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Objective: Increasing numbers of young people live with a chronic health condition. Much research to date has explored young people's self-management of their illness and related symptomatology. Relatively less is known about how young people manage their long-term condition in everyday social contexts. This paper reports on findings from a qualitative study examining the perspectives of university students with a chronic health condition, including how they negotiate their health (and experiences of ill health) while at university. Design: A qualitative interview study was conducted with 16 students with a medically diagnosed chronic health condition. Setting: The study was conducted at a major university in Australia. Methods: Data were collected via in-depth semi-structured interviews and analysed thematically and inductively. Results: Findings illustrate how young people sought to position themselves as being 'healthy' while simultaneously distancing themselves from labels of ill health and disability. The relative invisibility of their health conditions enabled participants to align with and enact a preferred health identity. Yet, this invisibility presented particular challenges for students when navigating university systems and processes. Indeed, the fluctuating nature of their (ill) health status prompted a felt need continuously to prove their ill health to the university in order to receive academic support. Inevitably, this illness identity was at odds with participants' own health narratives -- triggering additional anxieties and (academic and social) exclusions for these young people. Conclusion: These contradictory (ill) health positions carry a number of implications for how best to support young people living with chronic health conditions while at university.

As the culture of silence that once surrounded cancer has gradually given way to greater public awareness, normative visions of what cancer survivorship should entail have proliferated. These visions emphasise positivity and perseverance in pursuit of cure. While these visions provide comfort to many, for people with metastatic cancer, the emphasis on cure can undermine their sense of belonging to the broader collective of people living with cancer. Drawing on semi‐structured interviews with 38 Australian women living with metastatic breast cancer, we explore how incurable cancer inflects understandings of self and transforms interpersonal relationships. Extending ideas around biosociality and belonging, we explore the tenuousness of social bonds, revealing how (in)visibility, (in)authenticity and (in)validation circulate within the daily lives of women with metastatic breast cancer. We conceptualise accounts according to four social bonds: (1) threatened bonds where a relationship is strained by misunderstanding, (2) severed bonds where a relationship is ruptured due to misunderstanding, (3) attuned bonds whereby a relationship is based on shared identification and (4) flexible social bonds when a relationship is based on mutual understanding. More broadly, we illustrate the persistence of normative visions of cancer survivorship and their enduring effects on those whom such visions exclude. [ABSTRACT FROM AUTHOR]

Voluntary assisted dying laws have now been enacted in all six Australian States with reform being considered in the remaining two. While there is an emerging body of literature examining various aspects of regulation, there has been scant consideration of what these reforms mean for First Nations peoples, and to what extent their experiences have been considered in the process of developing legislation. This article provides a critical analysis of how Indigenous perspectives both contributed to, and were engaged with, during the law reform processes in Victoria and Western Australia, the first two States to grapple with this topic. Findings reveal the sophistication in how Indigenous organisations and individuals engaged with this issue and highlight the critical importance of not universalising Indigenous perspectives. Significantly, there was much greater engagement with Indigenous views in Western Australia than in Victoria. We conclude by considering how Indigenous voices can meaningfully influence Australian law reform processes. [ABSTRACT FROM AUTHOR]

Concepts and practices related to risk are central to people's experiences of the COVID-19 crisis and attempts to contain the spread of the novel coronavirus. Sociological perspectives and empirical research on risk and uncertainty have much to offer for insights into how people conceptualise and respond to health risks such those associated with this new pandemic: including identification of the geographical, political, socioeconomic and other contextual dimensions. In this article, we provide findings from a qualitative interview-based project on Australians' experiences of the first six months of the pandemic in 2020, including the national lockdown. A total of 40 adults from across Australia took part in a semi-structured telephone interview. Adopting a narrative analysis approach, we explored people's biographical, embodied, spatial and affective experiences in what we term their 'COVID-19 risk narratives'. We further identified the events and circumstances that contributed to people beginning to feel at heightened personal risk from COVID-19 or which helped them feel safe or less vulnerable. The findings highlight the roles of factors including media coverage, previous experiences with infectious disease, beliefs about personal health and immunity, the government's implementation of containment measures, observations of others' behaviours and experiences, interactions with healthcare providers, geographical location and concern for family members. We argue that surfacing the interplay of these dynamic complex and highly contextual forces and relationships is vital to understanding COVID-19 risk understandings and practices. [ABSTRACT FROM AUTHOR]

Background: International consensus guidelines recommend patients with metastatic breast cancer have access to a nurse experienced in the treatment of metastatic breast cancer. This study aimed to explore women's experiences of supportive care from breast care nurses, including their perspectives on the role breast care nurses currently play in providing support to people with metastatic breast cancer.Methods: Multiple semi-structured qualitative interviews with 38 women with metastatic breast cancer in Australia. Data relating to nursing care were extracted and analysed using thematic analysis.Results: Three themes were identified: (1) feeling that supportive care needs are unrecognised; (2) confusion about role and relevance of breast care nurse to those with metastatic breast cancer; (3) care from metastatic breast care nurses (when available) was appreciated, valued and beneficial. Participants' experiences differed in relation to ease of access to, amount of contact with, and level of care provided by breast care nurses. Contact and care ranged from little or none to comprehensive and ongoing. A key system-level challenge was that the diversity of diagnostic and treatment pathways for metastatic breast cancer meant that no systematic means existed to support routine or regular contact between breast care nurses and participants. Participants who did report having access to a specialised metastatic breast care nurse placed considerable value on the care received. For these participants, care from the breast care nurse extended and complemented care from the oncologist and included much needed psychosocial and practical support. For these participants, the breast care nurse assumed the role of key contact and care coordinator and was valued for their availability, accessibility and responsiveness. High levels of trust developed between patient and breast care nurse.Conclusions: Findings indicate that there may be gaps and inequities in supportive care in Australia for people diagnosed with metastatic breast cancer, a finding that supports earlier reports of limited access to breast care nurses for people with metastatic breast cancer in Australia. The specialised metastatic breast care nurse could potentially play a key role in addressing the high level of unmet supportive care needs and improve continuity of care for these patients. [ABSTRACT FROM AUTHOR]

Australia experiences some of the world's most variable rainfall. Previous studies have mostly focused on understanding rainfall variability in terms of frequency and intensity. However, understanding the timing of when extreme rainfall occurs is crucial for seasonal prediction, although it largely remains unexplored. Here we investigate the timing of extreme rainfall in Australia and the spatial variability of this timing. This study examines how some of the large‐scale drivers, such as the El Niño–Southern Oscillation (ENSO) and the Interdecadal Pacific Oscillation (IPO), determine the timing and interannual variability of the timing of extreme rainfall in Australia. Our results show that there is a clear spatial north–south delineation in the season when extreme rainfall occurs in Australia, shown by a contour diagonally extending roughly from 21°S in the west of Australia to 33°S in the east. North of this contour, extreme rainfall usually occurs in austral summer, with the smallest interannual variability in the timing of extreme rainfall in this region. In the south, extreme rainfall usually occurs in autumn/winter months; however, the timing is highly variable. In southeast Australia (SEA), extreme rainfall can fall at any time of the year, which makes seasonal prediction extremely challenging for this region. Both observation and reanalysis data show that the area where extreme rainfall occurs in summer extends further south during negative IPO years. We also find that IPO and ENSO phases, and the interaction between them, play significant roles in both determining the timing of extreme rainfall and constraining the interannual variability, especially in SEA. We focus on SEA for further analysis as this region shows the greatest shift in seasonality of extremes in response to large‐scale variability. We conclude that studying the relationship between rainfall and large‐scale drivers is important for verification and improvement of the seasonal prediction of extreme rainfall. [ABSTRACT FROM AUTHOR]

What does migrancy mean for personhood, and how does this flow through caring relations? Drawing on life history interviews and photo elicitation with 43 people who identify as migrants and live with cancer, here we argue for the significance of recognising complex personhood as it inflects illness and care. Drawing on social science theory around temporalities, moralities and belonging, we assemble a series of cross-cutting themes at the intersection of personhood and care; relations that transcend cultural origins yet are vividly illustrated in relation to migrant pasts. In seeking a multidimensional view of personhood, we attend to the intersecting layers of complexity that make up care in this context vis-a-vis an emphasis on forms of difference, vulnerability and otherness. In this way, we develop an approach to personhood and care that broadens the lens on migrancy and cancer, but also, one that speaks to the importance of recognition of complexity and how it shapes care more generally. [ABSTRACT FROM AUTHOR]

Objectives: Health professional-led group programmes are a common form of long-term condition self-management support. Much research has focused on clinical outcomes of group participation, yet there is limited research on how group participants perceive and experience the support they receive. We aim to identify the different types of support that participants receive from both facilitators and other participants, and how they value this support. Methods: Semi-structured interviews were conducted with 20 participants taking part in a self-management group programme for a long-term condition (obesity, type 2 diabetes or chronic obstructive pulmonary disease). Data pertaining to support types were deductively identified through a social support framework prior to interpretive thematic analysis. Results: Participants identified information and emotional support from both facilitators and other participants as complementary yet distinct. Facilitators' support came from professional training and other participants' support reflected the contextual, lived experience. Professional interactions were prioritised, constraining opportunities for participant–participant support to be received and exchanged. Discussion: We identified a key gap in how self-management support is enacted in groups. Engaging participants to share experiential knowledge will make group support more relevant and mutually beneficial to participants living with a long-term condition. [ABSTRACT FROM AUTHOR]

Historical simulations of models participating in the sixth phase of the Coupled Model Intercomparison Project (CMIP6) are evaluated over 10 Australian regions for their performance in simulating extreme temperatures, among which three models with initial‐condition large ensembles (LEs) are used to estimate the effects of internal variability. Based on two observational data sets, the Australian Water Availability Project (AWAP) and the Berkeley Earth Surface Temperatures (BEST), we first analyze the models' abilities in simulating the probability distributions of daily maximum and minimum temperature (TX and TN), followed by the spatial patterns and temporal variations of the extreme indices, as defined by the Expert Team on Climate Change Detection and Indices (ETCCDI). Overall, the CMIP6 models are comparable to CMIP5, with modest improvements shown in CMIP6. Compared to CMIP5, the CMIP6 ensemble tends to have narrower interquartile model ranges for some cold extremes, as well as narrower ensemble ranges in temporal trends for most indices. Over southeast, tropical, and southern regions, both CMIP ensembles generally exhibit relatively large deficiencies in simulating temperature extremes. We also confirm that internal variability can affect the trends of the extremes and there is uncertainty in representing the irreducible variability among different LEs in CMIP6. Furthermore, the evaluation based on Perkins' skill score (PSS) and root‐mean‐square error (RMSE) in the three LEs does not directly correlate with the ranges of the trends for extreme temperatures. The findings of this study are useful in informing and interpreting future projections of temperature‐related extremes over Australia. Key Points: The assessment on the probability distributions of daily maximum and minimum temperature makes the evaluation of extremes more robustTemperature extremes over Australia are broadly similar in CMIP5 and CMIP6There are differences in estimating internal variability across multiple CMIP6 models [ABSTRACT FROM AUTHOR]

Young people's experiences of living with a long-term health condition have been largely investigated from the perspective of developing autonomy and optimal self-management of treatment regimens. Little existing research explores how young people adjust to the experience of chronic illness within everyday social contexts. Drawing on sociocultural theories of healthism, in this article, we examine the everyday strategies students employed to manage their health condition at university. Data were drawn from a qualitative study with 16 undergraduate students in Australia. Findings from interviews highlight how participants took up discourses of the (hard-working, diligent) Self to discursively position themselves as 'health conscious' and 'in control'. This positioning was maintained through separating the controlled Self from the (uncontrollable) body. The unpredictability of the body posed a threat to young people's abilities to maintain control and denied them opportunities to exercise personal agency. Yet, participants also described a number of subversive strategies in order to take back control and resist the experience of ill health. These potential agentic practices often held unintended consequences, including loss of optimal medical control or (self) exclusion from university life – offering new insights into the differing ways young people concomitantly take-up, rework and resist the pursuit of healthism to 'successfully' manage their health conditions. [ABSTRACT FROM AUTHOR]

Self-management is a contemporary model of chronic condition care that places expectations on, and roles for, both patients and health professionals. Health professionals are expected to form partnerships with their patients, and patients are expected to be active participants in their own care. In these new roles, control and responsibility for self-management are shared between people with chronic conditions and their health professionals. We still have limited knowledge about how these new roles are enacted in self-management support. In this article, we examine how health professionals perceive the roles of patients and professionals in chronic condition self-management, drawing on Bourdieu's concepts of field, doxa and capital. In this qualitative study, 32 in-depth interviews were conducted with 11 health professionals in Sydney, Australia. Data were analysed thematically. Three themes were derived. First, there was incongruence between how participants characterised and enacted their roles. Second, participants compartmentalised clinical and non-clinical aspects of self-management support. Finally, the roles of health professionals entwined with emotions and judgements of patienthood revealed that the provision of self-management support was linked to a fit between individuals' cultural health capital and the expectations governing the field. We argue that 'taken for granted' assumptions about self-management and self-management support must be challenged to mitigate negative social representations and unrealistic expectations placed on patients and health professionals, particularly those patients with less capital, who are more marginalised within clinical interactions. [ABSTRACT FROM AUTHOR]

Disastrous bushfires during the last months of 2019 and January 2020 affected Australia, raising the question to what extent the risk of these fires was exacerbated by anthropogenic climate change. To answer the question for southeastern Australia, where fires were particularly severe, affecting people and ecosystems, we use a physically based index of fire weather, the Fire Weather Index; long-term observations of heat and drought; and 11 large ensembles of state-of-the-art climate models. We find large trends in the Fire Weather Index in the fifth-generation European Centre for Medium-Range Weather Forecasts (ECMWF) Atmospheric Reanalysis (ERA5) since 1979 and a smaller but significant increase by at least 30 % in the models. Therefore, we find that climate change has induced a higher weather-induced risk of such an extreme fire season. This trend is mainly driven by the increase of temperature extremes. In agreement with previous analyses we find that heat extremes have become more likely by at least a factor of 2 due to the long-term warming trend. However, current climate models overestimate variability and tend to underestimate the long-term trend in these extremes, so the true change in the likelihood of extreme heat could be larger, suggesting that the attribution of the increased fire weather risk is a conservative estimate. We do not find an attributable trend in either extreme annual drought or the driest month of the fire season, September–February. The observations, however, show a weak drying trend in the annual mean. For the 2019/20 season more than half of the July–December drought was driven by record excursions of the Indian Ocean Dipole and Southern Annular Mode, factors which are included in the analysis here. The study reveals the complexity of the 2019/20 bushfire event, with some but not all drivers showing an imprint of anthropogenic climate change. Finally, the study concludes with a qualitative review of various vulnerability and exposure factors that each play a role, along with the hazard in increasing or decreasing the overall impact of the bushfires. [ABSTRACT FROM AUTHOR]

Disastrous bushfires during the last months of 2019 and January 2020 affected Australia, raising the question to what extent the risk of these fires was exacerbated by anthropogenic climate change. To answer the question for southeastern Australia, where fires were particularly severe, affecting people and ecosystems, we use a physically-based index of fire weather, the Fire Weather Index, long-term observations of heat and drought, and eleven large ensembles of state-of-the-art climate models. In agreement with previous analyses we find that heat extremes have become more likely by at least a factor two due to the long-term warming trend. However, current climate models overestimate variability and tend to underestimate the long-term trend in these extremes, so the true change in the likelihood of extreme heat could be larger. We do not find an attributable trend in either extreme annual drought or the driest month of the fire season September February. The observations, however, show a weak drying trend in the annual mean. Finally, we find large trends in the Fire Weather Index in the ERA5 reanalysis, and a smaller but significant increase by at least 30 % in the models. The trend is mainly driven by the increase of temperature extremes and hence also likely underestimated. For the 2019/20 season more than half of the July December drought was driven by record excursions of the Indian Ocean dipole and Southern Annular Mode. These factors are included in the analysis. The study reveals the complexity of the 2019/20 bushfire event, with some, but not all drivers showing an imprint of anthropogenic climate change. [ABSTRACT FROM AUTHOR]

Purpose: A cancer diagnosis is an emotive and challenging time for patients. This study aimed to systematically explore patients' accounts of experiencing their cancer diagnosis. The purpose of this article is to offer a typology of patient responses to receiving a cancer diagnosis as a means through which to affirm the range of patients' experiences and to guide clinicians' practice.Methods: Qualitative semi-structured interviews were conducted between 2015 and 2017 with 80 patients living with cancer: 34 females and 46 males, aged between 31 and 85, diagnosed with a range of cancer types, stages and treatment trajectories, from two metropolitan hospitals on the east coast of Australia. Interview data were analysed thematically, using the framework approach.Results: A typology of responses to the cancer diagnosis was derived from the analysis and included (1) the incongruent diagnosis, unexpected because it did not 'fit' with the patient's 'healthy' identity; (2) the incidental diagnosis, arising from seemingly unrelated or minor medical investigations; (3) the validating diagnosis, as explanation and confirmation of previously unexplained symptoms, pain or feelings; (4) the life context diagnosis, where the cancer diagnosis was positioned relative to other challenging life events, or as relatively inconsequential compared with the hardship of others.Conclusions: A diagnosis of cancer is not always (or only) experienced by patients with shock and despair. Diagnosis is perceived and experienced in diverse ways, shaped by broader social or life contexts, and with important implications for the clinical encounter and communication from an oncology perspective. [ABSTRACT FROM AUTHOR]

Premised on the idea that setting goals motivates action and allocation of resources toward a desired future state, goal-setting has become a key component of self-management support. The notions that underpin goal-setting situate self-management firmly within the control and responsibility of individuals. Yet, we argue that goals are not solely individual pursuits to be achieved if individuals have the right knowledge and enough motivation; rather, they are social products, influenced by individual and collective subjectivities, which are structured over time. Drawing primarily on Bourdieu's concept of habitus, along with capital and field, we examine how goals are constructed in self-management support encounters. Seventeen patient-professional dyads comprising 15 patients and 11 health professionals were interviewed on up to three occasions. In total 64 semi-structured interviews were conducted between 2015 and 2017 in Sydney, Australia. Goals were manifested through patient participants' expressions of goal agency (as self-owned wants and opportunities; responsibilities to self and others; or necessities); goal-oriented dispositions (determined; responsible; or powerless); temporal orientations (past, present or future); and access to resources to support self-management. These characteristics were grouped into three typologies: 'Goals as opportunities'; 'From goals to responsibilities'; and 'Necessities when living precariously'. The way goals were constructed was structured over time by present experiences superimposed on past experiences and access to resources. These findings help broaden understandings of the tensions between patient and professionals' goals for living well with chronic conditions and draw attention to the need for structural change to support people to live well with their chronic conditions. • Goals for self-management are complex social products. • Goal orientations are shaped by dispositions, temporalities and resources. • People are differentially positioned in the field of self-management support. • Structural factors must be addressed for all to have opportunities for meaningful goals. [ABSTRACT FROM AUTHOR]

A person-centered approach to goal-setting, involving collaboration between patients and health professionals, is advocated in policy to support self-management. However, this is difficult to achieve in practice, reducing the potential effectiveness of self-management support. Drawing on observations of consultations between patients and health professionals, we examined how goal-setting is shaped in patient–provider interactions. Analysis revealed three distinct interactional styles. In controlled interactions, health professionals determine patients' goals based on biomedical reference points and present these goals as something patients should do. In constrained interactions, patients are invited to present goals, yet health professionals' language and questions orientate goals toward biomedical issues. In flexible interactions, patients and professionals both contribute to goal-setting, as health professionals use less directive language, create openings, and allow patients to decide on their goals. Findings suggest that interactional style of health professionals could be the focus of interventions when aiming to increase the effectiveness of goal-setting. [ABSTRACT FROM AUTHOR]

In this paper, we examine the intersections between place and healthcare choice, drawing on Bourdieu's concepts of distinction and social space, and engaging with data from interviews with 78 Australians living in varied geographic locations. We find the status of an area is used to judge the quality of its healthcare services. Areas with high status are assumed to have better quality health services than areas of disadvantage. Where people live shapes the choices they make and their judgements about the status of a place. Moreover, having less choice is not necessarily problematic. Participants in regional and remote areas with less choice tend to report positive experiences with healthcare providers. Place can constrain people's ability to make good healthcare choices, yet participants have differing capacities to mobilise resources to overcome the constraints of place. [ABSTRACT FROM AUTHOR]

Various human heat stress indices have been developed to relate atmospheric measures of extreme heat to human health impacts, but the usefulness of different indices across various health impacts and in different populations is poorly understood. This paper determines which heat stress indices best fit hospital admissions for sets of cardiovascular, respiratory, and renal diseases across five Australian cities. We hypothesized that the best indices would be largely dependent on location. We fit parent models to these counts in the summers (November-March) between 2001 and 2013 using negative binomial regression. We then added 15 heat stress indices to these models, ranking their goodness of fit using the Akaike information criterion. Admissions for each health outcome were nearly always higher in hot or humid conditions. Contrary to our hypothesis that location would determine the best-fitting heat stress index, we found that the best indices were related largely by health outcome of interest, rather than location as hypothesized. In particular, heatwave and temperature indices had the best fit to cardiovascular admissions, humidity indices had the best fit to respiratory admissions, and combined heat-humidity indices had the best fit to renal admissions. With a few exceptions, the results were similar across all five cities. The best-fitting heat stress indices appear to be useful across several Australian cities with differing climates, but they may have varying usefulness depending on the outcome of interest. These findings suggest that future research on heat and health impacts, and in particular hospital demand modeling, could better reflect reality if it avoided “all-cause” health outcomes and used heat stress indices appropriate to specific diseases and disease groups. [ABSTRACT FROM AUTHOR]

Australia experienced much above average rainfall in association with strong, extended La Niña conditions during 2010-2012. Was the heavy Australian rainfall influenced by La Niña conditions and/or anthropogenic greenhouse gases? We investigate the relative contributions of anthropogenic climate change and natural climatic variability to the likelihood of heavy Australian rainfall using three distinct model datasets. Area-average rainfall anomalies for model simulations with natural forcings only were compared to simulations with both anthropogenic and natural forcings using 16 models participating in the Coupled Model Intercomparison Project Phase 5. Using fraction of attributable risk to compare the likelihood of unusual rainfall between the parallel experiments, we find attribution statements are uncertain, with FAR values sensitive to the attribution parameters considered, including thresholds, regions and seasons. When heavy rainfall probabilities were next investigated in ensembles of two atmospheric general circulation models, run with and without anthropogenically-induced sea surface temperature changes, results were model-dependent. Overall, the attribution of seasonal-scale heavy Australia rainfall to a particular cause is likely more complicated than for temperature extremes. As estimates of the greenhouse gas attributable change in rainfall risk may depend on the model datasets considered, it is also useful to consider model outputs from several datasets and using various estimates of counterfactual surface conditions to establish robust attribution statements for extreme rainfall events. In contrast, comparing the likelihoods of heavy rainfall during simulated La Niña years with El Niño/neutral years reveals a substantial La Niña influence on Australian rainfall during 2010-2012 that is robust to changes in the attribution framework. [ABSTRACT FROM AUTHOR]

Objectives To investigate how gamblers interact with, and respond to, downstream social marketing campaigns that focus on the risks and harms of problem gambling and/or encourage help seeking. Methods Qualitative study of 100 gamblers with a range of gambling behaviours (from non-problem to problem gambling). We used a Social Constructivist approach. Our constant comparative method of data interpretation focused on how participants' experiences and interactions with gambling influenced their opinions towards, and interactions with social marketing campaigns. Results Three key themes emerged from the narratives. (i) Participants felt that campaigns were heavily skewed towards encouraging individuals to take personal responsibility for their gambling behaviours or were targeted towards those with severe gambling problems. (ii) Participants described the difficulty for campaigns to achieve 'cut through' because of the overwhelming volume of positive messages about the benefits of gambling that were given by the gambling industry. (iii) Some participants described that dominant discourses about personal responsibility prevented them from seeking help and reinforced perceptions of stigma. Conclusions and implications Social marketing campaigns have an important role to play in the prevention of gambling risk behaviours and the promotion of help seeking. Social marketers should explore how to more effectively target campaigns to different audience segments, understand the role of environmental factors in undermining the uptake of social marketing strategies and anticipate the potential unforeseen consequences of social marketing strategies. [ABSTRACT FROM AUTHOR]

The article focuses on impact of human activity on heat waves experienced in summer 2012/13 in Australia, which experienced its hottest month in January 2013 when temperature reached 36.9 degrees Celsius. Topics discussed include the results of the investigation that made use of the Community Earth System Model's preindustrial control, historical and RCP8.5 experiments, including the rapid increase in high heat wave frequency anomaly in summer 2012/13.

The article focuses on human being's contribution to the extreme temperature recorded in Australia in 2013, when annual temperature exceeded the 1911-40 mean by 1.53 degrees Celsius. Topics discussed include results of their simulation that proved achieving such a temperature is very impossible due to naturally forced climate variability, findings of former studies that showed man's contribution to extreme temperatures and the probability of spring and September Tmean anomalies.

Background: To investigate the alcohol, gambling, and unhealthy food marketing strategies during a nationally televised, free to air, sporting series in Australia. Methods/approach: Using the Australian National Rugby League 2012 State of Origin three-game series, we conducted a mixed methods content analysis of the frequency, duration, placement and content of advertising strategies, comparing these strategies both within and across the three games. Results: There were a total of 4445 episodes (mean = 1481.67, SD = 336.58), and 233.23 minutes (mean = 77.74, SD = 7.31) of marketing for alcoholic beverages, gambling products and unhealthy foods and non-alcoholic beverages during the 360 minutes of televised coverage of the three State of Origin 2012 games. This included an average per game of 1354 episodes (SD = 368.79) and 66.29 minutes (SD = 7.62) of alcohol marketing; 110.67 episodes (SD = 43.89), and 8.72 minutes (SD = 1.29) of gambling marketing; and 17 episodes (SD = 7.55), and 2.74 minutes (SD = 0.78) of unhealthy food and beverage marketing. Content analysis revealed that there was a considerable embedding of product marketing within the match play, including within match commentary, sporting equipment, and special replays. Conclusions: Sport is increasingly used as a vehicle for the promotion of range of 'risky consumption' products. This study raises important ethical and health policy questions about the extent and impact of saturation and incidental marketing strategies on health and wellbeing, the transparency of embedded marketing strategies, and how these strategies may influence product consumption. [ABSTRACT FROM AUTHOR]

People living with pre-existing illnesses were identified as one of the groups most at risk when COVID-19 erupted. In this article, using the method of case studies developed from interviews, we explore how Australians in this category considered their risk and responded to it as they were learning about COVID-19 and living with restrictions and lockdown conditions in the early months of the pandemic. Building on the literature on assemblages of health and illness, therapeutic landscapes and the materialities of care, our analysis considers sociomaterialities of health, risk and care described in six featured case studies. Each person recounted a unique narrative that described the coming together of several different human and nonhuman agents in their experiences. Yet a number of overarching and intersecting themes can also be traced across the participants' narratives: the vital contributions of lay care and self-care as part of the materialities of care, health and wellbeing; the role played by social networks, both online and in-person, for people in learning about and coping with COVID-19 and its potential risks; previous embodied and affective experiences of illness, vulnerability and care; and the role played by place and space in generating either therapeutic or distressing affective atmospheres. These findings have implications for better understandings of the situated sociomaterial contexts of how embodied experience, affective forces and encounters and relationships with other people and with things, place and space come together in crises such as COVID-19. • An analysis of how people with pre-existing medical conditions experienced COVID-19. • Draws on 40 indepth interviews with adult Australians early in the pandemic. • Uses a sociomaterial theoretical framework. • Builds on the literature on health assemblages, therapeutic spaces and the materialities of care. • Presents six rich case studies detailing participants' experiences. [ABSTRACT FROM AUTHOR]

Gambling is emerging as a significant health issue. Problem gambling does not develop instantaneously and is often the result of risky consumption patterns over a period of time. Early intervention strategies depend on a detailed understanding of 'at risk' gamblers, yet surprisingly little is known about this group. This qualitative study explores the beliefs, behaviours, risk perceptions, and consumption patterns of 35 individuals who were screened as having 'moderate risk' gambling behaviours. Two thirds of participants gambled at least once a week and most consumed multiple types of gambling products. Participants gambled for social or emotional reasons, with many using gambling as a mechanism to socially connect and interact with others. Perceptions of behavioural control led many to believe that they were not at risk or could control gambling risks. Understanding the range of drivers that influence gambling risk is essential in developing prevention and harm minimisation strategies. [ABSTRACT FROM AUTHOR]

Background Current population-based anti-obesity campaigns often target individuals based on either weight or socio-demographic characteristics, and give a 'mass' message about personal responsibility. There is a recognition that attempts to influence attitudes and opinions may be more effective if they resonate with the beliefs that different groups have about the causes of, and solutions for, obesity. Limited research has explored how attitudinal factors may inform the development of both upstream and downstream social marketing initiatives. Methods Computer-assisted face-to-face interviews were conducted with 159 parents and 184 of their children (aged 9-18 years old) in two Australian states. A mixed methods approach was used to assess attitudes towards obesity, and elucidate why different groups held various attitudes towards obesity. Participants were quantitatively assessed on eight dimensions relating to the severity and extent, causes and responsibility, possible remedies, and messaging strategies. Cluster analysis was used to determine attitudinal clusters. Participants were also able to qualify each answer. Qualitative responses were analysed both within and across attitudinal clusters using a constant comparative method. Results Three clusters were identified. Concerned Internalisers (27% of the sample) judged that obesity was a serious health problem, that Australia had among the highest levels of obesity in the world and that prevalence was rapidly increasing. They situated the causes and remedies for the obesity crisis in individual choices. Concerned Externalisers (38% of the sample) held similar views about the severity and extent of the obesity crisis. However, they saw responsibility and remedies as a societal rather than an individual issue. The final cluster, the Moderates, which contained significantly more children and males, believed that obesity was not such an important public health issue, and judged the extent of obesity to be less extreme than the other clusters. Conclusion Attitudinal clusters provide new information and insights which may be useful in tailoring anti-obesity social marketing initiatives. [ABSTRACT FROM AUTHOR]

As gambling products have diversified so too have the ways in which the gambling industry has been able to target, reach and engage different sectors of the community. Limited research has explored the ways in which individuals conceptualize and respond to gambling marketing strategies. Semi-structured, qualitative interviews were conducted with 100 adults in Victoria, Australia, who had gambled at least once during the previous year. Participants described the multi-layered ways in which gambling was marketed and were concerned about the role of marketing in ‘normalizing’ gambling for some groups. Male participants felt ‘bombarded’ and ‘targeted’ by sports bet marketing. Most women and older men actively resisted gambling marketing strategies. Older women, younger men, moderate and high risk gamblers and those from low socio-economic backgrounds were particularly influenced by incentivization to gambling. This study highlights the complex ways in which different individuals interpret and respond to gambling industry marketing strategies. [ABSTRACT FROM AUTHOR]

Introduction In Australia the incidence of obesity is increasing rapidly and has become a significant public health concern. In addition to the many physical consequences of obesity many studies have reported significant mental health consequences, including major depression, mood and anxiety disorders. The purpose of this study was to explore the relationship between severity of obesity and perceived mental health in an Australian community sample. Methods A cross-sectional survey design was used. A total of 118 participants, aged between 19 and 75 years with a body mass index ( BMI) ≥ 30 kg/m2 returned a completed questionnaire. The SF-36 Health Survey, Kessler Psychological Distress Scale, Social Interaction Anxiety Scale and the Multidimensional Scale of Perceived Social Support were used. Results After adjusting for age, gender, perceived social support and physical health quality of life, obesity was not significantly associated with mental health quality of life ( SF-36). The strongest factor influencing mental health was perceived physical health. Mediation analyses suggest that physical health mediates the relationship between obesity and mental health quality of life. Discussion Our findings support the view that physical health mediates the relationship between obesity and mental health. Public health interventions should focus on reducing the impact of obesity on physical health by encouraging participation in healthy lifestyles, which in turn, may improve mental wellbeing. [ABSTRACT FROM AUTHOR]

Introduction This study explores what types of information obese individuals search for on the Internet, their motivations for seeking information and how they apply it in their daily lives. Method In-depth telephone interviews with an Australian community sample of 142 individuals with a BMI ≥ 30 were conducted. Theoretical, purposive and strategic samplings were employed. Data were analysed using a constant comparative method. Results Of the 142 individuals who participated in the study, 111 (78%) searched for information about weight loss or obesity. Of these, about three quarters searched for weight loss solutions. The higher the individual's weight, the more they appeared to search for weight loss solutions. Participants also searched for information about health risks associated with obesity ( n = 28), how to prevent poor health outcomes ( n = 30) and for peer support forums with other obese individuals ( n = 25). Whilst participants visited a range of websites, including government-sponsored sites, community groups and weight loss companies, they overwhelmingly acted upon the advice given on commercial diet websites. However, safe, non-judgemental spaces such as the Fatosphere (online fat acceptance community) provided much needed solidarity and support. Conclusions The Internet provides a convenient source of support and information for obese individuals. However, many turn to the same unsuccessful solutions online (e.g. fad dieting) they turn to in the community. Government and community organisations could draw upon some lessons learned in other consumer-driven online spaces (e.g. the Fatosphere) to provide supportive environments for obese individuals that resonate with their health and social experiences, and address their needs. [ABSTRACT FROM AUTHOR]

Abstract: Obesity stigma exists within many institutions and cultural settings. Most studies suggest that stigmatising experiences have a negative impact on individuals’ health and social behaviours and outcomes. However, some studies indicate that obesity stigma can motivate individuals to lose weight. Limited research has examined weight-based stigma from the perspective of obese individuals, including their perceptions of, and responses to, the different types of weight-based stigma they face in their daily lives. This study advances knowledge about weight-based stigma by documenting how obese adults (mostly female) described the different types of obesity stigma that they faced, how they responded to this stigma, and how different types of stigma impact on health and social wellbeing. Semi-structured, qualitative interviews were conducted between April 2008 and March 2009 with a diverse sample of 141 obese Australian adults. Guided by categorisation of different types of discrimination, participants’ experiences could be grouped into three distinct types of stigma: 1) Direct (e.g. being abused when using public transport); 2) Environmental (e.g. not being able to fit into seats on planes); and 3) Indirect (e.g. people staring at the contents of their supermarket trolley). Participants described that more subtle forms of stigma had the most impact on their health and social wellbeing. However, it was the interaction between direct, environmental and indirect stigma that created a barrier to participation in health-promoting activities. Participants rarely challenged stigma and often blamed themselves for stigmatising experiences. They also avoided situations where they perceived they would be stigmatised and constantly thought about how they could find a solution to their obesity. [Copyright &y& Elsevier]

Objectives: To investigate obese men's health behaviors and strategies for change. Methods: Qualitative interviews with 36 men (BMI 30 and over). Results: All men felt personally responsible for their weight gain. Sedentary lifestyles, stress, lack of worklife balance and weight-based stigma were all significant causes of weight gain and barriers to weight loss. These factors also contributed to men's unwillingness to seek help for their overweight. Conclusion: Addressing the self-blame and stigma associated with obesity is important in developing strategies to improve the health and well-being of obese men. [ABSTRACT FROM AUTHOR]

Abstract: Little is known about the possible teleconnections between abrupt climatic changes originating in the North Atlantic and precipitation dynamics in the Australian–Indonesian summer monsoon (AISM) domain. We examine the climatic impacts of Heinrich stadial 3 (HS3) and Greenland interstadials 4 and 3 (GIS4/3) on AISM-associated precipitation through a high-resolution analysis of stable isotope (δ18O, δ13C) and trace element (Mg/Ca, P/Ca) ratios in a stalagmite from Liang Luar cave, Flores, Indonesia. Sixteen high precision 230Th dates indicate that stalagmite LR07-E1 grew rapidly (~0.3–1.0mm/yr) in two phases between ~31.5–30.1ka and ~27.8–25.6ka, separated by a ~2.3kyr unconformity. Temporally consistent abrupt responses occur in the Flores record during HS3 and GIS4, which are coherent with changes in stalagmite δ18O records from China and Brazil. The response of low-latitude precipitation to HS3 cooling and GIS4 warming, as demonstrated by the widely separated sites, comprises three distinct simplified phases: (1) a strong southward migration of the ITCZ during HS3 is associated with a decrease in rainfall at Liang Luar cave and in China, while wetter conditions are reconstructed from Brazil, (2) represents the peak of HS3 impacts and an extended hiatus begins in the Flores record and (3) where suggested dry conditions at Liang Luar throughout GIS4 form part of a coherent north–south anti-phasing in precipitation changes. The reconstructed changes are also broadly consistent with NASA GISS ModelE-R simulations of a Heinrich-like freshwater perturbation in the North Atlantic basin, which produces a southward shift in the ITCZ. The relationship between the palaeoclimate records indicates that atmospheric teleconnections rapidly propagate and synchronise climate change across the hemispheres during periods of abrupt climate change. Our findings augment recent proposals that large-scale atmospheric re-organisations during stadials and interstadials play a key role in driving changes in atmospheric CO2 concentration, air temperature and global climate change. [Copyright &y& Elsevier]

The news media plays an important role in making visible and shaping public understandings of health and health risks. In relation to overweight and obesity, it has been suggested that the media is more likely to engage in alarmist reporting in a climate in which it is taken for granted that obesity is an 'epidemic'. This study analyses Australian media coverage of a report on overweight and obesity, Australia's Future 'Fat Bomb': a report on the long-term consequences of Australia's expanding waistline on cardiovascular disease, by one of Australia's leading health and medical research institutes. Our study found that the report was consistently framed across media outlets as showing that Australia is the 'fattest nation' in the world, having overtaken the Americans. This is despite the fact that the Fat Bomb study did not include international comparisons and was based only on data from middle-aged Australians. Because reports of increasing rates of obesity had already been widely covered in the media, the press needed to find a new way of signifying the problem, which was provided by comments made by its lead author in publicising the report. Consistent with previous research, there was a notable absence of critical commentary on the study and a failure to test the claims of its lead author. We conclude that this reporting could have contributed to a policy environment in which the perceived threat of obesity is deemed to be so great that efforts to contain it may be subjected to less scrutiny than they warrant. [ABSTRACT FROM AUTHOR]

The rise of the 'obesity epidemic' in Western societies has led to an increased public gaze on obese individuals. Yet there is limited research that explores through qualitative methods the increased impact it has had on obese individuals' perceptions of self, body image and coping strategies, using their own words. This paper presents the findings of interviews with a community sample of 142 obese adults in Australia. We examined how obese individuals felt about themselves and their bodies, what influenced these feelings, and the subsequent coping strategies employed. While participants were able to identify many positive characteristics about their inner self, the vast majority used negative language to describe their physical appearance. Many participants described feelings of 'guilt', 'shame' and 'blame' associated with their weight. Coping strategies included striving for perfection in other areas of their life, social isolation, maximising aspects of their appearance and 'fat' acceptance. This study shows that, while different groups of obese adults experience, cope with and compensate for the influence of weight-based stereotyping in many different ways, they still feel an unrelenting otherness and difference associated with their weight. [ABSTRACT FROM AUTHOR]

Background: Previous studies of public perceptions of obesity interventions have been quantitative and based on general population surveys. This study aims to explore the opinions and attitudes of obese individuals towards population and individual interventions for obesity in Australia.Methods: Qualitative methods using in-depth semi-structured telephone interviews with a community sample of obese adults (Body Mass Index >or=30). Theoretical, purposive and strategic recruitment techniques were used to ensure a broad sample of obese individuals with different types of experiences with their obesity. Participants were asked about their attitudes towards three population based interventions (regulation, media campaigns, and public health initiatives) and three individual interventions (tailored fitness programs, commercial dieting, and gastric banding surgery), and the effectiveness of these interventions.Results: One hundred and forty two individuals (19-75 years) were interviewed. Participants strongly supported non-commercial interventions that were focused on encouraging individuals to make healthy lifestyle changes (regulation, physical activity programs, and public health initiatives). There was less support for interventions perceived to be invasive or high risk (gastric band surgery), stigmatising (media campaigns), or commercially motivated and promoting weight loss techniques (commercial diets and gastric banding surgery).Conclusion: Obese adults support non-commercial, non-stigmatising interventions which are designed to improve lifestyles, rather than promote weight loss. [ABSTRACT FROM AUTHOR]

Background: We are a society that is fixated on the health consequences of 'being fat'. Public health agencies play an important role in 'alerting' people about the risks that obesity poses both to individuals and to the broader society. Quantitative studies suggest people comprehend the physical health risks involved but underestimate their own risk because they do not recognise that they are obese.Methods: This qualitative study seeks to expand on existing research by exploring obese individuals' perceptions of public health messages about risk, how they apply these messages to themselves and how their personal and social contexts and experiences may influence these perceptions. The study uses in depth interviews with a community sample of 142 obese individuals. A constant comparative method was employed to analyse the data.Results: Personal and contextual factors influenced the ways in which individuals interpreted and applied public health messages, including their own health and wellbeing and perceptions of stigma. Individuals felt that messages were overly focused on the physical rather than emotional health consequences of obesity. Many described feeling stigmatised and blamed by the simplicity of messages and the lack of realistic solutions. Participants described the need for messages that convey the risks associated with obesity while minimising possible stigmatisation of obese individuals. This included ensuring that messages recognise the complexity of obesity and focus on encouraging healthy behaviours for individuals of all sizes.Conclusion: This study is the first step in exploring the ways in which we understand how public health messages about obesity resonate with obese individuals in Australia. However, much more research--both qualitative and quantitative--is needed to enhance understanding of the impact of obesity messages on individuals. [ABSTRACT FROM AUTHOR]

Protracted dry periods lasting multiple years to decades have occurred in regions including southern Australia, the southwest United States and parts of the Mediterranean, since the latter part of the 20th century. Typically, these protracted droughts have been identified when a multi-year or decadal-scale average of precipitation or a hydrologic variable such as streamflow is well-below normal. However, we show that one of the most defining features of several of these recent protracted dry periods is not the presence of below or much-below average precipitation. Interestingly, most if not all of these protracted drought periods have the occasional year of near or above average precipitation. Rather, a distinct characteristic of recent protracted droughts is the absence of seasons or years of well-above average precipitation i.e. years or seasons of extreme precipitation. In this sense, we argue that extreme precipitation might be just as more important for determining the continuation of a drought as below average precipitation.To demonstrate the importance of considering extreme precipitation for understanding drought, we present a case study in southeast Australia for the so-called "Millennium Drought". The Millennium Drought was a persistent and prolonged dry period that began around 1997 and was predominantly characterised by the lack of autumn and winter precipitation. It is widely accepted that the Millennium Drought ended abruptly with the onset of strong La Niña conditions in 2010. However, we provide evidence that despite the high precipitation in the spring and summer of 2010, the anomalously dry conditions in autumn and winter never ceased and are not markedly different to those conditions observed during the Millennium Drought. This raises the question of whether the Millennium Drought ended, or whether it was just interrupted by the 2010 La Niña. Rethinking how we characterise protracted drought is critical given that those areas described previously in Europe, Australia and North America have experienced several "bursts" of multi-year drought in the last few decades. Establishing what characteristics of precipitation variability are important for these "bursts" – and whether they are caused by decadal-scale variability or a non-stationarity in precipitation associated with anthropogenic climate change – are key questions. [ABSTRACT FROM AUTHOR]

Choice is an imperative for patients in the Australian healthcare system. The complexity of this healthcare ‘maze’, however, means that successfully navigating and making choices depends not only on the decisions of patients, but also other key players in the healthcare sector. Utilising Bourdieu's concepts of capital, habitus and field, we analyse the role of gatekeepers (i.e., those who control access to resources, services and knowledge) in shaping patients' experiences of healthcare, and producing opportunities to enable or constrain their choices. Indepth interviews were conducted with 41 gatekeepers (GPs, specialists, nurses, hospital administrators and policymakers), exploring how they acquire and use knowledge within the healthcare system. Our findings reveal a hierarchy of knowledges and power within the healthcare field which determines the forms of knowledge that are legitimate and can operate as capital within this complex and dynamic arena. As a consequence, forms of knowledge which can operate as capital, are unequally distributed and strategically controlled, ensuring democratic 'reform' remains difficult and 'choices' limited to those beneficial to private medicine. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 crisis has wrought major changes to people's lives across the globe since the beginning of the outbreak in early 2020. The "Australians' Experiences of COVID-19" qualitative descriptive study was established to explore how Australians from different geographical areas and social groups experienced the COVID-19 crisis., Methods: Three sets of semi-structured interviews, each with a diverse group of 40 adults across Australia, were completed between 2020 and 2022. This article reports findings from the first set of interviews, conducted by telephone in mid-2020., Results: The participants discussed their experiences of living through this period, which was characterized by strong public health measures to contain the spread of COVID, including a national lockdown and border closures. Interview fieldnotes and verbatim transcripts were used to conduct an interpretive thematic analysis. The analysis is structured around the following five themes covering the quotidian and affective aspects of participants' lives in the early months of the COVID crisis: "disruption to routines;" "habituating to preventive measures;" "social isolation and loneliness;" "changes to work and education;" and "little change to life." A sixth theme concerns how participants responded to our question about what they imagined their lives would be like after the pandemic: "imagining post-COVID life.", Discussion: The crisis affected participants' experience of daily life variously according to such factors as their social circumstances and obligations as well as their histories of illness, making visible some of the unequal social and economic effects of the pandemic across different genders, ages, localities and socioeconomic groups. Our participants fell into three roughly equal groups: (i) those who found the lockdown and associated restrictions very difficult; (ii) those who reported feeling barely affected by these conditions; and (iii) those who found benefits to the "slowing down" of life during this period., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lupton and Lewis.)

The COVID-19 pandemic has intensified existing workplace stresses and created new challenges for people working on the healthcare frontline, including rapid workplace changes and increasing uncertainty at work, along with fear of contracting the virus. The purpose of this study is to examine the workplace challenges described by Australian frontline health workers during the pandemic. Drawing on a national online anonymous survey of 9518 healthcare workers, we analysed free-text responses to the question: "What did you find to be the main challenges that you faced during the pandemic?" A qualitative content analysis was undertaken. We identified five key themes relating to participant experiences of workplace challenges. These were: Work-life imbalance; Following orders or caring for patients; Unpredictability, disruption, and inconsistency at work; The right to be safe at work; and (Un)preparedness in the workplace. We argue that working during the COVID-19 pandemic illuminated existing occupational health and safety issues that have serious implications for job satisfaction, health workforce retention, and ultimately, patient care.