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This article uses discursive approaches to examine the utility and functions of language in public health, focusing on social constructions of e-cigarettes. Due to the ambiguity surrounding the use of e-cigarettes, understanding may be negotiated collaboratively through co-construction in talk. Ten participants, three men and seven women aged 26–47 years, took part in two focus groups in Manchester, UK, where they discussed e-cigarettes. Data were analysed using blended discourse analysis, with a view to identifying dominant repertoires used by speakers. Participants drew from two discursive frameworks to communicate perceptions of e-cigarettes: (1) uncertainty and risk and (2) the social acceptability and stigma spectrum. The ambiguity surrounding e-cigarettes was reflected in the linguistic devices used in talk. This article demonstrates the value of drawing on discourse analysis to better understand the impact of health-related communication by providing insight into how existing messages are interpreted, co-constructed, and assigned meaning through shared interactions.

Objective. This study was designed to investigate UK smokers' accounts of impacts of COVID-19 on their smoking, to develop implications for supporting smoking cessation. Design. One hundred and thirty-two smokers aged 19-52 years (mean age 25 years), recruited through an advert distributed through social media and a dedicated Twitter page, completed an anonymous online questionnaire. Main Outcome Measures. Smokers produced written accounts of how COVID-19 had impacted their smoking. Responses were of unlimited length and completed online 22nd May-22nd June 2020 during UK COVID-19 lockdown. Results. Inductive thematic analysis generated three themes: i) increased smoking as a coping mechanism to deal with anxiety, boredom, stress, and anger in COVID-19 lockdown; ii) lockdown as enabling quitting through lifting social barriers and enabling a focus on health benefits; and iii) no change, avoiding Government/media COVID-19 information due to disbelief, lack of trust, and perceptions of bias. Conclusions. Results demonstrate a need for credible public health messaging on COVID-19 risk aimed at smokers. Implications for supporting smoking cessation are discussed, including maintaining quitting in those "social smokers" who quit during lockdown, and support on stress-management and emotion regulation in those who use smoking as a way to cope with stress, anger, and boredom.

© 2019 Research has demonstrated that eating disorders (ED) and higher weight have lifetime co-occurrence suggesting that they may be best considered within a common etiological model. Although we know that body dissatisfaction is likely to be a risk factor for both outcomes, other proposed risk and protective factors for each condition have not been adequately explored. The current paper tests a conceptual model that is based on a review of the existing literature from both areas of scholarship. It considers biological, sociocultural, psychological, and behavioral factors that may contribute to both outcomes. The model will be tested in a longitudinal design with an initial sample of 600 emerging adults (aged 18–30) per country in nine different countries (total sample = 5400 participants). Questionnaires will be completed online on two occasions, 12 months apart. The first full phase of the study commenced in July 2018, the same time Body Image was approached to publish this protocol paper (the final revised paper was submitted in September 2019), and data collection will be finalized in December 2019. Multi-group path analysis will identify the biopsychosocial predictors – both cross-sectionally and longitudinally – of both ED and higher weight, and how these vary across countries and gender.

This study investigated how women constructed body image following cancer. Four women, aged 32-67 years who had experienced breast or bowel cancer took part in a two-hour, in-depth focus group. Discourse analysis revealed that women orientated to positive aspects of the post-treatment body (silhouette, trust, acceptance) whilst acknowledging that their experiences were also traumatic (hair loss, scarring, sickness, swelling). Bodies and illness were concealed from public judgment, and women developed new trust in their bodies due to overcoming cancer; post-cancer bodies were accepted despite opportunities for normalisation. Implications for those wanting to support women during and after cancer are discussed.

Objectives: Skin cancer is a growing problem globally. Older men have been largely ignored in previous research, even though men may generally be prone to riskier exposure to the sun than women. Past research suggests that appearance-focused techniques such as facial morphing can increase motivations to use sun protection among women of all ages, and younger men. Design: was qualitative, consisting of individual interviews. Method: was semi-structured interviews with 25 older men, to examine attitudes to UV exposure and reactions to a facial morphing intervention. Interviews were subjected to thematic analysis. Results: Three themes were constructed: masculine UV exposure; appearance that’s accepted; personal responsibility. The men did not identify gaps in their sun protection behaviour, and demonstrated a lack of concern about ageing and appearance. These attitudes translated into a lack of motivation for behaviour change due to ageing acceptance. However, motivation to change behaviour came from health concerns resulting from the intervention. Conclusions: The men experienced different motivations and barriers for sun protection use than women of similar ages. Facial morphing can be effective with older men, but may need to be reframed to focus on health implications and personal choice.

This study investigates how men's body image develops over time. A total of 14 men aged between 45 and 67 years completed in-depth interviews where they discussed their body image since childhood, prompted in some cases by photographs of themselves at different ages that they brought to the interviews. Transcripts were analysed using inductive thematic analysis. From the participants' accounts, it was evident that body concerns did not steadily improve or worsen, but waxed and waned over time. Results are discussed in relation to understanding changing body concerns in men's lives, and the implications of these for future research and practice.

Research has demonstrated that eating disorders (ED) and higher weight have lifetime co-occurrence suggesting that they may be best considered within a common etiological model. Although we know that body dissatisfaction is likely to be a risk factor for both outcomes, other proposed risk and protective factors for each condition have not been adequately explored. The current paper tests a conceptual model that is based on a review of the existing literature from both areas of scholarship. It considers biological, sociocultural, psychological, and behavioral factors that may contribute to both outcomes. The model will be tested in a longitudinal design with an initial sample of 600 emerging adults (aged 18–30) per country in nine different countries (total sample = 5400 participants). Questionnaires will be completed online on two occasions, 12 months apart. The first full phase of the study commenced in July 2018, the same time Body Image was approached to publish this protocol paper (the final revised paper was submitted in September 2019), and data collection will be finalized in December 2019. Multi-group path analysis will identify the biopsychosocial predictors – both cross-sectionally and longitudinally – of both ED and higher weight, and how these vary across countries and gender.

Objective: To understand women’s experiences of coping with endometriosis, and impact on their lives. Design: Women accessed an online questionnaire through a UK-based endometriosis charity website. Methods: Thirty-four women, aged 22-56 years, with self-reported medically-diagnosed endometriosis, 30 of whom were White, responded to open-ended questions, analysed using inductive thematic analysis. Results: Participants spoke about their lives being a constant struggle, where they tried to maintain their personal and working lives whilst dealing with long-term pain. Women had to “battle” for an accurate diagnosis, and had limited faith in health professionals. Coping strategies included avoidance of social events to conserve energy (self-pacing), and avoiding taking painkillers to retain alertness. Women did not feel able to be honest with family and friends about their symptoms, and felt socially isolated and misunderstood. Conclusions: Implications for health professionals are discussed, including the need for earlier diagnosis and taking women’s symptoms more seriously at referral; understanding the need to conserve energy in the context of long-term pain; that not taking pain medication may be an active choice to retain alertness; and that avoiding being honest with friends and family and subsequent feelings of isolation may be common experiences relevant to designing treatment programmes.

Health inequalities are a major concern in the UK. Power imbalances are associated with health inequalities and should be challenged through health promotion and empowering strategies, enabling individuals who feel powerless to take control over their own life and act on the determinants of health (Green and Tones, 2010). This study aimed to explore resident expectations of a community engagement programme that intended to empower communities to take action on pre-identified priorities. The programme targeted communities in deprived areas of a mid-sized city in the UK. A qualitative design was implemented. In-depth semi-structured interviews were undertaken with 28 adult residents at the start of the programme. Transcripts were analysed using an inductive approach to thematic analysis. Resident expectations were explored from a constructivist epistemological perspective. The qualitative inductive approach allowed a second research question to develop which led this paper to focus on exploring how disempowerment was experienced by individuals before taking part in a community engagement programme. Analysis of interviews revealed a ‘process of deterioration’ that provided insight into how communities might become (more) disadvantaged through disempowerment. Five master themes were identified: external abandonment at the institutional-level (master theme 1); a resulting loss of sense of community (master theme 2); this negatively affected psychological wellbeing of residents (master theme 3); who adopted coping strategies (e.g., disengagement) to aid living in such challenging areas; (master theme 4); disengagement further perpetuated the deterioration of the area (master theme 5). Distrust was identified as a major barrier to participation in community engagement programmes. Overall, our data suggested that community engagement approaches must prioritise restoration of trust and be accompanied by supportive policies to mitigate feelings of abandonment in communities.

This study draws attention to the link between under-developed and ill-informed sizing practices, fit dissatisfaction and the creation of textiles waste. The literature review identifies: issues that limit the effective development and application of sizing systems, the link between the complexities of consumer fit expectations, body image and self esteem and maps the link between fit dissatisfaction and the creation of textiles waste. Data analysis draws from a wider study designed to investigate women’s experiences of dress fit and body image. 20 women aged 18-45 years were audio-recorded while they tried on a number of mass-produced dresses, and were asked to select one dress, which they could keep. All the dresses were selected except one style, which failed to satisfy any of the women’s fit requirements. The findings clearly demonstrate why this dress was considered to be unsatisfactory as well as the subsequent link between poor fit and body dissatisfaction. Findings support the theory that women identify with their clothes’ size and when this link is disrupted it causes discomfort and body dissatisfaction, which in turn contributed to rejection of the garment increasing the potential for the creation of waste. This study is the first to link unsatisfactory fashion sizing practice with the production of textiles waste. The process of capturing women's interactions with high street fashion dresses whilst trying them on, enabled a detailed analysis that contributes new evidence to the debate around sizing practice, poor fit and its impact on body image and self-esteem.

The current study was designed to test the efficacy of an appearance-based facial morphing program to reduce intentional UV exposure among individuals at risk for skin cancer. A three-arm randomized controlled trial was employed (N = 219) comparing facial morphing + health information to: (1) mindfulness + health information; and (2) health information only. Participants were young adults with a history of recent intentional tanning and future intentions to tan. Primary outcomes were indoor and outdoor tanning frequency and tanning intentions, with secondary outcomes of tanning attitudes, body image, and affect. Facial morphing participants reported less frequent tanning, compared to mindfulness and control participants at 1-month follow-up. Facial morphing participants also generally reported lower intentions to tan at immediate follow-up, although the magnitude of these effects weakened at 1-month follow-up. Facial morphing programs may offer a brief, efficacious, and scalable augmentation to standard of care in reducing intentional UV exposure.

Aims and objectives: are to, on a sample of nurses and the general public, examine whether victim blame varies according to level of familiarly between victim and perpetrator. It also examines how Ambivalent Sexism (AS) and Rape Myth Acceptance (RMA) impacts on this. Background: Around one in five women will be victims of sexual assault during their lifetime. The majority are acquaintance rapes, and these victims are generally attributed more blame than victims of stranger rape. Research indicates that nurses hold similar attitudes on gender roles and victim blame as do the general public. Methods: Eighty-one participants read a story depicting a sexual assault of a woman by either a stranger or an acquaintance, and completed scales measuring victim blame, AS and RMA. Results: indicated that victim-perpetrator relationship, benevolent sexism (BS), hostile sexism (HS) and whether he participant was a nurse contributed to the variance in attributed victim blame. Hierarchical regressions revealed that whether or not the participant was a nurse contributed to the variance in victim blame in the acquaintance rape condition, and HS and BS contributed to the variance in victim blame in the stranger rape condition. Conclusions: This paper gives a novel insight into attitudes involved in victim blame in rape cases, and makes a unique comparison between nurses and the general public. Findings suggests that victim blame correlates primarily with aggressively sexist attitudes, and that nurses generally attribute more blame to the victim of acquaintance rape.

Background: In cross-sectional surveys, increasing numbers of adolescents report using both electronic cigarettes (e-cigarettes) and cigarettes. This study assessed whether adolescent e-cigarette use was associated prospectively with initiation or escalation of cigarette use. Method: Data were from 2,836 adolescents (aged 13-14 years at baseline) in 20 schools in England. At baseline, breath carbon monoxide levels, self-reported e-cigarette and cigarette use, sex, age, friends and family smoking, beliefs about cigarette use, and percentage receiving free school meals (measure of socio-economic status) were assessed. At 12 month follow-up, self-reported cigarette use was assessed and validated by breath carbon monoxide levels. Results: At baseline, 34.2% of adolescents reported ever using e-cigarettes (16•0% used only e-cigarettes). Baseline ever use of e-cigarettes was strongly associated with subsequent initiation (N = 1,726; OR = 5•38, 95%CI = 4•02 to 7•22; controlling for covariates, OR = 4•06, 95%CI = 2•94 to 5•60) and escalation (N = 318; OR = 1•91, 95%CI = 1•14 to 3•21; controlling for covariates this effect became non-significant, OR = 1•39, 95%CI = 0•97 to 1•82) of cigarette use. Conclusions: This is the first study to report prospective relationships between ever use of e-cigarettes and initiation and escalation of cigarette use among UK adolescents. Ever use of e-cigarettes was robustly associated with initiation but more modestly related to escalation of cigarette use. Further research with longer follow-up in a broader age-range of adolescents is required.

As a majority of skin cancer cases are behaviourally preventable, it is crucial to develop effective strategies to reduce UV exposure. Health-focused interventions have not proved to be sufficiently effective, and it has been suggested that people might be more susceptible to information about the negative effects of the sun on their appearance. Method: This systematic review of 30 separate papers, reporting 33 individual studies published between 2005 and 2017 assesses the overall effectiveness of appearance interventions on participants’ UV exposure and sun protection behaviour. Results: Appearance-based interventions have positive effects on sun exposure and sun protection, immediately after the intervention as well as up to 12 months afterwards. The meta-analysis found a medium effect size on sun protection intentions for interventions which combined UV photography and photoaging information: r+ = .424; k = 3, N =319, CI = .279 - .568, p = .023. Conclusions: We provide a review of current research on the effectiveness of appearance-based interventions to reduce UV exposure. As well as highlighting methodological issues we recommend that practitioners administer a UV photo intervention in combination with photo-aging information to reduce UV exposure. Furthermore, the review specifically recommends that future research focuses on the use of theoretical constructs to enhance photoaging information, and is conducted with older participants and in countries where people have less opportunity for sun exposure.

The last decade has seen a significant increase in internet usage. In 2015, 86 per cent of households in Great Britain had internet access, compared with 57 per cent in 2006; and 78 per cent of adults (39.3 million people) accessed the internet every day in Great Britain in 2015, compared with 35 per cent (16.2 million) in 2006 (Office for National Statistics, 2016). Since the turn of the new millennium, worldwide usage of the internet has grown by more than 832.5 per cent, and it is now used regularly by more than 46 per cent of the world’s population (Internet World Stats, 2016). The availability of wireless hotspots has also increased in the last ten years – in 2015, 74 per cent of adults in Great Britain had used the internet through mobile phones or other portable devices (Office for National Statistics, 2016). Ofcom (2014) reported that 66 per cent of online adults in the UK have a current social networking site profile, with 60 per cent of these users visiting sites more than once a day. One of the more popular online platforms for research is the forum where people discuss topics, access and provide information, give and receive advice, and talk about their experiences. These kinds of online discussions provide a useful source of information for researchers wishing to access people’s accounts of a variety of experiences and behaviours, including experiences and embodiment and self-reported drug use. In this chapter, after reviewing work linking body image with social media and drug use, we draw on our recent research investigating discussions about using ephedrine and synthol in relation to sporting performance, health and body image. We discuss some of the theoretical, methodological and ethical considerations involved in undertaking online research, and provide readers with practical advice on venturing into this type of investigation.

This study aimed to explore University students’ understandings of mental health issues, mental health labels, and their attitudes towards these concepts. Five participants (four women aged 18-20, and one 24-year-old man) discussed in a focus group aspects of their childhood that they considered had affected their attitudes towards mental health and labelling. The three themes produced by inductive thematic analysis were ‘the language and context of labelling’, ‘stereotypes and social stigma’, and ‘personal experiences’. Findings have important implications for school nurses who work in primary schools, and who need to be aware of language use.

Skin cancer is to a large degree behaviourally preventable, meaning that evidence-based interventions have scope to make a difference. Previous research indicates that appearance-based interventions such as facial morphing may be more effective than health-based interventions, and that it can personalise the issue of skin cancer.This study examined attitudes to UV exposure, as well as reactions to a facial morphing intervention, through interviews with 25 women aged 35 years and older.Thematic analysis revealed four themes; two regarding attitudes to UV exposure (confusion and contradiction, and change and continuity), and two relating to the facial morphing intervention (negative reactions to UV-exposed photo and positive outcomes of the intervention). Women experienced a number of barriers to adopting safer behaviour in the sun; their current attitudes to UV exposure had been shaped by available information sources throughout their ageing. They expressed negative evaluations of the UV photo, which fed directly into motivation to reduce UV exposure.These results can be interpreted along the lines of goal-directed behaviour. This type of intervention has the potential to reduce UV exposure among this participant group, something that needs to be further investigated with randomised control trials.

The last decade has seen a significant increase in internet usage. In 2015, 86 per cent of households in Great Britain had internet access, compared with 57 per cent in 2006; and 78 per cent of adults (39.3 million people) accessed the internet every day in Great Britain in 2015, compared with 35 per cent (16.2 million) in 2006 (Office for National Statistics, 2016). Since the turn of the new millennium, worldwide usage of the internet has grown by more than 832.5 per cent, and it is now used regularly by more than 46 per cent of the world’s population (Internet World Stats, 2016). The availability of wireless hotspots has also increased in the last ten years – in 2015, 74 per cent of adults in Great Britain had used the internet through mobile phones or other portable devices (Office for National Statistics, 2016). Ofcom (2014) reported that 66 per cent of online adults in the UK have a current social networking site profile, with 60 per cent of these users visiting sites more than once a day. One of the more popular online platforms for research is the forum where people discuss topics, access and provide information, give and receive advice, and talk about their experiences. These kinds of online discussions provide a useful source of information for researchers wishing to access people’s accounts of a variety of experiences and behaviours, including experiences and embodiment and self-reported drug use. In this chapter, after reviewing work linking body image with social media and drug use, we draw on our recent research investigating discussions about using ephedrine and synthol in relation to sporting performance, health and body image. We discuss some of the theoretical, methodological and ethical considerations involved in undertaking online research, and provide readers with practical advice on venturing into this type of investigation.

University life can be stressful, and accurate measurement of perceived stress is important for research and practice. However, despite widespread use, disagreement persists regarding the latent structure of the Perceived Stress Scale (PSS), which poses serious consequences for how the measure should be administered. Furthermore, factorial invariance between genders has not been established with the 10-item PSS, though gender differences in perceived stress have been detected. This study examined the factor structure, composite reliability, convergent validity, and gender invariance of the PSS-10 among 524 UK university students. Four distinct factor models (one-factor, correlated two-factor, correlated three-factor, and bifactor) were examined using confirmatory factor analysis. The totality of results supported a bifactor solution. Multi-group analysis established configural, metric, and scalar invariance of this model across gender. This study supports the use of total PSS-10 scores with UK university students and suggests the scale is not significantly affected by gender bias.

University life can be stressful, and accurate measurement of perceived stress is important for research and practice. However, despite widespread use, disagreement persists regarding the latent structure of the Perceived Stress Scale (PSS), which poses serious consequences for how the measure should be administered. Furthermore, factorial invariance between genders has not been established with the 10-item PSS, though gender differences in perceived stress have been detected. This study examined the factor structure, composite reliability, convergent validity, and gender invariance of the PSS-10 among 524 UK university students. Four distinct factor models (one-factor, correlated two-factor, correlated three-factor, and bifactor) were examined using confirmatory factor analysis. The totality of results supported a bifactor solution. Multi-group analysis established configural, metric, and scalar invariance of this model across gender. This study supports the use of total PSS-10 scores with UK university students and suggests the scale is not significantly affected by gender bias.

This study investigated younger women’s body image after mastectomy. In all, 49 women, aged 29–53 years (mean age: 39 years) who had had bilateral (n = 8) or unilateral (n = 41) mastectomy responded to open-ended questions online. Inductive thematic analysis revealed that aesthetics were less important than survival between diagnosis and mastectomy. Following mastectomy, women negotiated new body identities. Treatment effects such as weight gain were significant concerns. However, impacts on body confidence varied, and some participants rejected mainstream body shape ideals and reported feeling proud of their scars. Implications for supporting younger women post-mastectomy, including promotion of body acceptance, are discussed.

This study investigated 30 male smokers' experiences of an appearance-focused, facial-ageing intervention. Individual interviews (n = 21) and three focus groups (n = 9) were conducted. Transcripts were analysed using thematic analysis. Male smokers explained that viewing the impacts of smoking on their own faces was the most effective part of the intervention and 22 men (73%) said that they intended quitting smoking or reducing number of cigarettes smoked post-intervention. It is recommended that designers of appearance-focused interventions target men in the future as the current findings demonstrated that the majority of men engaged well with the intervention.

The purpose of this study was to explore young British men’s understandings of prostate health and cancer of the prostate. A total of 16 White-British men between 31–50 years of age took part in interviews face-to-face or through computer-mediated communication. Thematic analysis broadly informed by grounded theory identified two key themes; ‘limited knowledge about the prostate’ and ‘early detection & unpleasant procedures’. Accounts are discussed with reference to implications for improving men’s understandings of prostate cancer, and likelihood of self-referral for prostate screening where necessary.

This study investigated men’s experiences of an appearance-focussed, facial-ageing, intervention designed to increase sun protection intentions, compared to a health literature intervention. Seventy men took part, with thirty-five in each condition. The men completed questionnaires at baseline, post-intervention and six months post-intervention. There was a significant improvement in sun benefit attitudes, sun risk attitudes and sun protection intentions in both groups, although there was no significant difference between the conditions. At six months followup, however, there was a significant difference in sun protection use, with those in the facial-ageing intervention condition using significantly more protection. It is suggested that in the future, interventions that incorporate both health and appearance factors are designed, in order to utilise the strengths of both interventions.

Middle-age is distinctive in both the quantity of stressors experienced and their nature, so is an important area of study. This study used semi-structured e-mail interviews to investigate how a group of nine Caucasian, middle-class, heterosexual men aged between 45 and 55 years made sense of ageing and middle-age. An Interpretative Phenomenological Analysis approach was employed. Analysis of the accounts indicated four superordinate themes: (1) feelings of being trapped in between post-industrial and contemporaneous gender ideals, (2) mind over body, and the disregard of the metrosexual body ideology, (3) fatherhood, being busy, and lost opportunities, (4) holistic and inward self-awareness. Future studies are needed to enable an understanding of middle-aged men's experiences of distress associated with ageing, and to investigate whether this is associated with the progress of long-term physical and mental conditions at midlife.

This study investigated younger women’s body image after mastectomy. In all, 49 women, aged 29–53 years (mean age: 39 years) who had had bilateral (n = 8) or unilateral (n = 41) mastectomy responded to open-ended questions online. Inductive thematic analysis revealed that aesthetics were less important than survival between diagnosis and mastectomy. Following mastectomy, women negotiated new body identities. Treatment effects such as weight gain were significant concerns. However, impacts on body confidence varied, and some participants rejected mainstream body shape ideals and reported feeling proud of their scars. Implications for supporting younger women post-mastectomy, including promotion of body acceptance, are discussed.

The aim of the current study was to use interviews to explore midwives’ experiences of talking to pregnant women about smoking cessation. Eight midwives based in one UK hospital took part in face-to-face semi-structured interviews. Thematic analysis revealed that midwives were aware of health risks associated with smoking, saw providing smoking cessation advice as part of their role, would value more support from GPs, and were clear that support and a woman-centred approach were key. Failure to refer women for support was related to cumbersome or misunderstood referral procedures rather than reluctance to refer.

The purpose of this study was to explore young British men’s understandings of prostate health and cancer of the prostate. A total of 16 White-British men between 31–50 years of age took part in interviews face-to-face or through computer-mediated communication. Thematic analysis broadly informed by grounded theory identified two key themes; ‘limited knowledge about the prostate’ and ‘early detection & unpleasant procedures’. Accounts are discussed with reference to implications for improving men’s understandings of prostate cancer, and likelihood of self-referral for prostate screening where necessary.