An Exploration of Rural Housing Insecurity as a Public Health Problem in California's Rural Northern Counties.

Although widely acknowledged as an important social determinant of health, until recently researchers and policymakers have primarily approached housing insecurity as an urban issue, obscuring the visibility of its impacts in rural contexts, including the ways in which housing insecurity intersects with other health and structural inequities facing rural populations. Working to address this gap in the existing literature, this paper explores the experiences of housing insecurity in a rural context by reporting on an analysis of 210 in-depth interviews with 153 adults between the ages of 18-35, living in California's rural North State, a relatively overlooked far northern region of the state comprised of 12 north central and north eastern counties. Using in-depth qualitative interview data, we conducted an exploratory pattern-level analysis of participants' narratives structured by four dimensions of housing insecurity defined in the literature (housing affordability, housing stability, housing conditions, and neighborhood context). Drawing attention to the pervasiveness of rural housing insecurity within our sample, this analysis highlights the unique ways in which rurality creates distinct experiences not currently captured in the existing literature. Further research is needed across different types of rural communities to better understand the various ways that housing insecurity affects the everyday lives and health of rural residents. By grounding research within the experiences of rural residents, we are better able to respond to the crisis of rural housing insecurity and develop solutions that are tailored to rural residents' unique needs.

RETHINKING INTOXICATED SEXUAL ENCOUNTERS.

Social research on alcohol and sexual encounters has tended to be siloed into several different research endeavors, each addressing separate aspects of wanted and unwanted sexual encounters. While sociologists have focused on the patterns of social interaction, status competition, and emotional hierarchies of sexual encounters, they have left the role of alcohol intoxication largely unexamined. Conversely, the two dominant approaches to sexual encounters within alcohol research, the theories of alcohol myopia and alcohol expectancy, while focusing on alcohol have tended to take little account of the socio-relational dynamics and gendered meanings involved in those encounters. Our aim in this theoretical paper is to begin to bring together some of the concepts from these different research strands in examining how the social processes of intoxication potentially impact heteronormative sexual scripts and hence notions of femininity and masculinity among cisgender, heterosexual women and men. Our discussion is focused on the concepts of ritual and scripts; power, status, and hierarchies; and socio-spatial contexts, which are central to an understanding of the gendered and embodied social practices that take place within intoxicated sexual events; the emotional nature of the socio-spatial contexts within which they occur; and the socio-structural conditions that frame these events.

"BLURRING THE LINE:" INTOXICATION, GENDER, CONSENT AND SEXUAL ENCOUNTERS AMONG YOUNG ADULTS.

Social concern about sexual practices and sexual consent among young adults has increased significantly in recent years, and intoxication has often played a key role in such debates. While many studies have long suggested that alcohol plays a role in facilitating (casual) sexual encounters, intoxication has largely either been conceptualized as a risk factor, or researchers have focused on the pharmacological effects of alcohol on behaviors associated with sexual interaction and consent. To date little work has explored how young adults define and negotiate acceptable and unacceptable levels of intoxication during sexual encounters, nor the ways in which different levels of intoxication influence gendered sexual scripts and meanings of consent. This paper explores the latter two research questions using data from 145 in-depth, qualitative interviews with cisgender, heterosexual young adults ages 18-25 in the San Francisco Bay Area. In examining these interview data, by exploring the relationship between intoxication and sexual consent, and the ways in which gender plays out in notions of acceptable and unacceptable intoxicated sexual encounters, we highlight how different levels of intoxication signal different sexual scripts. Narratives about sexual encounters at low levels of intoxication highlighted the role of intoxication in achieving sexual sociability, but they also relied on the notion that intoxicated consent was dependent on the social relationship between the partners outside drinking contexts. Narratives about sexual encounters in heavy drinking situations were more explicitly gendered, often in keeping with traditionally gendered sexual scripts. In general we found that when men discussed their own levels of intoxication, their narratives were more focused on sexual performance and low status sex partners, while women's and some men's narratives about women's levels of intoxication were focused on women's consent, safety, and respectability. Finally, some participants rely on 'consent as a contract' and 'intoxication parity'- the idea that potential sexual partners should be equally intoxicated - to handle relations of power in interpersonal sexual scripts. Since these notions are sometimes deployed strategically, we suggest that they may serve to "black-box" gendered inequalities in power between the parties involved.

Tobacco Harm Reduction as a Path to Restore Trust in Tobacco Control.

The controversy of tobacco harm reduction in the United States persists despite evidence that an important audience of tobacco prevention and control, i.e., the people who use or are likely to use nicotine and tobacco products, are engaging in practices that may be considered harm reduction. Despite this, a significant proportion of the US tobacco control and prevention field continues to be guided by a precept that there is "no safe tobacco," therefore failing to acknowledge practices that may be used to reduce the harms associated with consuming combustible forms of nicotine and tobacco. In this commentary, we argue that ignoring the potential benefits of harm reduction strategies may unintentionally lead to an erosion of trust in tobacco control among some members of the public. Trust in tobacco control as an institution is crucial for the success of tobacco control efforts. To ensure trust, we must return to our basic principles of doing no harm, developing programs that are responsive to people's experiences, and providing resources in assisting people to reduce the harms that may be associated with practices, such as smoking, which adversely affect health. Only by respecting an individual's priorities can we cultivate trust and develop tobacco prevention efforts that are grounded in the realities of people's lives and responsive to their needs.

Is Smoking Queer? Implications of California Tobacco Denormalization Strategies for Queer Current and Former Smokers.

This article is concerned with normative conceptions of health structuring tobacco control strategies designed to "denormalize" tobacco use. Analysis of 201 interviews with non-heterosexual and/or non-cisgender adults in California revealed that participants implicated tobacco use in exacerbating health inequities and perpetuating harmful narratives of queer suffering, but also regarded smoking as a critical tool for self-care and symbol of resistance. Participant narratives suggest that using stigma in health promotion efforts which reinforce normative conceptions of health may be harmful to queer people whose social identities exist within ongoing legacies of pathology, health stigma, and deviance from hegemonic structural norms.

Legitimizing and negotiating abstinence: Young adults' narratives about practicing situational and long term abstinence in Denmark.

BACKGROUND: In this paper, we explore how Danish youth legitimize and negotiate abstaining from drinking alcohol. While most literature on abstinence focuses either on abstainers or non-drinkers, we focus on young peoples' reasons for abstaining either for shorter or longer periods of time. METHODS: The article draws on narrative data from in-depth qualitative interviews with 140 young Danes between 18 and 25 years of age, all of whom had used alcohol in the past three months before the interview. In the analyses we identify different ways in which young Danes explain, justify and legitimize shorter or longer periods of abstinence, while still participating in friendship groups where consuming alcohol is a central part of being together. RESULTS: We employ two concepts that identify what we mean when talking about abstaining from drinking alcohol. The first is 'situational abstinence' which covers abstaining from drinking alcohol in certain situations and for particular reasons while nevertheless consuming in other situations. The second concept, 'long term abstinence', covers taking a break from drinking for longer periods of time. We thus focus on young people, who participate in the Danish youth drinking cultures, but choose to abstain from drinking in certain situations and for a certain period of time. One important finding to emerge from our analysis is that while other studies show some of the same reasons for not drinking, our study shows that timing, negotiation and legitimization also play important roles. Furthermore, these roles are modified by gender. CONCLUSION: Friendship and peer groups are central relationships for young people and are important arenas for feelings of comfort, a sense of belonging and a source of identity. If policy and/or prevention initiatives focus solely on abstaining as an individual choice or an individual concern, as for example in the 'just say no' campaigns, then these initiatives fail to emphasize important aspects of young people's lives.

SUBSTANCE USE AMONG SEXUAL AND GENDER MINORITIES: ASSOCIATION WITH POLICE DISCRIMINATION AND POLICE MISTRUST.

We investigated associations between experiences with police discrimination, police mistrust, and substance use in a convenience sample of 237 sexual and gender minority (SGM) adults in California. In a cross-sectional survey, collected between January 2016 and July 2017, participants reported substance use, lifetime experiences with SGM-related police discrimination, police mistrust, demographics and SGM visibility. In adjusted logistic regression models, we found a positive association between lifetime police discrimination and past-two-week heavy episodic drinking. Police mistrust also was positively associated with past-month marijuana use. Several significant interactions between lifetime police discrimination or police mistrust with other socially stigmatized identities including being African American, insecure housing, and being a gender minority on a few substance use outcomes suggest that effects of police discrimination and mistrust on substance use are stronger among participants with multiple stigmatized identities. Results suggest the importance of policies and interventions that focus on eliminating police discrimination and increasing police legitimacy to reduce risk of substance use among SGM individuals.

Experiencing police violence and insults: narratives from ethnic minority men in Denmark.

Young men living in socially deprived areas are more likely to be exposed to criminal activity and extraordinary policing measures. This article focuses on the narratives of police encounters told by ethnic minority young men living in a deprived neighbourhood in Denmark, defined by the Danish government as a 'ghetto'. In total, 76 young men and 6 young women (age 15 to 26) were interviewed between 2016 and 2017. The article focusses on their experiences of the police's use of force, interpreted as violence by the participants. We have categorized their experiences into three types: unnecessary use of force, inconsistent violence, and humiliation/insults. While police violence is often understood as primarily physical, we also show that in the young people's recollections of these incidences, issues of 'moral violence' becomes important. While not only specifically violating the body, this type of violence also affects the integrity and dignity of individuals. Our participants recounted forms of violence, which were extra-judicial in terms of physical use of force and they described how the police used indirect and degrading techniques of violence, some of which can be categorized as sexual harassment, embarrassment and public humiliation. From their perspectives, police power appeared unpredictable and illegible.

Pathways of Nicotine Product Use: A Qualitative Study of Youth and Young Adults in California.

INTRODUCTION: Existing research on youth's adoption of alternative nicotine delivery systems (ANDS) has focused on identifying pathways of nicotine product use, specifically examining whether vaping encourages progression to smoking. Few studies have considered other pathways of initiation. Qualitative studies suggest that meanings of vaping vary significantly, suggestive of the need for a more nuanced understanding of the role of vaping for youth with different pathways into vaping and smoking. METHODS: We conducted in-depth qualitative interviews with 49 Californian youth between 15 and 25 years old who reported ever vaping nicotine to gain a deeper understanding of their initiation pathways of vaping and smoking, paying special attention to youth's experiences and reasons for ANDS initiation and use. Categorizing participants into initiation pathways by self-reported use and age of initiation of ANDS and cigarettes, we then compared the meaning and role of vaping across three distinct pathways of use: (1) smoking to vaping, (2) vaping to smoking, and (3) vaping only. RESULTS: The most common pathway reported was smoking to vaping (74%), eight participants began vaping before smoking, and five participants reported only vaping but never smoking. Analysis of participants' narratives emphasized that youth in our study, regardless of initiation pathway, were generally aware of the health consequences of smoking and negotiated their use of nicotine products considering relative risks. CONCLUSION: Findings from this study suggest that ANDS serve as a transitional tool for youth who are keenly aware of the health consequences of smoking, thus challenging conventional discourses about ANDS as a threat to youth's health. IMPLICATIONS: This qualitative study queries concerns about the potential of alternative nicotine delivery systems (ANDS) to serve as a gateway into cigarette smoking for youth and young adults. Findings suggest that most of the youth participants discussed and considered relative risks in their pathways of initiation, highlighting the need to acknowledge harm reduction in constructing public health messaging and policies for smoking cessation.

Young women's narratives on sex in the context of heavy alcohol use: Friendships, gender norms and the sociality of consent.

BACKGROUND: Although young women's friendships remain understudied in drinking contexts, some researchers have pointed to how young women can make use of each other to manage sexual advances when drinking. In this paper, we explore how young women make use of friends to negotiate their sexual boundaries, and construct the meaning of sexual experiences in a context of heavy alcohol use. METHODS: The data stems from a large scale research project at the Centre for Alcohol and Drug Research, Aarhus University, which included 140 interviews with young Danes between the ages of 18-25. In the present study, we primarily use narratives from 33 in-depth interviews with young women, who recall their personal sexual experiences with men in the context of heavy alcohol use. RESULTS: We find that these young women make meaning of their sexual experiences in relation to friends through a negotiation of their emotional response as well as dominant gender norms. We argue that friends may serve to prevent sexual regret and offer support in instances where young women feel regret after engaging in sex when drinking heavily. However, we also argue that friends may encourage a more humorous approach in recounting sexual encounters in the context of heavy alcohol use, which may contradict their initial feelings of the encounter and gloss over issues of sexual consent. CONCLUSION: With this article we point to how young women's ability to negotiate the meaning of their sexual experiences as well as that of sexual consent more generally, are interlinked with prevalent gender norms that play out in the context of friendships. The young women in our study narrated friends as more central to negotiations of sexual boundaries than sexual partners when in a context of heavy alcohol use. On this basis, we develop the term 'social consent', which we suggest that future studies and preventive efforts should take into account in order to challenge the gender norms that can serve to normalize sexual violence in drinking contexts.

Drinking comfortably? Gender and affect among Danish pre-partiers.

BACKGROUND: The aim of this paper is to examine the relationship between youthful drinking practices and gender within the domestic pre-party (prior to a night out), an arena, which has been relatively ignored in existing qualitative research on youthful alcohol use. An examination of the relationships between gender and drinking practices in this context is important for three reasons. First, pre-parties are associated with heavy drinking, which has traditionally been associated with masculinity. Second, because pre-drinking takes place in the private sphere of the home, it is therefore 'controlled' in terms of who can participate and hence what precisely is the gender composition. Third, whilst being located in the private sphere of the home, pre-party practices are nevertheless informed by the (hyper) gendered environments of public drinking spaces in the Night-Time Economy (NTE), most dominantly mainstream clubs and bars. We suggest that such characteristics allow for the emergence of specific gendered relationships, activities and affectivities, thereby demarcating the pre-party as a particular gendered drinking space. METHODS: We draw on narrative data from 140 in-depth face-to-face interviews with young Danish alcohol users between 18-25 years of age. The interviews were part of a large-scale research project on the gendered aspects of youthful alcohol use and intoxication. Theoretically, we draw on a combination of the 'doing gender' paradigm (West & Zimmerman, 1987) and affect theoretical notions on (un)comfortability (Ahmed, 2014). We propose that these perspectives mark out the pre-party as a particularly gendered drinking space. RESULTS: While our analysis supports the observation of existing qualitative studies, that pre-partying is not merely motivated by the possibility of becoming intoxicated in a cheap and un-surveilled way before going out, we especially argue that pre-partying is fueled by a desire for 'comfortability', which seems almost impossible to disassemble from the gendering that pre-partying also entails. Our analysis therefore contributes to the ongoing academic discussion around the relationship between 'intoxicated femininity' and 'intoxicated masculinity' by suggesting that we need to take the affective implications of young people's (gendered) drinking practices into account in a thorough discussion of the relationship between youthful alcohol use and gender.

Playing with gender borders: flirting and alcohol consumption among young adults in Denmark.

In the present article we explore and discuss the gendered aspects of how flirting among young people is an integrated part of a night out among young adults in Denmark, specifically a night out in mainstream bars and clubs. Empirically, we base our analysis on 140 qualitative interviews with regular alcohol users between 18 - 25 years of age. Drawing on Ahmed's (2006) notion on orientation in combination with Thorne's (1993) notions on gender play and borderwork, our aim is to explore and discuss how flirting - for these young people - become an unavoidable interactional practice in Night Time Economy (NTE) contexts, which, in some cases is experienced as easy and enjoyable, and in others as uncomfortable and challenging. In the analysis we specifically focus on how gender norms related to the NTE is navigated and/or challenged by our participants, in relation to flirting. On this basis, we show how the gendered structures of the mainstream NTE are, in some instances, supportive of its participants flirting practices and experiences, and challenging in other cases. In conclusion, we emphasize that the young people relate challenges to queer flirting as well as heterosexual flirting, and that notions of risks in this context relate to risks of marginalization, rather than health risks.

Ring and bring drug services: Delivery dealing and the social life of a drug phone.

BACKGROUND: Illegal drug dealers no longer compete for customers only through the quality of their products, but also in convenience and speed of delivery. This article investigates "ring and bring" drug dealing, and argues that a focus on dealers' use of mobile phones is useful for exploring current changes within retail level drug markets. METHODS: The article is based on 21 face-to-face in-depth interviews with active drug dealers in Denmark all of whom were involved in the delivery of drugs (mainly cannabis and cocaine) often to buyers' homes. RESULTS: Contrary to studies emphasising how drug dealers often take up new communication technologies with enthusiasm, the dealers in this study displayed a technological conservatist stance. Moreover, mobile phones have become key to dealers' construction of in-group hierarchies, and have led to retail level drug selling becoming more flexible, individualised and more of a service on par with other services in the consumer society. Finally, the increasing use of mobile phones has also created a situation where portfolios of drug customers, held on cell phone SIM cards, are today traded and sold alongside other commodities in the drug economy. CONCLUSION: We show how a social constructivist approach to technology can provide a more detailed and nuanced account of the socio-technical ensemble and the meaning-making processes giving shape to retail level "delivery dealing."

Youth perspectives on concurrent smoking and vaping: Implications for tobacco control.

Most people who smoke cigarettes begin young. Consequently, public health efforts directed at youth are a priority. The increasing popularity of electronic nicotine delivery systems (ENDS) among youth in the United States has raised concerns in the public health community about the potential of ENDS to renormalize cigarette smoking and perpetuate nicotine addiction, creating dual users who both vape and smoke. Despite limited and inconclusive evidence about dual use for young people, restrictive approaches towards ENDS have shaped tobacco control agendas in the United States. Based on analysis of 26 interviews with young dual users in California, we explored the meanings young people ascribe to their dual using practices and how those meanings relate to the broader tobacco control environment which structures their lives. Results suggest that dual users of ENDS and cigarettes overwhelmingly perceive a utilitarian meaning of dual use and view vaping as a tool for reducing smoking-related harm in the near term and facilitating quitting smoking in the long term. Also, participants' narratives related to Tobacco 21 laws, which prohibit sales of both ENDS and cigarettes to individuals under 21 years of age, revealed concerns about restrictive policies that limit access to less harmful tobacco products. Results of this study raise important questions about whether we are working towards further reductions in the prevalence of smoking and tobacco-related diseases.

The Role of Multiple Social Identities in Discrimination and Perceived Smoking-Related Stigma among Sexual and Gender Minority Current or Former Smokers.

AIMS: We investigated how intersections of being a racial minority (i.e. being African American) and economically-disadvantaged (i.e. housing insecurity) may influence experiences with discrimination and perceptions of smoking-related stigma among sexual and gender minority (SGM) current and former smokers. Methods: Survey data were collected from 227 SGM current and former smokers in California (19-65 years old), oversampling African American participants. Participants reported their race, ethnicity, past month housing insecurity, number of lifetime experiences with SGM discrimination, and perceptions of smoking-related stigma. FINDINGS: Using univariate General Linear Models and controlling for age, ethnicity, and SGM visibility, we found a significant interaction between being African American and facing housing insecurity on experiences with SGM discrimination [F(1,220)=7.21, p=0.01], perceived smoker stigma [F(1,220)=5.48, p=0.02], perceived differential treatment due to smoking [F(1,220)=10.03, p=0.00], and social withdrawal from non-smokers [F(1,220)=6.18, p=0.01]. These interactions suggest that economically-disadvantaged African American SGM current or former smokers experience increased levels of discrimination and perceive more smoking-related stigma compared to other SGM current and former smokers. Conclusions: Results suggest that people's multiple identities intersect to intensify oppression and inequities for some people and raise questions about the unintended consequences of stigmatizing smokers for reducing smoking among SGM adults.

"They Can't Search Her": How Gender Imbalances in the Police Force Contribute to Perceptions of Procedural Unfairness.

Research suggests that gender imbalances in police forces can significantly affect individuals' experiences when interacting with police. Of importance, yet rarely examined, is the extent to which predominantly male police forces, in conjunction with adherence to gendered departmental policies, can simultaneously send signals of procedural justice and procedural injustice. Drawing on data from 253 in-depth interviews of San Francisco-based male and female drug-dealing gang members, we investigated how interactions with a male-dominated police force, who were required to search only suspects of the same gender, affected perceptions of fair policing. Our findings revealed that the study participants raised concerns that the police unfairly enforced the law to the detriment of the men in the study. The gang members were aware that male officers could only search same-sex suspects, and this exacerbated the gendered experiences of the gang members. Specifically, it contributed to the perception that male officers targeted male gang members to the omission of women and, if women were stopped, they were frequently released. These findings suggest that the gender composition of the police force is important in shaping attitudes toward equitable enforcement of the law and procedural fairness. Of theoretical importance, these findings highlight a contradiction that compliance with rules can contribute, counter intuitively, to perceptions of procedural injustice. Procedurally unfair police behavior may be a systemic problem where the gender composition of the police force itself creates an inherently unfair system.