Food, eating and taste: parents' perspectives on the making of the middle class teenager.

This paper reports findings from a qualitative study of views and understandings of dietary practices in middle class families. Thirty five parents/main food providers of boys and girls aged 13/14 years, living in Eastern Scotland, were interviewed about their and their teenagers' everyday lives, food, health and family practices. One of our aims was to understand more about the social and cultural conditions which might be promoting more positive dietary health and physical well-being amongst middle class families. Most parents' accounts appeared rooted in a taken-for-grantedness that family members enjoyed good health, lived in relatively secure and unthreatening environments regarding health and resources, and were able to lead active lives, which they valued. Although controlling teenagers' eating practices was presented as an ongoing challenge, active supervision and surveillance of their diets was described, as was guiding tastes in 'the right direction'. Parents described attempts to achieve family eating practices such as commensality, cooking from scratch, and encouraging a varied and nutritional 'adult' diet and cosmopolitan tastes, though work and activities could compromise these. These middle class families might be characterized as having future oriented 'hierarchies of luxury and choice', in which controlling and moulding teenagers' food practices and tastes was assigned a high priority.

Practitioner perspectives on tackling health inequalities: findings from an evaluation of healthy living centres in Scotland.

Little is known about how health practitioners tasked with tackling health inequalities account for their own programmes and actions. This paper attempts to address this gap by drawing on data collected in the course of an evaluation of the Healthy Living Centre (HLC) programme, which was designed to address the wider determinants of health, in particular social exclusion and socioeconomic disadvantage, through targeting services at the most deprived local communities. Six Scottish HLC case studies explored in depth how HLC practitioners conceptualised 'health inequalities' and applied the construct to legitimate their public health and health improvement work. Practitioners drew on multiple explanations of health inequalities, sought to apply holistic approaches to service provision, and developed activities that took account of classed practices intended to overcome class-related disempowerment and stigma. They discussed the challenges of positioning services to appeal to and reach target groups and the difficulties in assessing the impact of their work on reducing health inequalities. Responses to tackling inequalities were variable across time and between HLCs, resulting from uneven learning about target groups and their changing needs, an evolving policy agenda and consideration given to the longer-term sustainability of HLC sites. Although practitioners' work to address health inequalities was limited by the programme's focus on working with disadvantaged groups, findings illustrate how classed practices are linked to the challenges of attracting and successfully engaging with such groups. Practitioner accounts highlighted the importance of gaining acceptance to overcome barriers to engagement with disadvantaged communities, the time required to achieve a satisfactory level of engagement, the proximity of service providers to clients and the adaptability of services necessary to address evolving needs.

Constructing health and sickness in the context of motherhood and paid work.

Changes in the labour market, especially the rise in the employment of women (lone or partnered) with children, alongside an increased policy emphasis on work as a component of active citizenship for men and women, have stimulated the development of research examining the balance between work and home. Although sociologists have long been interested in the interface between the spheres of paid work and domestic life, understandings of the subjective experience of health and illness have tended to keep the domains of family and work separate. This paper addresses the construction of health and illness as operating at the interface between the worlds of work and home. Interviews were conducted with 30 mothers in paid work and having primary school aged children; the study was located in Edinburgh, Scotland. Through an analysis of the interview accounts, this paper examines respondents' experiences and constructions of health, sickness and wellbeing in themselves and in their children. Four areas are discussed: respondents' accounts of the effects of caring and providing on their own health; respondents' accounts of the influence of workplace relationships in the construction of sickness; respondents' accounts of negotiating absence for their children's sickness and how they made sense of and defined child sickness. We argue that managing sickness, itself an anticipated but unpredictable event, gives analytical purchase to understanding the values and practices that characterise the interrelationship between work and family life. The intersections of home and work operate powerfully in respondents' constructions of health and sickness, and the analysis demonstrates how these are played out in everyday life, at home and at work.

Making sense of eating, weight and risk in the early teenage years: views and concerns of parents in poorer socio-economic circumstances.

This paper reports findings from a qualitative study which examined the perceptions and understandings underpinning the dietary practices in families with 'normal' weight and 'overweight' young teenagers living in poorer socio-economic circumstances. Thirty four parents/main food providers of boys and girls aged 13-14 years from socio-economically disadvantaged areas in Eastern Scotland were interviewed. Within the home there was a strong acknowledgement of these early teenagers' own food preferences; parents also saw them as having increasing responsibility for their own food choices outwith the home but these were often described as 'not healthy' choices. However, parents saw dietary issues as of fairly low priority in the hierarchy of health-relevant and other risks facing their teenagers. Equally, these interviewees felt that issues around body shape and size at this age were less potentially problematic than the risks to teenagers' mental or physical health of their becoming obsessed with weight loss. Parents often made sense of their teenager's body size and shape in terms of the variety of body types in families and inherited traits. Interviewees seemed to lack a discourse to understand weight and overweight in this age group, falling back on understandings derived from the adult lifestage.

Young teenagers' perceptions of their own and others' bodies: a qualitative study of obese, overweight and 'normal' weight young people in Scotland.

The rise in numbers of overweight/obese children in the UK is causing widespread concern. Biomedical constructions of body acceptability and 'good health' mean that overweight/obese young people are frequently seen as deviant. The socio-cultural contexts within which young teenagers become fat, and lay conceptualisations of fatness, have largely been ignored. This qualitative study involved in-depth interviews with teenagers aged 13-14 years (n = 36), drawn from families living in areas classified as socio-economically disadvantaged. Half of the sample had a Body Mass Index (BMI) classifying them as overweight or obese, whilst the remainder were classified as being 'normal' weight. Participants' embodied perceptions of fatness were complex and sometimes contradictory. We discuss what young teenagers perceive the influences on fatness and body size to be; the professed consequences of being fat; participants' experiences of attempting to lose weight; and, their reported interactions with friends and family relating to fatness and dieting. Participants rarely mentioned any health-related consequences of their own and others' fatness, although wearing 'nice' clothes and being slowed down were raised as considerations by girls and boys, respectively. 'Normal' weight teenagers who disliked their bodies or who wanted to lose weight often claimed to be anxious about this. Being very obese also led to anxiety and reported attempts at 'crash dieting'. Acceptance of body size/shape was, however, common amongst the overweight and obese teenagers, although some had attempted weight loss. The teenagers in this study were rarely supportive of friends or family who attempted to lose weight and frequently disagreed with others' perceptions of fatness. These findings are important as they contradict the common perception that being overweight/obese is related to body dissatisfaction and that young people have a fear of fatness.

The contextual development of healthy living centres services: an examination of food-related initiatives.

The Healthy Living Centre (HLC) programme was designed to address the wider determinants of health, in particular social exclusion and socio-economic disadvantage, through targeting services at the most deprived local communities. This paper draws on data collected during an in-depth process evaluation of six Scottish HLC case study sites. Food-related services, which were found to cross-cut all the sites, were used to address social exclusion and to promote health. Three types of service, each linked to a social model of health, were found to be in operation: those which enhance skills; those which promote social inclusion; and those which influence food accessibility. The paper illustrates how food-related services have developed in the case study HLCs to take account of the differing needs of the communities and neighbourhoods that have been targeted. Consideration is then given to how HLCs adapt to meet the practicalities of improving health while addressing social exclusion through targeting health inequalities.

Recovering from a heart attack: a qualitative study into lay experiences and the struggle to make lifestyle changes.

BACKGROUND: The adoption of healthy living advice by people with heart disease is known to be poor even in targeted interventions. Reasons for this can range from confusion about the seriousness of the condition to ineffectiveness in the form of advice and how it is conveyed. However, the social setting can be an important influence on lifestyle change. OBJECTIVES: To identify views and experiences of people recovering from myocardial infarction, specifically barriers to, and facilitators of, following advice about lifestyle change and maintenance. METHODS: Focus groups and interviews were undertaken with men and women discharged from hospital two/three years previously. A total of 53 people (35 men and 18 women) took part, recruited via a coronary care unit and patients' GPs. RESULTS: A major finding was participants' desires for long-term monitoring and support. While reported sources, form and content of coronary heart disease advice varied, most participants agreed that long-term follow up or back-up would be helpful, although what this should include and how it should be undertaken was not the same for all participants. This would fulfil needs such as: help in following lifestyle advice; sharing with people with similar experiences; regular contact with medical/health professionals (for confirmation of good heath and to ask questions); providing reassurance to other members of the patients' families. CONCLUSIONS: A long-term programme is needed incorporating mutual support and sharing with regular (not necessarily frequent) input from practitioners of information, advice and reassurance, as a support strategy for lifestyle change.

Contrasting lives, contrasting views? Understandings of health inequalities from children in differing social circumstances.

Children's differing socio-economic, cultural and familial circumstances and experiences are part of the pathways implicated in health and illness in adulthood. However, in the existing, mainly survey based, work children's own voices tend to be absent and adult-defined data about health and illness accumulated. Little is known about the social and cultural processes, in children's very different childhoods, which underpin and ultimately constitute these epidemiological findings. This paper reports findings from a qualitative study examining the socio-economic and cultural contexts of children's lifestyles and the production of inequalities in health, carried out in a large Scottish city. Two rounds of semi-structured interviews, using a range of child-friendly techniques (photographs, drawings, vignettes), were carried out with 35 girls and boys aged 9-12 years living in two contrasting but contiguous areas, one relatively advantaged and one relatively disadvantaged. Thirty of their parents were also interviewed and community profiling and observational work undertaken. Children and parents described often starkly contrasting lives and opportunities, regularly involving material differences. However, children appeared to locate inequalities as much in relationships and social life as in material concerns; in this their direct experiences of relationships and unfairness were central to their making sense of inequality and its impact on health. Although children from both areas highlighted several different inequalities, including those related to material resources, they also spoke of the importance of control over their life world; of care and love particularly from parents; of friendship and acceptance by their peer group. Many children challenged straightforward causal explanations for future ill-health, privileging some explanations, such as psychological or lifestyle factors. The accounts of children from both areas displayed considerable resilience to and downplaying of the effects of both relationship and material inequalities; also showing how familial and personal challenges, such as bullying, divorce, learning difficulties, cut across structurally based differences.

Healthy eating: the views of general practitioners and patients in Scotland.

BACKGROUND: Scotland has one of the poorest health records of all Western countries, and this has been linked to poor diet. A key part of efforts to improve health has been an action plan to improve the Scottish diet. General practice has been identified as an important setting for health promotion and the provision of healthy eating advice. OBJECTIVE: The objective was to investigate the views of general practitioners (GPs) and their patients about healthy eating and the provision of healthy eating advice in general practice. DESIGN: This qualitative research study used semistructured in-depth interviews with 15 general practitioners (8 female and 7 male) and 30 patients (15 married couples in social class 3, 4, or 5 with young children). RESULTS: The study found that health was only one priority in patients' everyday lives and that these patients were also questioning the relevance of healthy eating advice. GPs were divided in their opinions, with greater enthusiasm being displayed by the younger and female doctors. However, despite their differing views, GPs felt that general practice was better suited to specific rather than general health advice. CONCLUSIONS: If programs in general practice to address dietary inequalities are to succeed, both patients' views and GPs' views must be taken into account.