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Background Health and Safety Executive data show that teachers are at heightened risk of mental health difficulties, yet few studies have attempted to address this. Poor teacher mental health may impact on the quality of support provided to young people, who also report increased mental health difficulties themselves. Objective To test the effectiveness of an intervention aiming to improve secondary school teachers’ well-being through mental health support and training. Design A cluster randomised controlled trial with embedded process and economic evaluations. Setting Twenty-five mainstream, non-fee-paying secondary schools in the south-west of England and South Wales, stratified by geographical area and free school meal entitlement, randomly allocated to intervention or control groups following collection of baseline measures (n = 12, intervention; n = 13, control) between May and July 2016. Participants All teachers in the study schools at any data collection. All students in year 8 (baseline) and year 10 (final follow-up). Intervention Each intervention school received three elements: (1) a 1-day mental health first aid for schools and colleges training session delivered to 8% of all teachers; (2) a 1-hour mental health session delivered to all teachers; and (3) 8% of staff trained in the 2-day standard mental health first aid training course set up a confidential peer support service for colleagues. Control schools continued with usual practice. Main outcome measures The primary outcome was teacher well-being (using the Warwick–Edinburgh Mental Wellbeing Scale). Secondary outcomes were teacher depression, absence and presenteeism, and student well-being, mental health difficulties, attendance and attainment. Follow-up was at 12 and 24 months. Data were analysed using intention-to-treat mixed-effects repeated-measures models. Economic evaluation A cost–consequence analysis to compare the incremental cost of the intervention against the outcomes measured in the main analysis. Process evaluation A mixed-methods study (i.e. qualitative focus groups and interviews, quantitative surveys, checklists and logs) to examine intervention implementation, activation of the mechanisms of change outlined in the logic model, intervention acceptability and the wider context. Results All 25 schools remained in the study. A total of 1722 teachers were included in the primary analysis. We found no difference in mean teacher well-being between study arms over the course of follow-up (adjusted mean difference –0.90, 95% confidence interval –2.07 to 0.27). There was also no difference in any of the secondary outcomes (p-values 0.203–0.964 in the fully adjusted models). The average cost of the intervention was £9103 (range £5378.97–12,026.73) per intervention school, with the average cost to Welsh schools being higher because of a different delivery model. The training components were delivered with high fidelity, although target dosage was sometimes missed. The peer support service was delivered with variable fidelity, and reported usage by teachers was low (5.9–6.1%). The intervention had high acceptability, but participants reported low support from senior leadership, and minimal impact on school culture. Limitations Participants and the study team were unblinded, self-report for the main outcome measures and inaccurate measurement of peer support service usage. Conclusions The Wellbeing in Secondary Education (WISE) intervention was not effective at improving teacher or student well-being, or reducing mental health difficulties, possibly because of contextual barriers preventing it becoming embedded in school life. Future work Identification of ways in which to achieve system-level change and sustained support from senior leaders is important for future school-based mental health interventions. Trial registration Current Controlled Trials ISRCTN95909211. Funding This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information. Intervention costs were met by Public Health Wales, Public Health England and Bristol City Council.

Background COVID-19 lockdown measures may have led to more, and increasingly severe, domestic abuse. This study examines police referrals to a specialist domestic abuse service in Wales, UK before and during the first lockdown. Methods Routine data relating to 2292 police referrals for female adult victim-survivors from December 2019 until July 2020 were analysed and presented in the form of descriptive statistics to monitor changes in referral rates and the profile of those referrals. Results There was little increase in the overall volume of police referrals during lockdown, but the proportion assessed as high risk increased, and children became the primary source of third-party referrals, with a higher proportion of reports made by other third parties as restrictions eased. Police reports for cases of Child/Adolescent to Parent Violence (C/APV) occurred almost exclusively during lockdown. Conclusions The increase in risk level despite less clear increase in volume may suggest unmet need, with victims less likely to seek help during lockdown other than for more severe instances. Increased reports by children suggest increased exposure of children to domestic abuse during school closure. Unmet need for women and children may have been made visible to services, and acquaintances, as measures began to ease.

We used the HealthWise Wales (HWW) platform to explore public knowledge about the UK Yellow Card scheme (YCS), the spontaneous reporting scheme for suspected adverse drug reactions (ADRs) and whether a short information video could improve awareness. Members of the public in Wales (n= 1,606) completed a questionnaire about the YCS, watched the information video and then completed a follow‐up questionnaire.\ud \ud Almost half (46.5%) of respondents said they had previously experienced an ADR (over 90% of the ADRs involving prescribed medicines). Before the video, 18% of respondents knew how to report an ADR via the YCS and of these, 34% were from allied‐health professions. Immediately after watching it, 71% participants reported knowing how to report and 82% reported being confident to report. If this awareness were maintained, such an approach could contribute to improved reporting of suspected ADRs by the public.

The purpose of this study is to bridge the gap between sustainable fashion and customer purchase intentions by analysing the current trends and offering techniques to increase sustainable fashion awareness and overcome price consumption issues among Generation Z (Gen Z) consumers. A mixed methods approach was employed in this study consisting of online surveys and focus groups surrounding the topic of sustainable apparel consumption among the Gen Z age group. Focus groups served to lead to an online survey of questions to help better understand the phenomena on an exploratory scale. Three focus groups of eight to ten volunteers each aged 18–25 from a large Midwestern university took part in 60-minute discussions regarding their understanding of fast fashion and their purchase intentions/awareness of ethical issues within the apparel industry. Online surveys were conducted through the online platform Qualtrics consisting of 29 questions with a total of 445 participants ranging from 18 to 23 years old taking part in the online survey. Main themes found in the focus groups are the idea of shopping second hand, laziness among consumers and the quality of garments. Surveys found that this age group was willing to pay up to 25 per cent more for a sustainable apparel item and that uniqueness of the item was of utmost importance. Implications for brands and retailers as well as academics are presented.

This study aims for a better understanding of social networks (SN) regarding sustainable apparel. This study utilises a quantitative, online survey research approach of U.S. consumers to understand...

PurposeTo help brands persuasively communicate their environmentally responsible initiatives, this study aims to involve two experiments, examining the impact of brand schema, information transparency and skepticism toward climate change for brands both familiar and unfamiliar to US consumers.Design/methodology/approachTwo online experiments were designed recruiting a total of 510 participants. The design incorporates both message and treatment variance to increase internal and external validity of the study. Data collected were analyzed using PROCESS, a regression-based conditional path analysis technique.FindingsThe results indicated that for both familiar and unfamiliar brands, increased congruity of consumers' schemas to information presented in brands' pro-environmental messages led consumers to evaluate the messages as more persuasive, have more positive opinions about brands' environmentally responsible initiatives as well as behavioral intentions toward the brand. Also, presence of high information transparency on environmental responsibility-related messages influenced consumers' schemas positively, and in turn, their evaluations were more favorable. However, consumers’ climate change skepticism seemed to influence unfamiliar, not familiar brands.Originality/valueThe study provides both theoretical and managerial implications. The findings are important for established apparel brands that suffer from negative reputations, but are willing to revitalize their images, and for new ventures who want to establish their image as environmentally responsible.

Political consumerism refers to the deliberate purchase or avoidance of products, goods, or services for political reasons. For decades, researchers have studied the micro-level predictors of political consumerism in many countries and across a variety of contexts. However, many questions remain. Do resource-based models of political participation or theories of lifestyle politics best explain why some people are more likely to engage in political consumerism? To answer this question, we conduct a meta-analysis of 66 studies with more than 1000 tests. We find more support for theories of lifestyle politics. Political consumerism is associated with political distrust, liberal ideology, and media use, as well as education, political interest, and organizational membership. The findings help us understand the subset of people who are using their purchasing power to express political opinions. They also help us identify gaps in existing research.

Measurement of urinary protein is an essential part of the evaluation of chronic kidney disease; it has both diagnostic and prognostic significance. Proteinuria is an independent risk factor for progression of renal disease, but is also independently associated with increased cardiovascular mortality. Despite its far-reaching implications, the definition, diagnosis and treatment of proteinuria can cause confusion in primary care. Early detection of proteinuria in the context of diabetes or otherwise is vital given the potential for intervention to reduce urinary protein losses and improve renal and cardiovascular outcomes. This article will focus on the definition, potential causes and management of proteinuria, including which individuals should be referred to secondary care.

Teaching staff report poorer mental health and wellbeing than the general working population. Intervention to address this issue is imperative, as poor wellbeing is associated with burnout, presenteeism, and adverse student mental health outcomes. The Wellbeing in Secondary Education (WISE) intervention is a secondary school-based programme aimed at improving the mental health and wellbeing of teachers and students. There are three components: awareness-raising for staff; a peer support service delivered by staff trained in Mental Health First Aid (MHFA); and Schools and Colleges Mental Health First Aid (MHFA) training for teachers. A cluster randomised controlled trial with integrated process and economic evaluation was conducted with 25 secondary schools in the UK (2016–2018). The intervention was largely ineffective in improving teacher mental health and wellbeing. This paper reports process evaluation data on acceptability to help understand this outcome. It adopts a complex systems perspective, exploring how acceptability is a dynamic and contextually contingent concept. Data sources were as follows: interviews with funders (n = 3); interviews with MHFA trainers (n = 6); focus groups with peer supporters (n = 8); interviews with headteachers (n = 12); and focus groups with teachers trained in Schools and Colleges MHFA (n = 7). Results indicated that WISE intervention components were largely acceptable. Initially, the school system was responsive, as it had reached a ‘tipping point’ and was prepared to address teacher mental health. However, as the intervention interacted with the complexities of the school context, acceptability became more ambiguous. The intervention was seen to be largely inadequate in addressing the structural determinants of teacher mental health and wellbeing (e.g. complex student and staff needs, workload, and system culture). Future teacher mental health interventions need to focus on coupling skills training and support with whole school elements that tackle the systemic drivers of the problem.

Funder: Public Health England, Funder: Public Health Wales, Funder: Bristol City Council, BACKGROUND: Teachers are at heightened risk of poor mental health and well-being, which is likely to impact on the support they provide to students, and student outcomes. We conducted a cluster randomised controlled trial, to test whether an intervention to improve mental health support and training for high school teachers led to improved mental health and well-being for teachers and students, compared to usual practice. We also conducted a cost evaluation of the intervention. METHODS AND FINDINGS: The intervention comprised (i) Mental Health First Aid training for teachers to support students; (ii) a mental health awareness session; and (iii) a confidential staff peer support service. In total 25 mainstream, non-fee-paying secondary schools stratified by geographical area and free school meal entitlement were randomly allocated to intervention (n = 12) or control group (n = 13) after collection of baseline measures. We analysed data using mixed-effects repeated measures models in the intention-to-treat population, adjusted for stratification variables, sex, and years of experience. The primary outcome was teacher well-being (Warwick-Edinburgh Mental Well-being Scale). Secondary outcomes were teacher depression, absence, and presenteeism, and student well-being, mental health difficulties, attendance, and attainment. Follow-up was at months 12 (T1) and 24 (T2). We collected process data to test the logic model underpinning the intervention, to aid interpretation of the findings. A total of 1,722 teachers were included in the primary analysis. Teacher well-being did not differ between groups at T2 (intervention mean well-being score 47.5, control group mean well-being score 48.4, adjusted mean difference -0.90, 95% CI -2.07 to 0.27, p = 0.130). The only effect on secondary outcomes was higher teacher-reported absence among the intervention group at T2 (intervention group median number of days absent 0, control group median number of days absent 0, ratio of geometric means 1.04, 95% CI 1.00 to 1.09, p = 0.042). Process measures indicated little change in perceived mental health support, quality of relationships, and work-related stress. The average cost of the intervention was ��9,103 per school. The study's main limitations were a lack of blinding of research participants and the self-report nature of the outcome measures. CONCLUSIONS: In this study, we observed no improvements to teacher or student mental health following the intervention, possibly due to a lack of impact on key drivers of poor mental health within the school environment. Future research should focus on structural and cultural changes to the school environment, which may be more effective at improving teacher and student mental health and well-being. TRIAL REGISTRATION: www.isrctn.com ISRCTN95909211.

Background Today’s primary school children have grown up in a climate of strong smoking restrictions, decreasing tobacco use, and the emergence of e-cigarettes. Children’s exposure to tobacco declined substantially in years following the introduction of smoke-free legislation, with smoking uptake and perceived smoking norms declining. There is debate regarding whether emergence of e-cigarettes may interrupt trends in children’s smoking perceptions, or offer a means for adults to limit children’s exposure to tobacco. This study examines change in children’s tobacco and e-cigarettes experimentation (ever use), exposure to secondhand smoking and vaping, and perceived smoking norms. Methods Data from four, repeat cross-sectional surveys of Year 6 primary school pupils (age 10–11 years) in Wales in 2007, 2008, 2014 and 2019 (n = 6741) were combined. E-cigarette use and perceptions were included in 2014 and 2019 surveys. Analyses used binary logistic regression analyses, adjusted for school-level clustering. Results Child tobacco experimentation and most indicators of exposure to tobacco smoke indicated a graded decreasing trend over time from 2007 to 2019. Exposure to e-cigarettes increased from 2014 to 2019, as did pupil awareness of e-cigarettes (OR = 2.56, 95%CI = 2.12–3.10), and parental use (OR = 1.26, 95%CI = 1.00–1.57). A decrease in child e-cigarette experimentation was not significant (OR = 0.80, 95%CI = 0.57–1.13). Children’s normative perceptions for smoking by adults and children indicated a graded decrease over time (OR = 0.66, 95%CI = 0.54–0.80; OR = 0.69, 95%CI = 0.55–0.86; respectively from 2014 to 2019). However, fewer reported disapproval of people smoking around them in 2019 relative to 2014 (OR = 0.68, 95%CI = 0.53–0.88). Higher exposure to tobacco cigarettes and e-cigarettes in public places, cars and households were associated with favourable normative perceptions for tobacco smoking; however in models adjusted for exposure to both associations of e-cigarette exposure were attenuated. Conclusion Children’s experimentation with and exposure to tobacco, and their perceptions of smoking as a normative behaviour, have continued to decline alongside growth in exposure to e-cigarettes. Although a large majority of pupils reported they minded people smoking around them, there was some evidence of diminishing disapproval of secondhand smoke since 2007. Further research is needed to understand whether use of e-cigarettes in cars and homes is displacing prior smoking or being introduced into environments where smoking had been eliminated.

RationaleMany expectant and new mothers have been impacted by the restructuring of maternal services that has occurred in response to the pandemic. Although there is hopefully an end in sight, restrictions may continue for some months. It is therefore important to assess the changes that have occurred, in order to prevent further harm to mothers, or to realise and implement any positive changes permanently. Aim: To analyse the different ways in which antenatal, obstetric, and postnatal services in the UK have adapted to the COVID-19 pandemic.MethodsKey-word searches were used to systematically scope three databases for papers that reported on any aspect of maternal care or services and COVID-19 until 03/12/2020. In total, 2,299 papers’ titles and abstracts were screened according to pre-set eligibility criteria. Half were double-screened by a second researcher, and discrepancies were discussed between three researchers until resolved. Full-text screening (n=344) excluded papers that weren’t relevant, or didn’t include primary data. Excluded papers and papers that the lead researcher flagged for a second opinion were checked by a second researcher. At this point, the decision was made to focus on UK services, due to the high number of papers. Next steps will be to extract data from the final sample of papers (n=12) and appraise their quality. Narrative synthesis will form a coherent report on how services in the UK have changed.ResultsPreliminary results show that there have been shifts in some maternal services towards virtual delivery. Additionally, there has been a change in the number of antenatal and postnatal appointments, including the number and nature of antenatal emergency presentations. There has also been a reduction in the care choices available to pregnant women, including changes to birth plans. Furthermore, there have been changes to obstetric unit layouts and care delivery, including changes to the rates of C-sections and general anaesthesia. Additional results will be submitted before the June 28th.Population Health RelevanceThis review is expected to highlight some interesting changes that have occurred in UK maternal services since the beginning of the pandemic. Some may have changed maternal services for the better, while others may highlight some difficulties that new mothers have faced, and will be important to address in case of continuing restrictions or future pandemics. Further research will focus on qualitatively assessing the experiences of new mothers during the pandemic, to gain first-hand insights into how they were affected by the changes.

ObjectivesResearch on the adaptation of population health interventions for implementation in new contexts is rapidly expanding. This has been accompanied by a recent increase in the number of frameworks and guidance to support adaptation processes. Nevertheless, there remains limited exploration of the real-world experiences of undertaking intervention adaptation, notably the challenges encountered by different groups of stakeholders, and how these are managed. Understanding experiences is imperative in ensuring that guidance to support adaptation has practical utility. This qualitative study examines researcher and stakeholder experiences of funding, conducting and reporting adaptation research.SettingAdaptation studies.ParticipantsParticipants/cases were purposefully sampled to represent a range of adapted interventions, types of evaluations, expertise and countries. Semistructured interviews were conducted with a sample of researchers (n=23), representatives from research funding panels (n=6), journal editors (n=5) and practitioners (n=3).MeasuresA case study research design was used. Data were analysed using the framework approach. Overarching themes were discussed within the study team, with further iterative refinement of subthemes.ResultsThe results generated four central themes. The first three relate to the experience of intervention adaptation (1) involving stakeholders throughout the adaptation process and how to integrate the evidence base with experience; (2) selecting the intervention and negotiating the mismatch between the original and the new context; and (3) the complexity and uncertainty when deciding the re-evaluation process. The final theme (4) reflects on participants’ experiences of using adaptation frameworks in practice, considering recommendations for future guidance development and refinement.ConclusionThis study highlights the range of complexities and challenges experienced in funding, conducting and reporting research on intervention adaptation. Moving forward, guidance can be helpful in systematising processes, provided that it remains responsive to local contexts and encourage innovative practice.

Implementing interventions with a previous evidence base in new contexts might be more efficient than developing new interventions for each context. Although some interventions transfer well, effectiveness and implementation often depend on the context. Achieving a good fit between intervention and context then requires careful and systematic adaptation. This paper presents new evidence and consensus informed guidance for adapting and transferring interventions to new contexts.

Relatively few US fashion programmes incorporate sustainable practice into their curriculum even though climate change, and the scope of damage caused by the fashion industry, is well docum...

Purpose The apparel industry is often scrutinized for its lack of environmental stewardship, and thus pro-environmental initiatives have been of significant consideration among apparel brands in recent years. However, one personality trait of specific concern to brand marketers is consumer skepticism toward climate change, which has the potential to negatively impact the success of brands’ pro-environmental initiatives. In this light, research indicates that knowledge of the environmental impact of products can lead to lower skepticism (Tobler et al., 2012) and ultimately higher purchase intentions of such products. Thus, this study investigates the impact of consumers’ knowledge about environmental impact of apparel, climate change skepticism on their evaluation of brands’ pro-environmental initiatives (shared value and perceived benefit) and ultimately their relationship with the brand (perceived trust, commitment), leading to purchase intention for both familiar and unfamiliar brands. Design/methodology/approach Two separate studies were conducted for familiar and unfamiliar brands. Data for online surveys were collected from two US nationwide samples and analyzed using path analyses. Findings Consumers’ intention to purchase from a pro-environmental brand was influenced by knowledge and skepticism. Particularly, the obtained shared value perceptions and perceived benefits of consumers influenced their relationship with the brand through trust and commitment, which eventually impacted their intention to purchase from the brand. Differences were observed for familiar and unfamiliar brands. Practical implications Findings of this study will help brand managers design effective pro-environmental marketing messages. Both familiar and unfamiliar brands would benefit from educating consumers about the true environmental impact of their apparel choices, as well as the personal benefits and values earned when purchasing/consuming pro-environmental apparel. This, in turn, reduces consumer skepticism toward climate change, leading to favorable evaluations of the brand’s pro-environmental initiatives and improvement of long-term brand relations. Originality/value This study extended the social exchange theory by understanding antecedents of consumers’ shared value and perceived benefits, namely, their knowledge about the environmental impact of apparel and their skepticism toward climate change, with the final outcome variable being consumers’ patronage intention of pro-environmental brands.

Purpose Social media and sustainability are changing Chinese consumers’ consumption behavior in notable ways. Few apparel industry sustainability efforts are enforced or well known in China. As China operates its own social media sites, it is necessary to study Chinese social media, rather than Western types, in order to understand its influence on Chinese consumer behavior with regard to sustainability. By extending the theory of reasoned action (TRA) and the prototype willingness model, the purpose of this paper is to investigate how Chinese consumers were taught their environmentally sustainable apparel (ESA) consumption behavior through social media, and also how the influence of peers affected their purchase intentions. Design/methodology/approach A total of 238 survey responses were collected and analyzed from a Chinese research firm in 2016. In accord with the study objectives, an exploratory factor analysis was first conducted, and then a two-step analysis of a structural equation model was employed for hypothesis testing. To test the significance of hypothesized mediated effects, a bootstrap procedure with 2,000 bootstrap samples from the original data was used to compute bias-corrected 95% CI for indirect effects. Moreover, hierarchical regressions were demonstrated to verify the unique contribution of social media influence. Findings The study findings support the previous literature that indicated positive attitudes toward environmentally sustainable purchasing behavior increased as Chinese consumers learned about social and environmental issues. Also, results of the analysis revealed that Chinese consumers’ engagement with social media and their peers were important social influences that were directly tied to increasing sustainable apparel purchase intentions. Originality/value By extending two grand theories of the prototype willingness model theory and the TRA, this study underlines a novel link between the influence of social media and ESA purchase intentions among Chinese consumers. Results are valuable in a global context as it is one of only a few studies to explore Chinese consumers’ purchase intentions of ESA through an exclusive social media platform – WeChat – in China.

Background Implementing evidence-informed population health interventions in new contexts often requires adaptations. While the need to adapt interventions to better fit new contexts is recognised, uncertainties remain regarding why and when to adapt (or not), and how to assess the benefits (or not) of adaptation. The ADAPT Study aims to develop comprehensive guidance on adaptation. This scoping review informs guidance development by mapping and exploring how adaptation has been undertaken in practice, in public health and health services research. Methods We searched seven databases from January 2000 and October 2018 to identify eligible studies for this scoping review and a related systematic review of adaptation guidance. We mapped the studies of adaptation by coding data from all eligible studies describing the methods, contexts, and interventions considered for adaptation. From this map, we selected a sample of studies for in-depth examination. Two reviewers extracted data independently into seven categories: description, key concepts, types, rationale, processes, evaluation methods, evaluation justification, and accounts of failures and successes. Results We retrieved 6694 unique records. From 429 records screened at full text, we identified 298 eligible studies for mapping and selected 28 studies for in-depth examination. The majority of studies in our map focused on micro- (i.e., individual-) level interventions (84%), related to transferring an intervention to a new population group within the same country (62%) and did not report using guidance (73%). Studies covered a range of topic areas, including health behaviour (24%), mental health (19%), sexual health (16%), and parenting and family-centred interventions (15%). Our in-depth analysis showed that adaptation is seen to save costs and time relative to developing a new intervention, and to enhance contextual relevance and cultural compatibility. It commonly follows a structured process and involves stakeholders to help with decisions on what to adapt, when, and how. Conclusions Adaptation has been undertaken on a range of health topics and largely in line with existing guidance. Significant gaps relate to adaptation of macro- (e.g., national-) level interventions, consideration of programme theories, mechanisms and contexts (i.e., a functional view of interventions), nuances around stakeholder involvement, and evaluation of the adapted interventions. Registration Open Science Framework, 2019, osf.io/udzma.

Background The adaptation of interventions for new contexts is a rapidly developing research area. To date there is no consensus-based guidance to support decision-making and recommend adaptation processes. The ADAPT study is developing such guidance. This aim of the qualitative component of the study was to explore stakeholders’ understandings of adaptation, as to date there has limited consideration of how different concepts and meanings shape decision-making and practice. Methods A case study research design was used. Participants/cases were purposefully sampled based on study outcome, study design, expertise, context and country. Semi-structured interviews were conducted with a sample of researchers (n = 23); representatives from research funding panels (n = 6); journal editors (n = 5) and practitioners (n = 3). Data were analysed using the Framework approach. Overarching themes were discussed with the ADAPT study team, with further iterative refinement of subthemes. Results The results generated four central themes. Four themes related to stakeholders’ understanding: 1) definitions of adaptation and related concepts; 2) rationales for undertaking adaptation; 3) the appropriate timing for adaptation; and 4) ensuring fidelity when implementing adapted interventions. Conclusion The findings highlight the lack of clarity around key concepts and uncertainty about central decision-making processes, notably why interventions should be adapted, when and to what extent. This has informed the ADAPT study’s guidance, shaping the scope and nature of recommendations to be included and surfacing key uncertainties that require future consideration.

This study aims to understand Gen Z and their relationship to influencers on #OOTD (Outfit Of The Day) on Instagram and how the credibility of the influencer, parasocial interaction (PSI), physical attractiveness, and self-confidence of the influencer are related and ultimately affect the purchase intention of consumers. The study was conducted using the online survey platform Qualtrics. A total of 304 participants of the study took an online survey consisting of 26 questions, including demographic and usage inquiries. All items were placed on a 3 pt. Likert scale (1: Disagree; 2: Neutral; 3: Agree) to discourage survey fatigue. This study’s main finding is that physical attractiveness is not as important to consumers as credibility, PSI, and confidence. With PSI being the strongest predictor of purchase intention. Transferring confidence and credibility are the most important aspects of influencing this generation on Instagram and creating a relationship with followers.

This project provides experiential learning to students through a collaborative, real-world opportunity to design, develop, merchandise and market a small collection for a retail setting. It is becoming more important than ever for high education to integrate these types of learning environments that encourage teamwork, communication, critical thinking and creative problem solving. Students were broken into teams of 3-4 to lead certain portions of the process which included buying and planning, communications and outreach, store planning design, and product design management. Each student took on an industry role that empowered them to engage in scenarios that required high-level problem solving, critical thinking, compromise and clear communication. It was discovered in student reflections that the students were able to strengthen their weaknesses, compromise and adapt to different ideas, and practice clear communication through this experiential learning adventure.

Augmented and Virtual Reality (AR/VR) are projected to be more commonly found in retail environments in the next few years, making it a key point of observation. The purpose of this study is to reveal what underlying values must be focused on to increase Fair Trade and social responsibility consumption by Generation Z consumers in the apparel industry through possible implementation of AR/VR. An online survey with a total of 214 respondents was conducted to better understand the use and perception of AR and VR, and how that moderates the effects of knowledge of Fair Trade leading to social responsibility concern and vice versa determining purchase intention. It was found that knowledge does not play a strong role in the use of AR/VR moderating purchase intention. However, focusing on concern of social responsibility in apparel production when using AR and VR and its impact on purchase intention is quite meaningful.

Digital media use can connect citizens across geographic boundaries into coordinated action by distributing political information, enabling the formation of groups, and facilitating political talk. These activities can lead to political consumerism, which is an important and popular form of political participation that translates across geographic borders. This article uses original survey data ( n = 9284) to examine the relationship between digital media use and political consumerism in the United States, United Kingdom, and France. Talking politics online, joining social groups on social media, and searching online for political information increase participation in political consumerism. However, the strength of these positive correlations differs by age, country, and mode of political consumerism. Joining social groups on social media has a much larger effect size on buycotting compared to boycotting. The findings imply that social groups are more salient in the mobilization process for buycotting campaigns compared to boycotting campaigns.

Background Adaptation of evidence-informed population health interventions for new contexts may be more efficient than de-novo intervention development, where well developed and tested interventions exist. There is however currently no consensus-based guidance for decision-making on adapting interventions for implementation and/or deciding on the need for re-evaluation in new contexts. We are developing guidance, with funding from MRC-NIHR. This presentation will describe the underpinning research used to develop this guidance, and draft content of the guidance, which will be completed by the end of 2020. Methods We used a phased approach to develop guidance. This began with a systematic review of existing guidance, including papers published between January 2000 and October 2018 identified through searches of 7 databases. This was followed by a scoping review focused on a purposive sample of cases of intervention adaptation identified through this search. Semi-structured qualitative interviews with researchers (N=23), practitioners (N=3), journal editors (N=5) and funders (N=6), were conducted, and analysed using framework analysis. Finally, a three round modified Delphi consensus process was undertaken (N=66). Results The systematic review identified and synthesised 35 sources of guidance to develop a draft framework, which was refined in subsequent phases. Reviews and qualitative interviews identified several ongoing debates in adapting interventions for new contexts, and areas of consensus. Informed by the review, we defined adaptation as ‘intentional modification(s) of an evidence-informed intervention, in order to achieve better fit between an intervention and a new context’. Consensus processes suggested this definition was useful, but emphasised the importance of including guidance for both pro-active and re-active adaptation. Different conceptualisations of fidelity were identified within the reviews and interviews which shaped approaches to adapting interventions. Further, while we initially defined ‘evidence-informed’ interventions as those with prior evidence of effects, qualitative interviews and DELPHI processes suggested a wider framing of ‘evidence-informed’, with interventions often adapted from elsewhere based on evidence of feasibility, but with no prior robust evaluation of effects. Draft recommendations for adapting interventions for new contexts include considerations in relation to what interventions to select, when and how to adapt these, the level of re-evaluation required in the new context, and reporting of adaptation processes and outcomes. Discussion Producers and users of population health evidence face significant uncertainties over whether and how to adapt and re-evaluate interventions in new contexts. This guidance should improve the commissioning, conduct and reporting of studies involving intervention adaptation for new contexts.

Background Children in the United Kingdom (UK) today have grown up amidst strong smoking restrictions, decreasing tobacco use and increasing e-cigarette use. It is debated whether e-cigarettes interrupt downward trends in children’s smoking uptake or offer a means for adults to limit tobacco use in front of their children. This study examines change over time in experimentation with, and exposure to, smoking (2007–2019) and e-cigarettes (2014–2019). Methods Mixed methods design combining data from four national surveys of Year 6 primary school pupils in Wales from 2007–2019 (n=6,741) and qualitative data from 22 focus groups within four primary schools. Results Parental smoking (OR=0.85 95%CI=0.78–0.94), child tobacco experimentation (OR=0.50, 95%CI=0.40–0.63), and exposure to tobacco in all locations declined over time. Exposure to e-cigarettes increased in all locations from 2014–2019, as did pupil awareness (OR=2.56, 95%CI=2.13–3.09), and parental use (OR=1.26 95%CI=1.01–1.57]). Child ever e-cigarette use was unchanged (OR=0.80, 95%CI=0.58–1.12). Since 2014, pupils’ reports that parents used only e-cigarettes increased. Qualitative research identified strong disapproval for smoking and vaping indoors among children. Pupils from smoking families were more knowledgeable about e-cigarettes, with family smoking and e-cigarette use important in shaping children’s exposure to, and perceptions of, smoking and vaping. Conclusion Children’s experimentation with, and exposure to, tobacco continues to decline. Further research is needed to understand whether use of e-cigarettes in cars and homes is displacing prior smoking in these locations or being introduced into environments where smoking had already been eliminated.

Background Improving children and young people’s provision for mental health is a current health priority in England. Secondary school teachers have worse mental health outcomes than the general working population, which the Wellbeing in Secondary Education (WISE) cluster randomised controlled trial aimed to improve. The WISE intervention comprised a Mental Health First Aid (MHFA) training package delivered to at least 16% of staff, a short mental health awareness session to all teachers and development of a staff peer support service. Twenty-five schools were randomised to intervention or control arms. This paper reports findings regarding the extent of uptake and fidelity of the intervention. Methods Mixed methods data collection comprised researcher observations of training delivery, training participant evaluation forms, trainer and peer supporter interviews, peer supporter feedback meetings, logs of support provided, and teacher questionnaires. Quantitative data were summarised descriptively, while thematic analysis was applied to the qualitative data. Results In the 12 schools assigned to the intervention arm, 113 (8.6%) staff completed the 2-day standard MHFA training course, and a further 146 (11.1%) staff completed the 1-day MHFA for schools and colleges training. In seven (58.3%) schools, the required 8% of staff completed the MHFA training packages. A 1-h mental health awareness-raising session was attended by 666 (54.5%) staff. Delivery of the MHFA training package was achieved with high levels of fidelity and quality across schools. All schools set up the peer support service following training, with a majority adhering to most of the operational guidelines developed from the pilot study at the outset. Teachers reported limited use of the peer support service during follow-up. At the 1-year follow-up, only three (25.0%) schools indicated they had re-advertised the service and there was evidence of a reduction in support from senior leadership. Conclusion The MHFA training package was delivered with reasonably high fidelity, and a staff peer support service was established with general, but not complete, adherence to guidelines. In some schools, insufficient staff received MHFA training and levels of delivery of the peer support service compromised intervention dose and reach. Trial registration ISRCTN 95909211. Registered on 15 January 2016

Background Knowledge of the prevalence of morbidity secondary to stroke is important for health care professionals, health care commissioners, third sector organizations, and stroke survivors to understand the likely progress of poststroke sequelae and to aid in commissioning decisions, planning care, and adjusting to life after stroke. Objective The primary aim of the Morbidity PRevalence Estimate In StrokE (MORe PREcISE) study is to determine the prevalence of morbidity secondary to a stroke, predictors of morbidity, and trends in quality of life and functional status using patient-reported outcomes, cognitive and functional assessments. Methods A total of 500 participants will be recruited across Wales and England within 14 days following an admission to a stroke unit for either an ischemic or hemorrhagic stroke as part of a multicenter cohort study. Participants are assessed at baseline ≤14 days poststroke and subsequently at 90 (± 14) days and 180 (± 14) days poststroke. At each time point, data will be collected relating to the following domains: participant demographics, routine clinical, patient reported, cognitive status, emotional well-being, and functional ability. Results Recruitment commenced in October 2018 with 20 sites opened as of September 2019 and was closed on October 31, 2019. Conclusions The primary outcome is the prevalence of morbidity at 6 months secondary to a stroke. Further analysis will consider temporal changes in the health-related domains to describe trends among baseline, 3-, and 6-month time points. Trial Registration ClinicalTrials.gov NCT03605381; https://clinicaltrials.gov/ct2/show/NCT03605381 International Registered Report Identifier (IRRID) DERR1-10.2196/15851

Brands and retailers have solidified their presence online and their interaction efforts with consumers on social media. Studies have looked at the interaction of brands with consumers and their ability to advertise (Ashley and Tuten 2015; Hudson et al. 2016). However, utilizing social media platforms in marketing brings a challenge to brands due to its openness as well as fast changing nature (Colliander and Marder 2018). The luxury market will be worth nearly 375 billion by 2020, and millennials (Generation Y and Z Cohort) are expected to account for 45% of the global personal luxury goods market (Luxury Goods Market 2014; Solomon 2017). The millennial generation is extremely technology savvy and more likely to use the internet wirelessly, thus expecting to be engaged and communicated via online seamlessly (Chu and Kamal 2011). Parasocial Interaction Theory (PSI) is defined as “an illusionary experience, such that consumers interact with personas (i.e. mediated representations of presenters, celebrities, or characters) as if they are present and engage in a reciprocal relationship” (Labrecque 2014, p. 135). This study adopts Instagram, a visual-oriented social media platform, as the study context. As one of the popular social media platforms, Instagram is recognized as the most effective platform for luxury fashion brands (WWD Staff 2017). college students from a large Midwestern university were recruited (n = 385). The survey was consisted of 35 series of questions that assess brand relationship to a celebrity influencer and the brand on Instagram. The survey questionnaire included consumers’ perceived interactivity (McMillan and Hwang 2002; Labrecque 2014), similarity/likeability (Reysen 2005), parasocial interaction (Rubin et al. 1985; Labrecque 2014); willingness to share information (Schoenbachler and Gordon 2002; Labrecque 2014). A total of 121 usable responses were retained, and the data was analyzed using SPSS 22.0. Since this study is an exploratory nature, simple statistical analyses such as descriptive statistics, reliability tests, Principal Component Analysis (PCA), independent t-test, and regression analysis were conducted. This study concludes that people who follow both (brand and celebrity influencer) feel more interacted with the brand. Overall the millennial consumer prefers interactions with both brand and celebrity influencer, which would create a feeling of PSI. The results present that if a brand is using a celebrity influencer, influencer needs to be interacting with the followers on Instagram more often whereas a brand needs to be transparent on Instagram in order to gain trust of millennials through open conversations (e.g. what they offer, sustainability, communication, etc.).

Background: This study examines primary schoolchildren&rsquo, s perceptions of e-cigarettes and tobacco cigarettes, and associations with parental smoking, vaping and socioeconomic status. Methods: Survey of 2218 10&ndash, 11-year-old children in 73 schools in Wales. Results: Overall, 36% reported that a parent figure smoked compared to 21% for vaping, with parental smoking lower in affluent families (OR = 0.72, 95% CI = 0.68 to 0.76). Overall, 1% had tried a cigarette, while 5% had tried an e-cigarette. Most said they would not smoke or vape in 2 years&rsquo, time, susceptibility to vaping (20%) was higher than smoking (12%). Exposure to and perceptions of tobacco cigarettes were more positive for children of smokers. Having a parent who vaped was associated with exposure to and positive perceptions of e-cigarettes, but not smoking. Most children perceived e-cigarettes as used by adults to stop smoking (64%). Susceptibility to smoking (OR = 0.57, 95% CI = 0.41 to 0.79) and vaping (OR = 0.78, 95% CI = 0.62 to 0.99) were lower among children who perceived e-cigarettes as cessation aids. Conclusions: Parental smoking continues to be concentrated in poorer families. This study provides no evidence that parental vaping in the absence of smoking is associated with more positive perceptions of tobacco cigarettes. Communicating to children the role of e-cigarettes as cessation devices for smokers may help to limit their appeal to young people.

Experimentation with e-cigarettes has grown rapidly among UK adolescents. To date, this topic has been primarily researched in secondary schools, with less understanding of development of attitudes and behaviours at an earlier age. This research reports qualitative data from interviews with pupils, parents, and teachers at 4 case study schools in Wales (N = 42). It draws on Bronfenbrenner’s Ecological Systems Theory to consider how the intersection of systems surrounding primary school-age children and their interaction with these systems, shape knowledge, and attitudes towards e-cigarettes and tobacco. Findings indicate that consistent messaging on smoking from school and family was reflected in strong disapproval among pupils and clear understanding of harms. This was less evident for e-cigarettes, where messages were mixed and inconsistent between home and school, with concerns over what to tell children about e-cigarettes in light of mixed messages and absence of official guidance. Implications of findings for policy and teaching are discussed.

PurposeRecruitment and follow-up in epidemiological studies are time-consuming and expensive. Combining online data collection with a register of individuals who agree to be contacted about research opportunities provides an efficient, cost-effective platform for population-based research. HealthWise Wales (HWW) aims to facilitate research by recruiting a cohort of individuals who have consented to be informed about research projects, advertising studies to participants, supporting data collection on specific topics and providing access to linked healthcare data for secondary analyses. In this paper, we describe the design of the project, ongoing data collection, methods of data linkage to routine healthcare records, baseline characteristics of participants, the strengths and limitations of the register, and the ways in which the project can support researchers.ParticipantsAdults (aged 16 years and above) living or receiving their healthcare in Wales are eligible for inclusion. Participants consent to be contacted for follow-up data collection and for their details to be used to access their routinely collected National Health Service records for research purposes. Data are collected using a web-based application, with new questionnaires added every 6 months. Data collection on sociodemographic and lifestyle factors is repeated at intervals of 2–3 years. Recruitment is ongoing, with 21 779 participants alive and currently registered.Findings to date99% of participants have complete information on age and sex, and 64% have completed questionnaires on sociodemographic and lifestyle factors. These data can be linked with national health databases within the Secure Anonymised Information Linkage (SAIL) databank, with 93% of participants matching a record in SAIL. HWW has facilitated the recruitment of 43 826 participants to 15 different studies.Future plansThe medium-term goal for the project is to enrol at least 50 000 adults. Recruitment strategies are being devised to achieve a study sample that closely models the population of Wales. Potential biosampling methods are also currently being explored.