Browse
Recent Submissions
- ItemEvaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial(BioMed Central, 2009-06-28) Wall, Martin; Hayes, Richard; Moore, Derek; Petticrew, Mark; Clow, Angela; Schmidt, Elena; Draper, Alizon; Lock, Karen; Lynch, Rebecca; Renton, AdrianBackground: In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach. The Well London project financed by the Big Lottery 'Wellbeing' Fund and implemented by a consortium of London based agencies led by the Greater London Authority and the London Health Commission is implementing a set of complex interventions across 20 deprived areas of London. The interventions focus on healthy eating, healthy physical activity and mental health and wellbeing and are designed and executed with community participation complementing existing facilities and services. Methods/Design: The programme will be evaluated through a cluster randomised controlled trial. Forty areas across London were chosen based on deprivation scores. Areas were characterised by high proportion of Black and Minority Ethnic residents, worklessness, ill-health and poor physical environments. Twenty areas were randomly assigned to the intervention arm of Well London project and twenty 'matched' areas assigned as controls. Measures of physical activity, diet and mental health are collected at start and end of the project and compared to assess impact. The quantitative element will be complemented by a longitudinal qualitative study elucidating pathways of influence between intervention activities and health outcomes. A related element of the study investigates the health-related aspects of the structural and ecological characteristics of the project areas. The project 'process' will also be evaluated. Discussion: The size of the project and the fact that the interventions are 'complex' in the sense that firstly, there are a number of interacting components with a wide range of groups and organisational levels targeted by the intervention, and secondly, a degree of flexibility or tailoring of the intervention, makes this trial potentially very useful in providing evidence of the types of activities that can be used to address chronic health problems in communities suffering from multiple deprivation. Trial Registration: Current Controlled Trials ISRCTN68175121
- ItemTauiwi general practitioners explanations of Maori health: Colonial relations in primary healthcare in Aotearoa/New Zealand?(Sage, 2002-09) McCreanor, Tim; Nairn, RaymondThis paper reports initial findings from qualitative research investigating how general practitioners talk about Maori health. Transcripts of semi-structured interviews with 25 general practitioners from urban Auckland were subjected to critical discursive analyses. Through this process of intensive, analytic reading, interpretative repertoires – patterns of words and images about a particular topic – were identified. This paper presents the main features of one such repertoire, termed Maori Morbidity, that the general practitioners used in accounting for poor Maori health status. Our participants were drawing upon a circumscribed pool of ideas and explaining the inequalities in health between Maori and Tauiwi in ways that gave primacy to characteristics of Maori and their culture. We discuss the implications of this conclusion for relations between Maori patients and Tauiwi doctors in primary healthcare settings.
- ItemMedia, racism and public health psychology(Sage, 2006-03) Nairn, Raymond; Pega, Frank; McCreanor, Tim; Rankine, Jenny; Barnes, AngelaA growing literature has established that racism contributes to ill-health of migrants, minority group members and indigenous peoples. Racial discrimination has been shown to act at personal, institutional and societal levels, negatively affecting physical health as evidenced by heart disease and other stress related conditions and generally negating wellbeing, signalled by psychological and psychiatric disorders including depression. In our highly mediatized world, mass communications in diverse forms are decisive for people’s knowledge and understandings of the world and their place in it. From critical studies we know that the media consistently marginalize, denigrate and neglect particular ethnic and cultural groups. Where media do focus on such groups much of the reporting is negative and stereotyping. Achievements are ignored or minimized while representations of those groups as problems for and threats to the dominant are highlighted. In this paper we consider the particular case of media representations of the indigenous Maori of Aotearoa New Zealand. We review extant studies to argue that detailed and systematic study is necessary for the development of critical, local media scholarship. Such scholarship is necessary if the current media impact on Maori health and wellbeing is to be mitigated. While such considerations may not have been traditional concerns of health psychology we, following George Albee (2003), argue for them as affirming the need for critical public health psychology.
- ItemCreating intoxigenic environments: Marketing alcohol to young people in Aotearoa New Zealand(Elsevier, 2008-09) McCreanor, Tim; Moewaka Barnes, Helen; Kaiwai, Hector; Borell, Suaree; Gregory, AmandaAlcohol consumption among young people in New Zealand is on the rise. Given the broad array of acute and chronic harms that arise from this trend, it is a major cause for alarm and it is imperative that we improve our knowledge of key drivers of youth drinking. Changes wrought by the neoliberal political climate of deregulation that characterised the last two decades in many countries including Aotearoa New Zealand have transformed the availability of alcohol to young people. Commercial development of youth alcohol markets has seen the emergence of new environments, cultures and practices around drinking and intoxication but the ways in which these changes are interpreted and taken up is not well understood. This paper reports findings from a qualitative research project investigating the meaning-making practices of young people in New Zealand in response to alcohol marketing. Research data included group interviews with a range of Maori and Pakeha young people at three time periods. Thematic analyses of the youth data on usages of marketing materials indicate naturalisation of tropes of alcohol intoxication. We show how marketing is used and enjoyed in youth discourses creating and maintaining what we refer to as intoxigenic social environments. The implications are considered in light of the growing exposure of young people to alcohol marketing in a discussion of strategies to manage and mitigate its impacts on behaviour and consumption.
- ItemConsuming identities: alcohol marketing and the commodification of youth experience(Informa Healthcare, 2005-12) McCreanor, Tim; Moewaka Barnes, Helen; Gregory, Mandi; Kaiwai, Hector; Borell, SuareeMarketing has successfully used the postmodern turn in conceptualisations of the human subject and incorporated contemporary theorising of identities and self into its understanding of the key drivers of consumption. Such developments clearly converge in alcohol marketing practices that target young people where commercialized youth identities available for consumption and engagement are a significant element. This paper reports data from young people that reflect the uptake of such identities and considers the challenges that these developments represent for public health and the wellbeing of young people.
- ItemResiliency, Connectivity and Environments: Their roles in theorizing approaches to the promoting the wellbeing of young people(Clifford Beers Foundation, 2004-02) McCreanor, Tim; Watson, PeterEarly theory and findings in the area of resilience among young people emphasised individual differences and personality characteristics to explain different reactions to stress and risk. The ‘modern’ resiliency literature views the possible explanatory variables for different outcomes in broader contexts such as family, schools and community. Despite this change over time the individualising, problem focused orientation of resilience approaches continues to obscure the environment, leaving it an under-interrogated factor in youth wellbeing. The importance of this rests on its impact on policy and practice in the fields of youth development and health promotion. In this paper we argue that contemporary resiliency theory and research continue to fall short of the paradigm shift called for by those orienting to environmentally-based public health measures to improve population level wellbeing among young people.
- ItemYouth identity formation and contemporary alcohol marketing(Taylor and Francis, 2005-09) McCreanor, Timothy; Greenaway, Alison; Moewaka Barnes, Helen; Borell, Suraee; Gregory, AmandaThis paper considers linkages between contemporary marketing theory and practice, and emerging conceptualizations of identity, to discuss implications for public health concerns over alcohol use among young people. Particular attention is paid to the theorizing of consumption as a component of youth identities and the ways in which developments of marketing praxis orients to such schemata. The authors’ analyses of exemplars of marketing materials in use in Aotearoa New Zealand, drawn from their research archive, emphasize the sophistication and power of such forms of marketing.They argue that public health policy and practice must respond to the interweaving of marketing and the self-making practices of young people to counter this complex threat to the health and well-being of young people.
- ItemMaori family culture: a context of youth development in Counties/Manukau(Royal Society of New Zealand, 2007) Edwards, Shane; McCreanor, Tim; Moewaka Barnes, HelenThis paper reports on a study designed to bring the voices of young people directly into the social science literature on environmental influences on wellbeing. We analyse accounts from young Maori about their families and the roles they play in their lives in order to focus on strengths and positive resources for the promotion of youth wellbeing. Interview data were gathered from 12 females and 15 males, aged between 12 and 25 years, resident in the Counties/Manukau region. Participants who were managing satisfactorily in their lives were purposively selected for diversity of background and circumstances. Our “lifestory” approach sought narrative accounts of both everyday experience and the highs and lows of life; data were transcribed verbatim and analysed using discursive methods. Clusters of themes relating to family environments including relationships with parents, siblings and extended kin groups emerged. Participants provided detailed and nuanced accounts of family cultures, reporting on conflict, caring, gender issues, sensitivity, discipline, levels of guidance and forms of support.
- ItemTowards promoting youth mental health in Aotearoa/New Zealand: Holistic "houses" of health(Clifford Beers Foundation, 2002-05) Anae, Melanie; Moewaka Barnes, Helen; McCreanor, Tim; Watson, PeterA study of the literature on mental health promotion suggests that to a far greater extent than ‘physical’ health concerns, mental health seems to be dominated by the illness focus of established clinical perspectives and practices. In Aotearoa/New Zealand this leaves little in the way of conceptual space or fiscal resources for the development of new preventative possibilities of population-oriented measures focussed on enhancing social and physical environments. Outflanking this unfortunate impasse, indigenous Maori and Samoan (Pacific) conceptual frameworks for health offer holistic theoretical foundations upon which we can work for health through positive development. This paper examines these frameworks and the youth development paradigm to draw out parameters of what might count as healthy youth development in this country.
