crowd-targeted campaigns are a novel approach to engage high-risk young adults in tobacco use prevention and cessation. We elicited the perspectives of young adult key informants to understand how and why two social branding interventions were effective: (1) "COMMUNE," designed for "Hipsters" as a movement of artists and musicians against Big Tobacco, and (2) "HAVOC," designed for "Partiers" as an exclusive, smoke-free clubbing experience. Design. Qualitative study (27 semistructured qualitative phone interviews). Setting. Intervention events held in bars in multiple U.S. cities. Participants: Twenty-seven key informants involved in COMMUNE or HAVOC as organizers (e.g., musicians, event coordinators) or event attendees. Measures. We conducted semistructured, in-depth interviews. Participants described intervention events and features that worked or did not work well. Analysis. We used an inductive-deductive approach to thematically code interview transcripts, integrating concepts from intervention design literature and emergent themes. Results: Participants emphasized the importance of fun, interactive, social environments that encouraged a sense of belonging. Anti-tobacco messaging was subtle and nonjudgmental and resonated with their interests, values, and aesthetics. Young adults who represented the intervention were admired and influential among peers, and intervention promotional materials encouraged brand recognition and social status. Conclusion. Anti-tobacco interventions for high-risk young adults should encourage fun experiences; resonate with their interests, values, and aesthetics; and use subtle, nonjudgmental messaging

Young adult perceptions of JUUL and other pod electronic cigarette devices in California: a qualitative study.

ObjectiveElectronic cigarettes (e-cigarettes) which utilise prefilled 'pods' (pod devices) entered the US market in 2015. One brand, JUUL, captured more than half the e-cigarette market in early 2018, and the US Food and Drug Administration recently warned its manufacturer about adolescent uptake. This is the first qualitative study to describe distinct features of pod devices that appear to contribute to their popularity among young people.DesignQualitative interview study of young adults who had used pod devices. Participants were recruited from Facebook, other social media, street recruitment and via snowball sampling.SettingParticipants were from California, with most from the San Francisco Bay Area.ParticipantsYoung adults (aged 18-29 years) using multiple tobacco products (cigarettes, e-cigarettes and/or smokeless tobacco) were recruited. Of the sample of 60 participants, 24 were included in this analysis: 10 who reported experience with pod devices and 14 who used other non-pod e-cigarette devices.ResultsTen participants had used a pod device in the past year. Of the pod device users, seven still used a pod device at the time of the interview and five did so daily. Nearly all (n=9) pod device users smoked cigarettes in the past month; none were daily smokers. The 14 participants who used non-pod devices provided a point of comparison. Participants highlighted some distinct aspects of pod devices that facilitated use, including their aesthetic similarity to personal electronics, high levels of nicotine delivery with distinct psychoactive effects, more discreet and shorter duration use sessions, and greater social acceptability than more ostentatious non-pod e-cigarettes.ConclusionsPod devices' unique characteristics likely encourage pod device uptake among young people. Limitations on advertising in youth channels, flavours and distribution, and education about nicotine addiction may decrease initiation among young people and non-smokers

Time, space, and everyday life with chronic illness: A qualitative case study of chronic kidney disease in Australia

This thesis investigates experiences of time, alongside space, in negotiating everyday life with chronic illness. In countries like Australia, increasingly large portions of populations spend many years of life living with and managing ill health. This financially burdens nations, challenges health care system design and the traditional patient role, and alters the health profile of the labour pool and available caregivers. On the individual level, chronic illness instigates a fundamental shift in how life is experienced and navigated. Research on place and health has relied primarily on traditional, Euclidian conceptualisations of space and place. Many health geographers have worked beyond these, providing rich accounts of chronically ill individuals’ everyday experiences with place. The temporal dimension of chronic illness, however, has received far less attention. Time, as well as space, likely plays an important role in how individuals negotiate different parts of everyday life given the long-term, permeating, and fluctuating nature of chronic illness.I draw from a qualitative case study of 26 individuals living with chronic kidney disease in the Australian Capital Territory and nearby New South Wales communities in Australia. My space-time geographical approach embraces multiple senses of time and space, and recognises the entangled relationship between the two – conceptualised as space-time. Attention to social practices illuminates how different senses of space-time shape, and are shaped by, everyday activities. The concept of habit reveals how mutual transformation occurs between individuals and their environments over time. Participants recorded travel and activity diaries and an illness management inventory over two sample days. In-depth interviews followed in which participants ‘led’ me through their sample days. I examine interactions between the spatio-temporal characteristics of four areas of participants’ everyday lives: self-management of chronic illness, paid work, caregiving, and leisure. Findings show that a unique dimension of living with chronic illness is the negotiation of the spatio-temporal characteristics of chronic illness symptoms and their management. These characteristics weave through, and sometimes clash with, those of other pressing areas of everyday life. When logistical or rhythmic incompatibilities arise, everyday activities become more difficult. In conclusion, health status is an important factor shaping spatio-temporal organisation of everyday activities and space-time accessibility, and rhythms circulating within everyday contexts influence the level of effort required to perform everyday activities. Efforts to increase quality of life and social inclusion for individuals with chronic illness should target the reduction of spatio-temporal conflicts within individuals’ everyday lives