Food references and marketing in popular magazines for children and adolescents in New Zealand. A content analysis

Food marketing is recognized as an important factor influencing children's food preferences and consumption. The purpose of this study was to examine the nature and extent of unhealthy food marketing and non-branded food references in magazines targeted at and popular among children and adolescents 10–17 years in New Zealand. A content analysis was conducted of all food references (branded and non-branded) found in the five magazines with the highest readership among 10–17 year olds, and the three magazines (of which two were already included among the five most popular magazines) targeted to 10–17 year olds. For each of the six magazines one issue per month (n = 72 issues in total) over a one-year period (December 2012–January 2014) was included. All foods referenced were classified into healthy/unhealthy according to the food-based Ministry of Health classification system. Branded food references (30% of total) were more frequent for unhealthy (43%) compared to healthy (25%) foods. Magazines specifically targeted to children and adolescents contained a significantly higher proportion of unhealthy branded food references (72%, n = 51/71) compared to the most popular magazines among children and adolescents (42%, n = 133/317), of which most were targeted to women. ‘Snack items’ such as chocolates and ice creams were marketed most frequently (n = 104; 36%), while ‘vegetables and fruits’ were marketed the least frequently (n = 9; 3%). Direct advertisements accounted for 27% of branded food references and 25% of those featured health or nutrition claims. Both branded and non-branded food references were common within magazines targeted at and popular among children and adolescents, and skewed toward unhealthy foods. This raises concerns about the effectiveness of self-regulation in marketing and emphasizes that government regulations are needed in order to curb children's current potential high exposures to unhealthy food marketing. In addition, magazine editors could take socially responsible editorial positions in regard to healthy eating.

Temporal analysis of tourism research collaboration network

Network analysis is an effective tool for the study of collaboration relationships among researchers. Collaboration networks constructed from previous studies, and their changes over time have been studied. However, the impact of individual researchers in collaboration networks has not been investigated systematically. We introduce a new method of measuring the contribution of researchers to the connectivity of collaboration networks and evaluate the importance of researchers by considering both contribution and productivity. Betweenness centrality is found to be better than degree centrality in terms of reflecting the changes of importance of researchers. Accordingly, a method is further proposed to identify key researchers at certain periods. The performance of the identified researchers demonstrates the effectiveness of the proposed method.

Overcoming data scarcity of Twitter: using tweets as bootstrap with application to autism-related topic content analysis

Notwithstanding recent work which has demonstrated the potential of using Twitter messages for content-specific data mining and analysis, the depth of such analysis is inherently limited by the scarcity of data imposed by the 140 character tweet limit. In this paper we describe a novel approach for targeted knowledge exploration which uses tweet content analysis as a preliminary step. This step is used to bootstrap more sophisticated data collection from directly related but much richer content sources. In particular we demonstrate that valuable information can be collected by following URLs included in tweets. We automatically extract content from the corresponding web pages and treating each web page as a document linked to the original tweet show how a temporal topic model based on a hierarchical Dirichlet process can be used to track the evolution of a complex topic structure of a Twitter community. Using autism-related tweets we demonstrate that our method is capable of capturing a much more meaningful picture of information exchange than user-chosen hashtags.

Should I and Can I?: a mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care

Background
Primary health care (PHC) clinicians have an important role to play in addressing lifestyle risk factors for chronic diseases. However they intervene only rarely, despite the opportunities that arise within their routine clinical practice. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about this for PHC clinicians working outside general practice. The aim of this study was to explore the beliefs and attitudes of PHC clinicians about incorporating lifestyle risk factor management into their routine care and to examine whether these varied according to their self reported level of risk factor management.

Methods
A cross sectional survey was undertaken with PHC clinicians (n = 59) in three community health teams. Clinicians' beliefs and attitudes were also explored through qualitative interviews with a purposeful sample of 22 clinicians from the teams. Mixed methods analysis was used to compare beliefs and attitudes for those with high and low levels of self reported risk factor management.

Results
Role congruence, perceived client acceptability, beliefs about capabilities, perceived effectiveness and clinicians' own lifestyle were key themes related to risk factor management practices. Those reporting high levels of risk factor screening and intervention had different beliefs and attitudes to those PHC clinicians who reported lower levels.

Conclusion
PHC clinicians' level of involvement in risk factor management reflects their beliefs and attitudes about it. This provides insights into ways of intervening to improve the integration of behavioural risk factor management into routine practice.

Shifts in media images of women appearance and social status from 1960 to 2010: a content analysis of beauty advertisements in two Australian magazines

Ageing well and successful ageing have become important themes to describe how older individuals should keep ageing at bay. Products and services aimed at controlling ageing have become associated with ageing well. In this study we aimed to analyse the representation of older women in advertisements specific to appearance and ageing. In particular, we sought to explore how ageing for women was presented in the media over a period 50 years and when advertisements began to use the term 'anti-ageing'. A content analysis of 710 advertisements from two prominent Australian women's magazines, from 1960 to 2010, was conducted. Analyses showed that advertisements provided a narrow range of images representing women's physical appearance. The underlying messages were that ageing is problematic and that it had become unforgivable to show any signs of ageing. Text contained in advertisements for beauty products from the two chosen Australian magazines often gave specific and prescriptive advice to women on ways to avoid losing their youthful appearance. It was concluded that media relay powerful messages to spread and modify cultural beliefs informing individuals of a range of options that propose liberation from the problem of ageing.

Concerns and worries in people living with inflammatory bowel disease (IBD): A mixed methods study.

OBJECTIVE: This mixed-methods study aimed to explore concerns and worries related to living with inflammatory bowel disease (IBD). METHODS: Overall, 294 patients with a clinically established diagnosis of IBD were enrolled in this cross-sectional study. Concerns and worries were measured with one open-ended question. Measures of anxiety and depressive symptoms and disease activity were also administered. A thematic analysis was conducted and thematic map created. Spearman's rho was used to identify univariate correlations between predictors and the main themes. Binary logistic regression was used to test the predictors of the main themes. RESULTS: Despite the majority of study participants being in IBD remission (74%, n=217), all but 11 reported significant IBD-related concerns. Twenty two percent reported symptoms of depression and 41% of anxiety. Four themes were identified: Quality of life (51%); Unpredictability (35%); Symptoms (34%) and Treatments (19%). Males and older people were less concerned about Quality of life (OR=.597, 95% CI: .363-.980 and OR=.980, 95% CI: .965-.995, respectively). Those in remission were less concerned about Symptoms (OR=.510, 95% CI: .281- .926) while those with longer disease duration worried more about the Symptoms (OR=1.035, 95% CI: 1.010-1.061). Males were less concerned about Treatments (OR=.422, 95% CI: .229-.777). CONCLUSION: IBD patients report significant disease-related concerns even when in remission. Further exploration of what predicts patient concerns may help in shaping health-care delivery so that it better addresses patient needs.

Maternity care experiences of Asia ethnic minorities in rural Tasmania, Australia : a mixed methods study

When migrating to Australia Asian women bring with them birthing cultural beliefs and practices, many of which are different from the Australian medical and cultural understanding of reproduction. Such cultural differences may result in conflicts between clients and health care providers especially when the migrants have a poor knowledge of English. The research investigates the maternity care experiences of Asian migrants in Tasmania. The barriers that Asian migrants face in accessing maternity care services and the factors that affect their views towards maternity care were also explored. A mix of quantitative and qualitative methods was employed. Ten women from different ethnic minorities were invited to semi-structured interviews. The qualitative data were analysed using grounded theory. Findings from the interviews were utilized to design a survey questionnaire. Of the 150 survey questionnaires posted, 121 questionnaires were returned. Descriptive statistics and Chi-square tests of independence were used to analyse the quantitative data. Asian migrants followed some traditional practices such as having good rest and eating hot food during the postpartum month. However, they tended to adapt or disregard traditional practices that were no longer applicable in the new environment including the practices of not washing or having a shower. Support is vital for women recovering after childbirth to prevent postnatal depression. Two main barriers migrant women face in accessing health care are language and cultural barriers. Country of origin, partner’s ethnicity, religion and length of stay in Australia are factors that shape the migrants’ views and attitudes towards and experience of maternity care. Providing interpreting services, social support for migrant women and improving the cross-cultural training for healthcare providers are recommended to improve available maternal care services. The factors that affect migrants’ view on maternity care should be taken into account when providing maternity care for Asian migrant women.

Using mixed-methods to investigate student teacher learning outcomes

The Deakin University Faculty of Arts and Education’s Global Experience Program (GEP) aims to “develop the knowledge, cultural sensitivity and skills needed to address diversity within the educational environment” among student teachers (Deakin, 2009). This research aims to investigate the short term student teacher learning outcomes from their participation in the program through their perceptions and real-life international teaching experiences. The data are collected using mixed-methods to get breadth and in-depth insights on learning outcomes. The survey was conducted to investigate student teacher perceptions on their professional and cultural learning using a Likert scale, while an ethnographic case study was intended to reveal the real-life student teachers learning outcomes from their participation in the GEP in Vanuatu.

Splash!: a prospective birth cohort study of the impact of environmental, social and family-level influences on child oral health and obesity related risk factors and outcomes

Background: Dental caries (decay) is the most prevalent disease of childhood. It is often left untreated and can impact negatively on general health, and physical, developmental, social and learning outcomes. Similar to other health issues, the greatest burden of dental caries is seen in those of low socio-economic position. In addition, a number of diet-related risk factors for dental caries are shared risk factors for the development of childhood obesity. These include high and frequent consumption of refined carbohydrates (predominately sugars), and soft drinks and other sweetened beverages, and low intake of (fluoridated) water. The prevalence of childhood obesity is also at a concerning level in most countries and there is an opportunity to determine interventions for addressing both of these largely preventable conditions through sustainable and equitable solutions. This study aims to prospectively examine the impact of drink choices on child obesity risk and oral health status.
Methods/Design: This is a two-stage study using a mixed methods research approach. The first stage involves qualitative interviews of a sub-sample of recruited parents to develop an understanding of the processes involved in drink choice, and inform the development of the Discrete Choice Experiment analysis and the measurement instruments to be used in the second stage. The second stage involves the establishment of a prospective birth cohort of 500 children from disadvantaged communities in rural and regional Victoria, Australia (with and without water fluoridation). This longitudinal design allows measurement of changes in the child’s diet over time, exposure to fluoride sources including water, dental caries progression, and the risk of childhood obesity.
Discussion: This research will provide a unique contribution to integrated health, education and social policy and program directions, by providing clearer policy relevant evidence on strategies to counter social and environmental factors which predispose infants and children to poor health, wellbeing and social outcomes; and evidence-based strategies to promote health and prevent disease through the adoption of healthier lifestyles and diet. Further, given the absence of evidence on the processes and effectiveness of contemporary policy implementation, such as community water fluoridation in rural and regional communities it’s approach and findings will be extremely
informative.

State of multilevel research perspective in the information systems discipline

Existing distinctions among macro and micro approaches have been jeopardising the advances of Information Systems (IS) research. Both approaches have been criticized for explaining one level while neglecting the other; thereby, the current situation necessitates the application of multilevel research for revealing the deficiencies. Instead of studying single level (macro or micro), multilevel research entails more than one level of conceptualization and analysis, simultaneously. As the notion of multilevel is borrowed from reference disciplines, there tends to be confusions and inconsistencies within the IS discipline, which hinders the adoption of multilevel research. This paper speaks for the potential value of multilevel research, by investigating the current application status of multilevel research within the IS domain. A content analysis of multilevel research articles from major IS conferences and journals is presented. Analysis results suggest that IS scholars have applied multilevel research to produce high quality work ranging from a variety of topics. However, researchers have not yet been consistently defining “multilevel”, leading to idiosyncratic meanings of multilevel research, most often, in authors’ own interpretations. We argue that a rigorous definition of “multilevel research” needs to be explicated for consistencies in research community.

Gender differences in recreational and transport cycling : a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints

Background
Gender differences in cycling are well-documented. However, most analyses of gender differences make broad comparisons, with few studies modeling male and female cycling patterns separately for recreational and transport cycling. This modeling is important, in order to improve our efforts to promote cycling to women and men in countries like Australia with low rates of transport cycling. The main aim of this study was to examine gender differences in cycling patterns and in motivators and constraints to cycling, separately for recreational and transport cycling.

Methods
Adult members of a Queensland, Australia, community bicycling organization completed an online survey about their cycling patterns; cycling purposes; and personal, social and perceived environmental motivators and constraints (47% response rate). Closed and open-end questions were completed. Using the quantitative data, multivariable linear, logistic and ordinal regression models were used to examine associations between gender and cycling patterns, motivators and constraints. The qualitative data were thematically analyzed to expand upon the quantitative findings.

Results
In this sample of 1862 bicyclists, men were more likely than women to cycle for recreation and for transport, and they cycled for longer. Most transport cycling was for commuting, with men more likely than women to commute by bicycle. Men were more likely to cycle on-road, and women off-road. However, most men and women did not prefer to cycle on-road without designed bicycle lanes, and qualitative data indicated a strong preference by men and women for bicycle-only off-road paths. Both genders reported personal factors (health and enjoyment related) as motivators for cycling, although women were more likely to agree that other personal, social and environmental factors were also motivating. The main constraints for both genders and both cycling purposes were perceived environmental factors related to traffic conditions, motorist aggression and safety. Women, however, reported more constraints, and were more likely to report as constraints other environmental factors and personal factors.

Conclusion
Differences found in men’s and women’s cycling patterns, motivators and constraints should be considered in efforts to promote cycling, particularly in efforts to increase cycling for transport.

Smokers and ex-smokers reaction to anti-smoking advertising : a mixed methods approach

Anti-smoking advertising is a central component of modern public health policy. Nevertheless, some smokers have reported that viewing anti-smoking advertising provokes intense nicotine craving. Anti-smoking advertising frequently features images of cigarettes and of individuals smoking. However, research indicates that images of tobacco paraphernalia may induce cravings in individuals addicted to nicotine. The effects of the presence of smoking cues in anti-smoking advertising were considered in the present study. Smokers and ex-smokers (N=63) were randomly assigned to view an anti-smoking advertisement or to complete a control task. Urge to smoke was measured pre- and post-test. Qualitative responses to anti-smoking advertising were also elicited from all participants in the intervention groups. According to both qualitative and quantitative data analyses viewing anti-smoking advertising, even with images of smoking related paraphernalia, led to decreases in craving amongst smokers. Ex-smokers experienced no change in quantitatively measured craving after viewing anti-smoking advertising. These findings are inconsistent with findings from studies using neutral or positive smoking cues. Qualitative data shows that no smokers or ex-smokers who viewed anti-smoking advertising reported an increase in tobacco craving as a result of viewing the campaign. Implications of these findings for future research and anti-smoking campaigns are discussed.

You kind of want to fix it don’t you? Exploring general practice trainees’ experiences of managing patients with medically unexplained symptoms

Background
Much of a General Practitioner’s (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees’ clinical and educational experiences of managing people presenting with MUS.
Method
A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach.


Results

Eighty questionnaires out of 120 (67 %) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient.
Conclusion
Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.

The usefulness of the distress thermometer in the management of cancer patients: a mixed methods approach

Objective: The aim of this study was to investigate the usefulness of the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List in identifying distress levels and psychosocial concerns over the cancer trajectory using a mixed-methods approach.
Method: Eighty-five cancer patients from the Barwon South West region of Victoria participated in this study by completing the NCCN Distress Thermometer and Problem List over three time periods. Three case studies were also conducted to add a qualitative dimension.
Results: Emotional concerns decreased as psychological distress levels decreased and a high level of physical concerns were consistent with a high level of psychological distress. Cancer patients’ narrative accounts also supported
the usefulness of the NCCN Distress Thermometer and Problem List as a screening tool.
Conclusions: Findings are discussed with reference to implications for psychological/emotional support of cancer patients, the provision of supportive care services and directions for future research.