Background Although global drinking rates are declining, this trend is less evident among women, with LGBTQ+ women and nonbinary people at elevated risk for hazardous drinking. In addition to minority stress (e.g., stigma, discrimination), drinking culture and social norms likely shape alcohol use within these groups, yet remain underexplored as potential intervention points. Objective This study was part of a larger multi-country project on alcohol use among LGBTQ+ women and nonbinary individuals. Because online resources have been found to appeal to stigmatized groups, we aimed to examine LGBTQ+ women’s and nonbinary people’s experiences with alcohol use in Aotearoa New Zealand, identify barriers and facilitators to reducing drinking, and explore their views on features of online interventions that may be acceptable and effective. Design &; Methods From July to October 2024, we conducted a web-based study using survey methods with LGBTQ+ women and nonbinary participants in Aotearoa New Zealand who drank alcohol at least once a week on average in the past six months. Results Participants (N = 108; ages 18–69, M = 34, SD = 13) primarily identified as cisgender women (88%), lesbian (60%), and New Zealand European (56.5%). Many had attempted to cut back on their alcohol use, motivated primarily by health, harm reduction, and cost. Support for reducing alcohol consumption included social support, social alternatives to bars and clubs, and No or Lo alcohol beverage options. Open text responses suggested that online interventions were seen as potentially valuable if they focused on health and wellness rather than pathology and abstinence. Conclusion Affirming health-focused online interventions tailored for LGBTQ+ women and nonbinary people in New Zealand that center sober-curious empowerment, may help reduce harmful alcohol use.

Suicide is the third leading cause of death among young people globally, and Indigenous populations experience higher suicide rates than non-Indigenous populations. In many jurisdictions, suspected suicides are investigated through coronial services established by governments as part of colonisation, and these services often fail to foster positive engagement with Indigenous families. This research took place in Aotearoa New Zealand and was guided by a Kaupapa Ma & strns;ori framework. It explored coroners' experiences and views of working with bereaved wha & strns;nau (Ma & strns;ori families) during investigations of suspected rangatahi (young Ma & strns;ori) suicides. Eleven coroners and one associate coroner (4 male, 8 female) participated in in-depth interviews, which were audio-recorded and transcribed verbatim. We undertook a reflexive thematic analysis of the transcripts and developed three themes that captured coroners' experiences, namely: (1) systemic issues in family exclusion from coronial processes; (2) wha & strns;nau factors within broader social structures; and (3) facilitating wha & strns;nau engagement through making use of leeway in the system. Coroners highlighted a number of barriers to engagement that could be addressed within the system, including poor communication, lengthy delays, lack of resourcing, and lack of time. However, they also noted that much broader structural change was required to enable wha & strns;nau to trust, and to feel valued and respected, in coronial investigations. Such findings may help inform the development of more inclusive coronial systems that engage respectfully with wha & strns;nau, and in turn, could contribute to more effective suicide prevention and postvention initiatives.

Increasingly companies use social media influencers to market unhealthy products to young people, although we know little about the influencers young people follow and the content influencers post. This study aimed to identify influencers young people follow, examine their exposure to harmful commodity content in influencer accounts, and examine the Instagram accounts of the most popular influencers for harmful commodity content and marketing. In Stage 1, 807 young people (aged 16-20 years, M = 17.1; 58% female, 33% male, 6% gender diverse, 3% did not say) completed a survey on social media use; recalled their exposure to alcohol, tobacco, and vape content and marketing within posts of influencers they follow; and named three favourite influencers. Among respondents who followed influencers (n = 665; 82.4%), 56% reported seeing influencer posts containing vapes (n = 347/620) and 23% vape marketing (n = 137/604); 47% reported seeing posts containing tobacco (n = 291/616) and 13% tobacco marketing (n = 78/604); and 76% reported seeing posts containing alcohol (n = 472/622) and 43% alcohol marketing (n = 260/602). Under-age respondents (16-17 years) reported seeing more tobacco marketing than older respondents (18-20 years). In Stage 2, researchers collected all Instagram posts of the 18 most frequently named influencers for 2 months and ephemeral 'stories' for 2 weeks. These posts/stories were analysed for harmful commodity content and marketing. Twelve influencers posted content with harmful commodities, primarily alcohol (117 posts, 6% of posts) but also vape and tobacco products (14 posts, 1% of posts). We need platform transparency and stronger policy to protect young people from harmful commodity marketing within influencers' accounts.

INTRODUCTION:For many women in Western countries, alcohol is associated with pleasure, sociability and coping, but also health risks. Drawing on postfeminist healthism concepts, this research explored how women at midlife perform health and well-being around drinking alcohol. METHODS:Eight friendship groups and 17 individual interviews were conducted with 50 women (35-59 years) in Aotearoa New Zealand about alcohol and drinking. Transcripts were analysed using discourse analysis. RESULTS:The women drew on discourses underpinned by healthism and postfeminist imperatives, including taking individual responsibility for health and viewing themselves as a 'psychologised self', to make sense of-and justify-drinking. These discourses enabled three 'drinker' subject positions for the women: (1) self-monitoring, controlled drinker; (2) self-investing, heavier drinker; and (3) self-aware drinker. The women were impelled to be continually reflexive and self-surveillant, to enact wellness practices, and to constantly monitor their alcohol consumption in performing postfeminist ideals. CONCLUSION:Industry and policy notions of 'responsible drinking' portray drinking as a potentially healthy activity. Action is needed to change women's environments to support reduced alcohol consumption, including reducing alcohol's social embeddedness and addressing activities that promote women's drinking and normalise alcohol consumption. A multi-faceted gendered lens on policy development and implementation is essential.

Alcohol consumption remains a major societal problem, contributing to myriad health conditions. Australian midlife women (aged 45-64 years) consume more alcohol than previous generations of midlife women and more than younger women now. Alcohol poses health risks that are unique to midlife women, including increased risk of breast cancer; 10% of breast cancers result from alcohol consumption and there is no "safe" limit. There is a global gap in knowledge about socially and culturally appropriate interventions for reducing alcohol consumption in these heavy-drinking groups of midlife women. The research questions (RQs) driving the study are as follows: RQ1-what are the shared social practices that constitute and connect alcohol consumption in each of the 4 case study groups of midlife women? RQ2-what are the perceptions of women in the case study groups about the "invisible hands" shaping alcohol consumption in their social worlds? RQ3-what are the possible "systems-level" interventions or strategies to counter or oppose the "invisible hands" impacting women's alcohol consumption? and RQ4-what is the validity, fidelity, and effectiveness of codeveloped critical consciousness interventions on alcohol-related social practices and consumption patterns? Our study will identify and implement ways to support the following groups of heavy-drinking midlife women to reduce their alcohol consumption (and their breast cancer risk): (1) women living in regional areas of Australia; (2) lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender identity women; (3) women living in poverty; and (4) women working in the corporate sector. An expert group of midlife women, termed a women's thought collective (WTC), will guide all stages of the study. Stage 1 (0-18 months) will collect qualitative data using social media analysis, netnography, photo elicitation, and ethnography to understand the forces oppressing women and shaping their alcohol consumption. We will recruit 50 participants in each of the case study groups. Stage 2 (19-24 months) will involve deliberative dialogue methods with the case study groups (15 participants per group) to identify policy-level changes required to support the reduction in participants' drinking. Stage 3 (25-36 months) will codevelop alcohol reduction interventions using critical consciousness development and then implement them using a quasi-experimental design. Primary outcomes are readiness to reduce alcohol and actual changes in consumption levels. This protocol was funded by the Australian Research Council (DP250104494) for 3 years, starting in July 2025. Human research ethics committee approval has been granted (0457). Expected outcomes include community actions and policy levers for alcohol reduction, addressing the intersecting sociocultural, political, and commercial factors shaping alcohol use among midlife women. The findings will help inform strategies to counter oppressive forces or transform them into sources of hope, encouraging new practices that challenge social norms. PRR1-10.2196/72628.

Compared with other age groups, adults at midlife consume alcohol at relatively high levels. Alcohol has been linked to a number of long-term health risks, including cancer, although awareness of cancer risk is low. The current study aimed to examine how adults at midlife talk about, understand and consider alcohol-related cancer risks within their life contexts. Individual interviews were undertaken with 37 adults (41-64 years; 28 female, 9 male) about their alcohol consumption, views on the health risks of drinking, and understandings of the alcohol-cancer association. Interviews were transcribed verbatim, coded and subjected to a discursive analysis. Participants constructed their drinking as low-risk because it was controlled, responsible, and moderate. They used discursive strategies to undermine the evidence on the cancer risks of alcohol by contrasting it with (stronger) evidence for tobacco risk, drawing on personal accounts of exceptional cases, and displaying 'risk fatigue' because alcohol was just one of many carcinogens they navigate in daily life. The pleasure they derived from alcohol outweighed cancer risks. Cancer risk evidence was itself constructed as risky because people with cancer could be blamed for their disease. These findings show that public health messages about alcohol and cancer risk need to incorporate people's own sense-making about alcohol and risk within their lives, including notions of pleasure. Unintended consequences of current messaging include short-term risks (to health and wellbeing) and moral risks (potential for people to be blamed for cancer) and therefore may be ignored or resisted by target populations.

aim: Patient barriers to accessing hospice and palliative care (PC) have been well studied. Important, yet less investigated, is how cancer patients whose hospice referrals were not accepted are being cared for. This article aims to understand the referral process from PC providers’ perspectives and the implications of the current palliative system for patients, families and health professionals. methods: We conducted interviews with 28 healthcare professionals via Zoom. Participants worked in specialist and primary PC settings, such as hospices and aged residential care, and were based in seven Aotearoa New Zealand regions. We thematically analysed the interview transcripts. results: We identified four themes: the state of the PC system; communication issues; unmet needs and inequities; and managing care within the current system. conclusion: The limited funding for PC and other health services is resulting in a decrease in PC services. The specialist–primary model of end-of-life supportive care in New Zealand is undermined by under-funding. The implications for cancer patients, their families/whānau and their healthcare professionals are moves towards a more biomedical model of PC, a reduction in training and unsustainable workarounds to manage care within the under-resourced system. Considering the ageing population, urgent action is needed.

Health psychology is concerned with applying psychological knowledge to all aspects of physical health and illness. Traditionally dominated by positivist approaches, in recent years critical perspectives have been increasingly employed. These focus on understandings of health and illness as socially, culturally, politically and historically situated and contributing to enhanced health and well-being. Critical health psychology approaches are sensitive to issues of power and benefit from theoretical and methodological pluralism. Key areas in critical health psychology include exploring people's experiences of health and illness; working with people in marginalised or vulnerable groups to provide insights; achieving change and social justice in communities through interventions and activism; engaging with arts-based approaches to researching health and illness; examining how health is understood in everyday life; and highlighting how the physical, psychosocial and economic environments in which we live dramatically influence our health.

Across their lifetimes, women at midlife have experienced shifts in idealised femininities and permissive alcohol environments. Rising drinking rates in midlife women have gained media attention and are often framed as a societal and public health issue. This research explored how women construct and position drinking and alcohol within their lives. Eight friendship groups and 17 individual interviews were conducted with 50 women (35–59 years) in Aotearoa New Zealand about alcohol and drinking. Transcripts were analysed using feminist Foucauldian-informed discourse analysis. The women constructed drinking alcohol as enhancing pleasure and happiness (within reason), facilitating care and fun in relationships, and enabling the performance of midlife roles and responsibilities. Simultaneously, the women positioned their drinking in line with gendered expectations of being controlled, mindful, and in accordance with social, parental, and economic success. These findings demonstrate an underlying postfeminist sensibility that shapes notions of living a good feminine life and creates imperatives for women at midlife. The neoliberal logics of seeking—and taking individual responsibility to achieve—pleasure, happiness, health, and self-care through consumption (including drinking) are salient. However, this reinforces women's work and care responsibilities and deflects attention from the structures that maintain unequal gendered roles.

AimAlcohol promotions in conventional channels are associated with subsequent alcohol consumption in young people, but little is known about young people's exposure to digital alcohol marketing. This exploratory study investigated young people's exposure to, and engagement with, alcohol marketing on social media platforms, variations across sociodemographic groups and associations with alcohol-related behaviors.MethodAn online survey was conducted with 3698 participants aged between 14 and 20 years (M = 17.1; SD = 1.8) in New Zealand. The survey asked about social media use and exposure to and engagement with alcohol product marketing on their preferred platforms, alcohol consumption patterns, hazardous drinking (AUDIT-C scores) and purchasing alcohol online.ResultsNearly three-quarters of the sample who responded to questions about exposure to alcohol marketing (70.6%; n = 1541) reported seeing marketing on at least one social media platform, with older respondents (18-20 years) more likely to report exposure than younger respondents (14-17 years); no differences were found across gender, ethnicity or socioeconomic groups. Over one-third of those who responded to questions about engagement (40.7%; n = 850) reported engaging with alcohol marketing and this varied by age, gender and ethnicity. Recall of exposure to alcohol marketing was less strongly associated with online purchase and having ever drunk alcohol than was engagement with alcohol marketing, which was also associated with hazardous drinking.ConclusionsEngagement with alcohol marketing was more strongly related to alcohol behaviors, including online purchasing, having ever drunk alcohol, and drinking at hazardous levels, than exposure. These findings also demonstrated inequitable patterns of engagement with alcohol marketing on social media associated with these novel algorithmic marketing methods.

aims: Little is known about the exposure of young people in Aotearoa New Zealand to marketing of vape products on social media. This study investigated vaping behaviour and the extent of vape marketing exposure and engagement that young people (14–20 years) report on social media and examined differences across socio-demographic groups. methods: An online survey was conducted with 3,698 participants aged between 14–20 years (M=17.1; SD=1.8). A range of genders (55.7% females, 38.3% males and 6% another gender), ethnicities (25.6% Māori, 46.7% Pākehā or NZ European, 6.5% Pasifika and 21.2% another ethnicity) and social classes took part. results: Half (50.8%; n=1,110) of the respondents (N=2,185) reported that they had vaped at least once; vaping history was positively related to exposure to and engagement with digital vape marketing. Half (50.3%; n=1,119) of the respondents (N=2,224) reported seeing vape marketing on at least one social media platform. Binary logistic regressions showed that younger respondents were more likely to report seeing vape marketing than older respondents, and Māori and Pasifika more likely than other ethnicities. Over a quarter (26%; n=563) of respondents (N=2,148) reported engaging with vape marketing online, with Māori and Pasifika respondents more likely to engage than other ethnicity groups, and similarly for respondents of lower compared to higher socio-economic status. No interaction effects were found. conclusions: Many young people, including a subset under the legal age for purchase, reported seeing vape product marketing on social media platforms. Patterns of exposure to vape product marketing on social media mirror the inequitable marketing exposure of harmful commodities in physical environments. Improved transparency and regulation of social media marketing is required.

Traditionally, males have been more involved in community sports, and they also consume alcohol at higher rates compared to other genders in Aotearoa NZ. The present study drew on notions of gender and hegemonic masculinity to explore people's experiences of sports clubs, alcohol and masculinity. In-depth individual interviews were undertaken with 12 participants (10 males, 2 females, aged 23–56), who belonged to a range of sports clubs. Following transcription, the data were analysed thematically, and three key themes were identified: (1) pervasiveness: alcohol is everywhere; (2) masculine behaviours dominate; (3) feeling alienated. Findings reinforce how hegemonic masculinity and alcohol consumption remain pervasive within many community sports settings. This impacts on feelings of belonging and views on what constitutes appropriate behaviours. Those who do not belong to the dominant group, or conform to the status quo, are subordinated and formal hierarchies continue to favour dominant groups. Harmful behaviours linked with hegemonic masculinity were also exacerbated by alcohol consumption. Findings are considered in terms of how to change power dynamics and drinking practices perpetuated by hegemonic masculine norms to promote a more inclusive and safer space for all members of community sports clubs.

BackgroundSexual and gender minority people have been found to drink more heavily than heterosexual and cisgender populations. Alcohol companies target rainbow communities by promoting alcoholic products through various promotional strategies. The current study examined the discourses that alcohol companies employed in their publicly available material when discussing LGBTQ+ people and rainbow communities.MethodsEight online websites containing alcohol and marketing content were identified. Across these websites, 4,353 alcohol-related documents were published from 2017-2023. We searched within these documents for texts that were freely available and included terms related to LGBTQ+ populations, leading to 53 texts that were downloaded and analysed using discourse analysis.ResultsAlcohol companies used three primary discourses when outlining their engagement with LGBTQ+ communities, namely 'exceptional support and pioneering philanthropy', 'genuine allyship' and 'shared values'. These discourses functioned to enable companies to overcome seemingly contradictory constructions of being authentic and genuine allies, while also being profitable businesses that are building their market share and profits.ConclusionsThe alcohol industry deflects accusations of rainbow-washing through discursive constructions that highlight their genuine and committed dedication to rainbow communities. These normalise alcohol within these communities, and function to enhance and promote alcohol brands while obscuring their negative consequences.

IssuesAlcohol marketing on social media platforms is pervasive and effective, reaching wide audiences and allowing interaction with users. We know little about the gendered nature of digital alcohol marketing, including how women and men are portrayed, how different genders respond and implications for gender relations. This review aimed to identify how males, females and other genders are targeted and represented in digital alcohol marketing, and how they are encouraged to engage with digital alcohol marketing content.ApproachA narrative synthesis approach was employed. Academic literature and research reports were searched for studies on digital alcohol marketing published within the previous 10 years with a range of methods and designs. We reviewed the studies, extracted data relevant to gender and synthesised findings thematically.Key FindingsThe review included 17 articles and 7 reports with a range of designs and methods, including content analyses of digital material, interviews, focus groups and surveys. Our analysis identified three conceptual themes that captured many of the gendered results, namely: (i) leveraging a diversity of idealised femininities; (ii) amplifying hegemonic masculinity; and (iii) infiltrating everyday gendered life.Implications and ConclusionAlcohol marketing on social media is highly gendered and is designed to embed itself into everyday life in agile ways that reinforce traditional and evolving gendered stereotypes, activities, lifestyles and roles. Gendered engagement strategies are widely used to link alcohol to everyday gendered activities and identities to encourage alcohol purchase and consumption. This marketing normalises alcohol consumption and reproduces harmful gender norms and stereotypes.

Introduction: Women at midlife have increased rates of harmful drinking in many high-income countries. This cohort grew up within permissive alcohol environments that encouraged women's consumption, linking it to success, femininity, and empowerment. This research drew on notions of 'structures of feeling' and 'affective atmospheres' to explore how women at midlife describe and make sense of alcohol and drinking within their lives. Methods: Eight friendship discussion groups and 17 individual interviews were conducted with 50 women (aged 35-59 years) in Aotearoa/New Zealand about alcohol and drinking. Transcripts were analysed using an affective- discursive approach. Findings: Shaped by idealised femininities and alcohol's chemical affordances, particular affective atmospheres and feelings arose in women before, during, and after drinking, providing insights into women's experiences and sense-making around alcohol. Three areas of life were highly affectively charged in discussions, namely drinking that: 1) enabled bonding with partner, 2) facilitated time out from busy lives, and 3) was part of coping with life's difficulties. Discussion and conclusions: Women at midlife experienced pressures to be economically and socially successful, to maintain slim bodies, and to have 'appropriate' feelings such as selflessness and gratitude. For women in this study, drinking alcohol was a way to achieve, and to cope with, expectations around idealised femininities and socially endorsed ways of living, being, and feeling. Repeated and routine affective experiences reinforced the role of alcohol in women's lives. Findings suggest the need for gender-transformative policies that address the structural environments of women's lives.

Although the creators of the world wide web never intended it to be regulated by state intervention, the rapid evolution of the online environment has necessitated regulation of certain aspects of the digital ecosystem. Harmful commodity marketing (e.g., alcohol, vaping and unhealthy food and beverage product marketing) on social media and in digital spaces has been linked to adverse health outcomes and there have been calls for its regulation. In this commentary we explain why this is important and consider how such regulation could be achieved.

Background Barriers to accessing hospice and palliative care have been well studied. An important yet less researched area is why people approaching the end-of-life decline a referral when they are offered services. This review focused on synthesising literature on patients in the last months of life due to a cancer diagnosis who have declined a referral to end-of-life care. Methods Six academic databases were systematically searched for qualitative literature published between 2007 and 2021. Two researchers independently reviewed and critically appraised the studies. Using meta-ethnographic methods of translation and synthesis, we set out to identify and develop a new overarching model of the reasons patients decline end-of-life care and the factors contributing to this decision. Results The search yielded 2060 articles, and nine articles were identified that met the review inclusion criteria. The included studies can be reconceptualised with the key concept of ‘embodied decisions unfolding over time’. It emphasises the iterative, dynamic, situational, contextual and relational nature of decisions about end-of-life care that are grounded in people’s physical experiences. The primary influences on how that decision unfolded for patients were (1) the communication they received about end-of-life care; (2) uncertainty around their prognosis, and (3) the evolving situations in which the patient and family found themselves. Our review identified contextual, person and medical factors that helped to shape the decision-making process. Conclusions Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients’ end-of-life care decision-making, in particular estimating how much time one has left and patients’ embodied knowing about when the right time for end-of-life care is. The multiple and intersecting domains of health that inform decision-making, namely physical, mental, social, and existential/spiritual as well as emotions/affect need further exploration. The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients.

Research has explored why people seek assisted dying (AD), families' bereavement, and AD providers' experiences, yet few studies have investigated decision-making of the time and date for AD. This article elucidates how cancer patients, families and AD providers decide on and experience living with a date and time for AD in New Zealand. We longitudinally interviewed 23 people. Using thematic analysis, we identified four decision-making phases: deciding how and when to draw a line in the sand, the final countdown, a date with death and the right time. Picking a date was an embodied, relational, situational decision that balanced time left, families' wishes, providers' needs, and AD regulations. Time is a silent factor in AD decision-making; choosing a date reorients time to clock, event and embodied time, and contrives the right time for death. We discuss the implications and recommend how AD providers and policymakers can support service users and providers.