Developing a Women's Thought Collective methodology for health research: The roles and responsibilities of researchers in the reflexive co-production of knowledge.

BACKGROUND: Co-produced research holds enormous value within the health sciences. Yet, there can be a heavy focus on what research participants think, do and know; while the researcher's responsibility to explore and re/work their own knowledge or praxis tends to escape from view. This is reflected in the limited use of co-production to explore broad structural distributions of health and risk(s). We argue this missed opportunity has the potential to unfold as what Berlant calls a 'cruel optimism', where something desirable becomes an obstacle to flourishing and/or produces harm. We explore challenges to involving lay populations meaningfully in health research amidst a neoliberal cultural landscape that tends to responsibilise people with problems they cannot solve. METHODS AND FINDINGS: Drawing together principles from hermeneutic and feminist philosophy, we develop a novel methodology for co-producing research about determinants of health and health risk (using a case study of alcohol consumption as an example) that centres on what researchers do, know and think during research: Women's Thought Collectives. DISCUSSION: Keeping the constructed nature of social systems-because they shape ideas of value, expertise and knowledge-in view during co-produced research illuminates the potential for cruel optimisms within it. Such reflexive awareness carves out starting points for researchers to engage with how social hierarchies might (tacitly) operate during the co-production of knowledge. Our work has broad utility for diverse population groups and provides important considerations around the roles and responsibilities for reflexive co-production of knowledge at all levels of health systems. PATIENT OR PUBLIC CONTRIBUTION: The development of these ideas was sparked by working with lay participants during the Women's Thought Collectives for Kristen Foley's doctoral research 2021-2023, but undertaken without their direct involvement-in accordance with the responsibilities of researchers in the reflexive co-production of knowledge. Forthcoming publications will address the outcomes and processes of this work.

Through the wine glass: How biographical midlife transitions and women's affective interpretations interact with alcohol consumption.

BACKGROUND: Women during midlife are consuming larger quantities of alcohol than any other age group of women and any other generation of midlife women previously. This is concerning given alcohol related-health risks coalesce with age-related health risks for women, in particular, breast cancer. METHODS: In-depth interviews with 50 Australian midlife women (aged 45-64) from different social classes explored women's personal accounts of midlife transitions and their descriptions of the role of alcohol in navigating these life experiences; both daily occurrences as well as significant moments in the life course. RESULTS: Our findings point to the complex, confusing and co-existing biographical transitions women experience during midlife (generational, embodied/physiological and material changes) that sharpen a role for alcohol in women's lives and are nuanced by social class (volumes of social, economic and cultural capital). We pay close attention to women's affective interpretations of these transitions and ways alcohol is used to feel robust in navigating daily life or easing their prospective futures. Critically, for women living with limited access to capital, and who could not 'measure up' to social ideals by comparison with the achievements and trajectories of other midlife women, alcohol reconciled their disappointment. Our exploration shows how the social class conditions that shape how women make sense of their transitions through midlife might be differently shaped to enable different options forreducing drinking. CONCLUSIONS: Policy must address the social and emotional concerns women experience through midlife transitions that give alcohol a worthwhile place in their lives. A first step might be responding to the absence of community and leisure spaces for midlife women especially those that do not integrate alcohol, with benefits including addressing loneliness, isolation and feeling invisible, and enabling positive constructions of midlife identities. Structural barriers to participation and feelings of worth must be removed for women who lack social, cultural and economic resources.

Understanding public perceptions in social media responses to posts about acute severe hepatitis of unknown etiology in Indonesia: a qualitative study.

BACKGROUND: Acute Severe Hepatitis of Unknown Etiology (ASHUE) emerged as a new global outbreak in Indonesia early May 2022, coinciding with the COVID-19 pandemic. This study aimed to understand public reactions and responses to the emergence of ASHUE Indonesia and to Government-led disease prevention responses. Understanding how the public perceived government-led preventive messaging about the hepatitis outbreak is crucial to controlling viral spread - particularly given the rapid and unforeseen emergence of ASHUE coincided with COVID-19 and public trust in the Indonesian Government to manage health outbreaks was already tenuous. METHODS: Social media users' responses to information disseminated via Facebook, YouTube, and Twitter were analyzed to understand public perceptions about ASHUE outbreak and their attitudes toward Government-led prevention measures. Data were extracted on a daily basis from 1st May 2022 to 30th May 2022 and analyzed manually. We inductively generated the codes, from which we formed a construct and then grouped to identify themes. RESULTS: A total of 137 response comments collected from 3 social medial platforms were analyzed. Of these, 64 were from Facebook, 57 were from YouTube, and 16 were from Twitter. We identified 5 main themes, including (1) disbelief in the existence of the infection; (2) suspicion about a potential new business after COVID-19; (3) suspicion that COVID-19 vaccine(s) are the cause; (4) religion-related fatalism and (5) trust in government measures. CONCLUSIONS: The findings advance knowledge about public perceptions, reactions and attitudes towards the emergence of ASHUE and the efficacy of disease countermeasures. The knowledge from this study will provide an understanding of why disease prevention measures might not be followed. It can be used to develop public awareness programs in Indonesia about both the ASHUE and its possible consequences and the available healthcare support.

Extending the sociology of candidacy: Bourdieu's relational social class and mid-life women's perceptions of alcohol-related breast cancer risk.

Alcohol is a modifiable breast cancer risk, increasing risk in a dose-dependent manner. Mid-life women (aged 45-64 years) consume alcohol at higher rates than younger women and this, combined with age, make them a high-risk group for breast cancer. This critical public health problem has a seemingly obvious solution (reduce drinking); however, women do not necessarily know alcohol causes breast cancer, and if they do, reducing consumption is not always possible, or desirable. To innovate public health responses, we employ an interpretative sociological framework 'candidacy' to understand women's perspectives on breast cancer risk relative to alcohol consumption and their social class. Drawing on 50 interviews with Australian mid-life women, our findings reveal the socio-structural determinants of 'candidacy', that mean modifying alcohol consumption for breast cancer prevention is impacted by social class. Utilising Bourdieu's relational capitals, our interpretations show how social class shapes women's ascriptions and enactments of breast cancer candidacy. We offer an important theoretical extension to 'candidacy' by demonstrating more or less fluidity in women's assessment of breast cancer risk according to their agency to adopt breast cancer prevention messages. Understanding the social class possibilities and limitations in women's perceptions of breast cancer risk provides a new opportunity to reduce inequities in breast cancer incidence.

Sober Curiosity: A Qualitative Study Exploring Women's Preparedness to Reduce Alcohol by Social Class.

BACKGROUND: Urgent action is required to identify socially acceptable alcohol reduction options for heavy-drinking midlife Australian women. This study represents innovation in public health research to explore how current trends in popular wellness culture toward 'sober curiosity' (i.e., an interest in what reducing alcohol consumption would or could be like) and normalising non-drinking could increase women's preparedness to reduce alcohol consumption. METHODS: Qualitative interviews were undertaken with 27 midlife Australian women (aged 45-64) living in Adelaide, Melbourne and Sydney in different social class groups (working, middle and affluent-class) to explore their perceptions of sober curiosity. RESULTS: Women were unequally distributed across social-classes and accordingly the social-class analysis considered proportionally the volume of data at particular codes. Regardless, social-class patterns in women's preparedness to reduce alcohol consumption were generated through data analysis. Affluent women's preparedness to reduce alcohol consumption stemmed from a desire for self-regulation and to retain control; middle-class women's preparedness to reduce alcohol was part of performing civility and respectability and working-class women's preparedness to reduce alcohol was highly challenging. Options are provided for alcohol reduction targeting the social contexts of consumption (the things that lead midlife women to feel prepared to reduce drinking) according to levels of disadvantage. CONCLUSION: Our findings reinstate the importance of recognising social class in public health disease prevention; validating that socially determined factors which shape daily living also shape health outcomes and this results in inequities for women in the lowest class positions to reduce alcohol and related risks.

Examining social class as it relates to heuristics women use to determine the trustworthiness of information regarding the link between alcohol and breast cancer risk.

BACKGROUND: High rates of alcohol consumption by midlife women, despite the documented risks associated with breast cancer, varies according to social class. However, we know little about how to develop equitable messaging regarding breast cancer prevention that takes into consideration class differences in the receipt and use of such information. OBJECTIVE: To explore the heuristics used by women with different (inequitable) life chances to determine the trustworthiness of information regarding alcohol as a modifiable risk factor for breast cancer risk. METHODS AND MATERIALS: Interviews were conducted with 50 midlife (aged 45-64) women living in South Australia, diversified by self-reported alcohol consumption and social class. Women were asked to describe where they sought health information, how they accessed information specific to breast cancer risk as it relates to alcohol, and how they determined whether (or not) such information was trustworthy. De-identified transcripts were analysed following a three-step progressive method with the aim of identifying how women of varying life chances determine the trustworthiness of alcohol and breast cancer risk information. Three heuristics were used by women: (1) consideration of whose interests are being served; (2) engagement with 'common sense'; and (3) evaluating the credibility of the message and messenger. Embedded within each heuristic are notable class-based distinctions. CONCLUSIONS: More equitable provision of cancer prevention messaging might consider how social class shapes the reception and acceptance of risk information. Class should be considered in the development and tailoring of messages as the trustworthiness of organizations behind public health messaging cannot be assumed.

'I have a healthy relationship with alcohol': Australian midlife women, alcohol consumption and social class.

Alcohol consumption by Australian women during midlife has been increasing. Health promotion efforts to reduce alcohol consumption in order to reduce alcohol-related disease risk compete with the social contexts and value of alcohol in women's lives. This paper draws on 50 qualitative interviews with midlife women (45-64 years of age) from different social classes living in South Australia in order to gain an understanding of how and why women might justify their relationships with alcohol. Social class shaped and characterized the different types of relationships with alcohol available to women, structuring their logic for consuming alcohol and their ability to consider reducing (or 'breaking up with') alcohol. We identified more agentic relationships with alcohol in the narratives of affluent women. We identified a tendency for less control over alcohol-related decisions in the narratives of women with less privileged life chances, suggesting greater challenges in changing drinking patterns. If classed differences are not attended to in health promotion efforts, this might mitigate the effectiveness of alcohol risk messaging to women.

Place of alcohol in the 'wellness toolkits' of midlife women in different social classes: A qualitative study in South Australia.

In this article, we explore how women in different social classes had differential access to resources and services to enhance their 'wellness'-resulting in classed roles in alcohol consumption. We analyse data from a qualitative study on alcohol by midlife women in South Australia and employ the analogy of a 'toolkit' in order to understand the structural patterning of 'wellness tools'. Bourdieu's relational model of class guides our exploration of women's inequitable opportunities for wellness. Higher social class women had 'choices' facilitated by bulging wellness toolkits, such as yoga, exercise and healthy eating regimens-alcohol consumption was not essential to promoting 'wellness' and did not have an important place in their toolkits. Middle-class women had less well-stocked toolkits and consumed alcohol in a 'compensation approach' with other wellness tools. Alcohol consumption received positive recognition and was a legitimised form of enjoyment, fun and socialising, which needed counterbalancing with healthy activities. Working-class women had sparse toolkits-other than alcohol-which was a tool for dealing with life's difficulties. Their focus was less on 'promoting wellness' and more on 'managing challenging circumstances'. Our social class-based analysis is nestled within the sociology of consumption and sociological critiques of the wellness industry.

Revisiting Candidacy: What Might It Offer Cancer Prevention?

The notion of candidacy emerged three decades ago through Davison and colleagues' exploration of people's understanding of the causes of coronary heart disease. Candidacy was a mechanism to estimate one's own or others risk of disease informed by their lay epidemiology. It could predict who would develop illness or explain why someone succumbed to it. Candidacy's predictive ability, however, was fallible, and it was from this perspective that the public's reticence to adhere to prevention messages could be explained, as ultimately anybody could be 'at-risk'. This work continues to resonate in health research, with over 700 citations of Davison's Candidacy paper. Less explored however, is the candidacy framework in its entirety in other illness spheres, where prevention efforts could potentially impact health outcomes. This paper revisits the candidacy framework to reconsider it use within prevention. In doing so, candidacy within coronary heart disease, suicide prevention, diabetes, and cancer will be examined, and key components of candidacy and how people negotiate their candidacy within differing disease contexts will be uncovered. The applicability of candidacy to address modifiable breast cancer risk factors or cancer prevention more broadly will be considered, as will the implications for public health policy.

COVID-19, Alcohol Consumption and Stockpiling Practises in Midlife Women: Repeat Surveys During Lockdown in Australia and the United Kingdom.

Introduction: This project examined the impact of COVID-19 and associated restrictions on alcohol practises (consumption and stockpiling), and perceptions of health risk among women in midlife (those aged 45-64 years). Methods: We collected online survey data from 2,437 midlife women in the United Kingdom (UK) and Australia in May 2020, recruited using a commercial panel, in the early days of mandated COVID-19 related restrictions in both countries. Participants were surveyed again (N = 1,377) in July 2020, at a time when COVID-19 restrictions were beginning to ease. The surveys included the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) and questions alcohol stockpiling. Analysis involved a range of univariate and multivariate techniques examining the impact of demographic variables and negative affect on consumption and acquisition outcomes. Results: In both surveys (May and July), UK women scored higher than Australian women on the AUDIT-C, and residence in the UK was found to independently predict stockpiling of alcohol (RR: 1.51; 95% CI: 1.20, 1.91). Developing depression between surveys (RR: 1.53; 95% CI: 1.14, 2.04) and reporting pessimism (RR: 1.42; 95% CI: 1.11, 1.81), and fear/anxiety (RR: 1.33; 95% CI: 1.05, 1.70) at the beginning of the study period also predicted stockpiling by the end of the lockdown. Having a tertiary education was protective for alcohol stockpiling at each time point (RR: 0.69; 95% CI: 0.54, 0.87). Conclusions: COVID-19 was associated with increases in risky alcohol practises that were predicted by negative emotional responses to the pandemic. Anxiety, pessimism and depression predicted stockpiling behaviour in UK and Australian women despite the many demographic and contextual differences between the two cohorts. Given our findings and the findings of others that mental health issues developed or were exacerbated during lockdown and may continue long after that time, urgent action is required to address a potential future pandemic of alcohol-related harms.

Social Class and Changes in Australian Women's Affect and Alcohol Consumption During COVID-19.

Introduction: Before the pandemic, mid-life women in Australia were among the "heaviest" female alcohol consumers, giving rise to myriad preventable health risks. This paper uses an innovative model of social class within a sample of Australian women to describe changes in affective states and alcohol consumption patterns across two time points during COVID-19. Methods: Survey data were collected from Australian mid-life women (45-64 years) at two time points during COVID-19-May 2020 (N = 1,218) and July 2020 (N = 799). We used a multi-dimensional model for measuring social class across three domains-economic capital (income, property and assets), social capital (social contacts and occupational prestige of those known socially), and cultural capital (level of participation in various cultural activities). Latent class analysis allowed comparisons across social classes to changes in affective states and alcohol consumption patterns reported at the two time points using alcohol consumption patterns as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and its component items. Results: Seven social classes were constructed, characterized by variations in access to capital. Affective states during COVID-19 differed according to social class. Comparing between the survey time points, feeling fearful/anxious was higher in those with high economic and cultural capital and moderate social capital ("emerging affluent"). Increased depression was most prominent in the class characterized by the highest volumes of all forms of capital ("established affluent"). The social class characterized by the least capital ("working class") reported increased prevalence of uncertainty, but less so for feeling fearful or anxious, or depressed. Women's alcohol consumption patterns changed across time during the pandemic. The "new middle" class-a group characterized by high social capital (but contacts with low prestige) and minimal economic capital-had increased AUDIT-C scores. Conclusion: Our data shows the pandemic impacted women's negative affective states, but not in uniform ways according to class. It may explain increases in alcohol consumption among women in the emerging affluent group who experienced increased feelings or fear and anxiety during the pandemic. This nuanced understanding of the vulnerabilities of sub-groups of women, in respect to negative affect and alcohol consumption can inform future pandemic policy responses designed to improve mental health and reduce the problematic use of alcohol. Designing pandemic responses segmented for specific audiences is also aided by our multi-dimensional analysis of social class, which uncovers intricate differences in affective states amongst sub-groups of mid-life women.

How Are the Links between Alcohol Consumption and Breast Cancer Portrayed in Australian Newspapers?: A Paired Thematic and Framing Media Analysis.

A dose-dependent relationship between alcohol consumption and increased breast cancer risk is well established, even at low levels of consumption. Australian women in midlife (45-64 years) are at highest lifetime risk for developing breast cancer but demonstrate low awareness of this link. We explore women's exposure to messages about alcohol and breast cancer in Australian print media in the period 2002-2018. METHODS: Paired thematic and framing analyses were undertaken of Australian print media from three time-defined subsamples: 2002-2004, 2009-2011, and 2016-2018. RESULTS: Five key themes arose from the thematic framing analysis: Ascribing Blame, Individual Responsibility, Cultural Entrenchment, False Equilibrium, and Recognition of Population Impact. The framing analysis showed that the alcohol-breast cancer link was predominantly framed as a behavioural concern, neglecting medical and societal frames. DISCUSSION: We explore the representations of the alcohol and breast cancer risk relationship. We found their portrayal to be conflicting and unbalanced at times and tended to emphasise individual choice and responsibility in modifying health behaviours. We argue that key stakeholders including government, public health, and media should accept shared responsibility for increasing awareness of the alcohol-breast cancer link and invite media advocates to assist with brokering correct public health information.

Alcohol Consumption and Perceptions of Health Risks During COVID-19: A Qualitative Study of Middle-Aged Women in South Australia.

Australian women's alcohol consumption has increased in frequency during COVID-19. Research suggests this is to cope with stress resulting from the pandemic and COVID-19 countermeasures that require social distancing. This is a critical public health concern because increased alcohol consumption, even for a short period, increases the myriad longer-term health risks associated with cumulative exposure to alcohol. This paper provides unique qualitative evidence of how health risk perceptions are re-focused toward the shorter-term during the pandemic, through analysis of interviews with 40 middle-aged Australian women (aged 45-64) representing a range of self-perceived drinking status' ("occasional"/"light"/"moderate"/"heavy") before and then during the pandemic (n = 80 interviews). Our analysis captures women's risk horizons drifting away from the uncertain longer-term during COVID-19, toward the immediate need to "get through" the pandemic. We show how COVID-19 has increased the perceived value of consuming alcohol among women, particularly when weighed up against the social and emotional "costs" of reducing consumption. Our findings have implications for the delivery of alcohol-related health risk messages designed for middle-aged women both during, and into the recovery phases of the pandemic, who already consume more alcohol and experience more alcohol-related health risk than women in other age groups.

Children's physical activity levels during organised sports practices.

OBJECTIVES: This study measured the physical activity levels of children during practice sessions of four popular organised sports in Australia. DESIGN: Cross-sectional observational design. METHODS: Participants comprised children from four local organised sports clubs in suburban Adelaide, South Australia. The sports examined were Australian Rules Football (AFL), girls' netball, boys' soccer and girls' soccer. Each participant wore a waist-mounted GT3X or GT3X+Actigraph accelerometer in either one or two of the practice sessions. RESULTS: Participants typically spent 40-50% of each sport practice session in moderate to vigorous physical activity (MVPA). Participants in the boys' soccer teams spent significantly greater time in MVPA (mean=47% of practice time, 95% CI=37%, 57%) than participants in the girls' netball teams (mean=40%, 95% CI=30%, 50%), participants in the girls' soccer teams (mean=38%, 95% CI=28%, 48%) and participants in the boys' AFL teams (mean=40%, 95% CI=36%, 44%). The practice sessions contributed approximately half of the 60min of MVPA per day recommended by physical activity guidelines for children and young people. CONCLUSIONS: The results suggested that organised sports provide a supportive environment for physical activity accrual; however, one practice session is insufficient for children to reach the amount of MVPA recommended in daily physical activity guidelines.

Ethical use of social media to facilitate qualitative research.

Increasingly, qualitative health researchers might consider using social media to facilitate communication with participants. Ambiguity surrounding the potential risks intrinsic to social media could hinder ethical conduct and discourage use of this innovative method. We used some core principles of traditional human research ethics, that is, respect, integrity, and beneficence, to design our photo elicitation research that explored the social influences of drinking alcohol among 34 underage women in metropolitan South Australia. Facebook aided our communication with participants, including correspondence ranging from recruitment to feeding back results and sharing research data. This article outlines the ethical issues we encountered when using Facebook to interact with participants and provides guidance to researchers planning to incorporate social media as a tool in their qualitative studies. In particular, we raise the issues of privacy and confidentiality as contemporary risks associated with research using social media.

The practise and practice of Bourdieu: the application of social theory to youth alcohol research.

BACKGROUND: Some years ago Australian anthropologist David Moore criticised the predominant form of understanding youth alcohol consumption for residing with biomedical approaches that individualise and ultimately stigmatise drinking behaviour and 'ignore' the social context of consumption. Of interest here is the ongoing insufficient integration of alternative approaches to understanding young people's drinking. METHODS: This paper presents theoretically informed qualitative research that investigates why young Australian females (aged 14-17) drink and how social and cultural context form the basis, rather than the periphery, of their drinking experience. RESULTS: We demonstrate the utility of Pierre Bourdieu's sociological framework for delving beyond the dichotomy of young people's drinking decisions as either a determination of their cultural environment or the singular result of a rational individual's independent decision-making. The paper is presented in two parts. First, we provide the interpretation, or 'practise', of Bourdieu's concepts through an outline and application of his complex theoretical constructs. Specifically, the concept of symbolic capital (or social power) is applied. Second, our explication of Bourdieu's 'practice', or epistemological contributions, offers a methodologically grounded example to other researchers seeking to attain more complete understandings of the social processes underpinning youth alcohol consumption. CONCLUSION: A sociological approach to exploring the complex relationship between drinking and contextual social factors amongst young Australian females is an unchartered area of enquiry. We contribute new theoretically supported insights to create a more complete picture of young females' drinking behaviours.

Strategies for facilitating change in alcohol and other drugs (AOD) professional practice: a systematic review of the effectiveness of reminders and feedback.

In all areas of health research, including the alcohol and other drugs (AOD) field, funds are committed to developing and evaluating research and resources, yet little is invested into helping potential resource users understand, adopt and implement innovations. This study evaluated the effectiveness of two professional practice change interventions (reminders and feedback) that are designed to bridge the 'research-practice gap' by increasing knowledge and changing behaviour of health-care professionals and specialist AOD workers. We conducted a systematic review of general health, AOD and mental health literature (1966 to March 2005). Fourteen existing systematic reviews and 15 primary studies were assessed. Because few studies evaluated the effectiveness of reminders and feedback in the AOD context, evidence is drawn largely from the general health-care literature. Use of reminders and feedback is supported for a range of health behaviours. AOD-specific clinical behaviours that are most likely to be improved with the use of reminders or feedback include pharmacotherapy prescribing, AOD education, screening and counselling and monitoring/management of AOD treatment and/or related problems (e.g. depression). Reminders and feedback are effective strategies to facilitate professional practice change and have potential in the AOD field. However, further well-designed empirical studies are needed to assess fully the effectiveness of these professional practice change strategies in AOD-specific contexts.