Strengthening the psychiatric advance directive system in New Zealand: Allowing the mentally ill to help themselves

<p>Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to manage their treatment by documenting treatment preferences in advance of periods of incapacity. However, the application of PADs has largely been neglected by the legal and psychiatric discourse in New Zealand. This paper presents some of the key purposes and unrealised benefits of PADs, and explains why New Zealand’s law and policy surrounding advance directives in the mental health arena is unclear compared to other jurisdictions. Though interviews conducted with New Zealand clinicians and consumer advocates, key practical and legal dilemmas around forming, monitoring, and enforcing PADs were extracted and dissected. Interviews elucidated that, while attitudes were generally positive attitude towards PADs in the mental health system, the lack of a focused PAD strategy stifled its promulgation where it could most benefit service users. This paper proposes that PADs should be promoted, and articulates a normative PAD strategy for New Zealand.</p>

Strengthening the psychiatric advance directive system in New Zealand: Allowing the mentally ill to help themselves

<p>Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to manage their treatment by documenting treatment preferences in advance of periods of incapacity. However, the application of PADs has largely been neglected by the legal and psychiatric discourse in New Zealand. This paper presents some of the key purposes and unrealised benefits of PADs, and explains why New Zealand’s law and policy surrounding advance directives in the mental health arena is unclear compared to other jurisdictions. Though interviews conducted with New Zealand clinicians and consumer advocates, key practical and legal dilemmas around forming, monitoring, and enforcing PADs were extracted and dissected. Interviews elucidated that, while attitudes were generally positive attitude towards PADs in the mental health system, the lack of a focused PAD strategy stifled its promulgation where it could most benefit service users. This paper proposes that PADs should be promoted, and articulates a normative PAD strategy for New Zealand.</p>

Reducing Resistance: The Impact of Nonfollowers’ and Followers’ Parasocial Relationships with Social Media Influencers on Persuasive Resistance and Advertising Effectiveness

Although social media influencers have become popular brand endorsers, previous research on this new form of advertising has neglected to analyze how the followers of these influencers are persuaded. Based on a key mechanism proposed by the entertainment overcoming resistance model, long-term parasocial relationships (PSRs) should reduce the amount of persuasive resistance in the forms of reactance and counterarguing. Consequently, the persuasive effects should be enhanced. To empirically test these assumptions, two online studies were conducted. The first experimental study (N = 151) confirmed that followers experienced stronger PSRs than did nonfollowers, which resulted in higher perceived source trustworthiness and reduced levels of both perceived freedom threat and counterarguing after exposure to a sponsored Instagram post. The second study (N = 225) further confirmed the enhanced persuasive impact of PSRs in terms of brand evaluations and behavioral intentions. The theoretical and practical implications for advertisers, consumer advocates, and future research are discussed.

Banking on a Revolution

Technological advancements are poised to completely transform the financial system, making it unrecognizable in just a few short decades. Banks are increasingly using financial technologies, or “fintech,” to deliver products and services and maximize their profits. Technology enthusiasts and some consumer advocates laude fintech for its potential to expand access to banking and finance. If history is any indication, however, fintech stands to reinforce digital forms of redlining and enable banks’ continued racialized exploitation of Black and Brown communities. Banking on a Revolution takes the perspective that the financial system needs a revolution—and not the impending revolution driven by technology. Studying various ways the financial system advantages whites by exploiting and marginalizing Black and Brown communities, Terri Friedline challenges the optimistic belief that fintech can expand access to banking and finance. Friedline applies the lens of financialized racial neoliberal capitalism to demonstrate the financial system’s inherent racism, and explores examples from student loan debt, corporate landlords, community benefits agreements, and banking and payday lending. She makes the case that the financial system needs a people-led revolution that centers the needs, experiences, and perspectives of those it has historically excluded, marginalized, and exploited.

Learning From New State Initiatives in Financing Long-Term Services and Supports

A number of states are taking concrete action on long-term services and supports (LTSS) financing which provides an opportunity to learn about the reasons why they are doing so, to identify the coalitions that have come together in support of such actions, and to understand factors associated with the choice of particular strategies and approaches. The purpose of the presentation is to report on a comparative qualitative study across six leading-edge states—Washington State, Hawaii, Maine, Minnesota, California, and Michigan—in order to describe their activities and identify and analyze commonalities and differences in their specific approaches and programs. An overarching goal is to help state officials, consumer advocates, and interested LTSS providers understand the strategies and approaches that other states—who may be further along in their development—are taking in this area so that they might have insights into strategies that might be a fit for their state.

Sensory Experiences and Cues among E-Cigarette Users

Background and Aims: We characterized the extent and quality of respiratory sensations and sensory related smoking cues associated with e-cigarette use among those who failed to quit combustible tobacco cigarette (CTC) use with traditional FDA approved medications but succeeded in doing so with e-cigarettes. Further, we sought to understand former smokers’ perceptions about the influence of sensory experience with e-cigarette use on CTC cessation outcomes.Methods: A nonrandom purposive sample of 156 participants recruited in the U.S. through the Consumer Advocates for Smoke Free Alternatives Association Facebook page completed an online cross-sectional survey to assess sensory experiences and smoking cues associated with e-cigarette use. Descriptive statistics were calculated, and the ANOVA/Kruskal-Wallis test with post-hoc testing and the two-sample t-test/Wilcoxon rank-sum test, as appropriate based on distribution, were used to assess the association between sample characteristics and sensory experiences and cues using investigator constructed questions, the Modified Cigarette Evaluation Questionnaire (mCEQ) and the Smoking Cue Appeal Survey (SCAS). Results With e-cigarette use, participants reported feeling the vapor in their throats, windpipes, noses, lungs, and on their tongues; reductions in nicotine craving; and enjoyment of their e-cigarette, including tasting, smelling, and seeing the vapor and touching the device. Women had greater craving reduction than men (p=0.023). Those who began smoking at 13 years of age or younger had more smoking satisfaction and had greater sensory enjoyment than those who began smoking at 16-17 years of age (p=0.015 and p=0.026, respectively), as well as greater sensory enjoyment than those who began smoking at 14-15 years of age (p=0.047). There was a significant overall association between the number of years a respondent smoked and e-cigarette sensory enjoyment (p=0.038). Participants 18-34 years old rated e-cigarettes as being more pleasant compared to 45+ year olds, (p=0.012). Eighty four percent of participants reported the sensation of the vapor as important in quitting CTCs, and 91% believed the sensations accompanying e-cigarette use contributed to their smoking cessation success. Conclusions: For those who failed to quit previously using approved cessation medications to stop smoking cigarettes, sensory experiences associated with e-cigarette use may help smokers quit smoking.

See No Evil

During the 2000s, universal banks originated and securitized trillions of dollars of toxic subprime loans and sold the resulting debt securities to investors around the world. Governments on both sides of the Atlantic encouraged universal banks to engage in high-risk lending and securitization. Universal banks enjoyed unrivaled influence, and government officials ignored warnings about the dangers of subprime lending from consumer advocates and academics who did not hold “mainstream” views. Policymakers in the U.S. and Europe recognized that many households were becoming more deeply indebted and were relying more heavily on home mortgages and other types of consumer credit to cover their living expenses. Officials tolerated those developments because they viewed housing construction and household consumption as the primary drivers of economic growth in an otherwise challenging environment. The decision by policymakers to rely on housing credit as the main stimulus for economic growth in a period of stagnant incomes had catastrophic results.

Sensory Experiences and Cues among E-Cigarette Users

Background and Aims: We characterized the extent and quality of respiratory sensations and sensory related smoking cues associated with e-cigarette use among those who failed to quit combustible tobacco cigarette (CTC) use with traditional FDA approved medications but succeeded in doing so with e-cigarettes. Further, we sought to understand former smokers’ perceptions about the influence of sensory experience with e-cigarette use on CTC cessation outcomes.Methods: A nonrandom purposive sample of 156 participants recruited in the U.S. through the Consumer Advocates for Smoke Free Alternatives Association Facebook page completed an online cross-sectional survey to assess sensory experiences and smoking cues associated with e-cigarette use. Descriptive statistics were calculated, and the ANOVA/Kruskal-Wallis test with post-hoc testing and the two-sample t-test/Wilcoxon rank-sum test, as appropriate based on distribution, were used to assess the association between sample characteristics and sensory experiences and cues using investigator constructed questions, the Modified Cigarette Evaluation Questionnaire (mCEQ) and the Smoking Cue Appeal Survey (SCAS). Results With e-cigarette use, participants reported feeling the vapor in their throats, windpipes, noses, lungs, and on their tongues; reductions in nicotine craving; and enjoyment of their e-cigarette, including tasting, smelling, and seeing the vapor and touching the device. Women had greater craving reduction than men (p=0.023). Those who began smoking at 13 years of age or younger had more smoking satisfaction and had greater sensory enjoyment than those who began smoking at 16-17 years of age (p=0.015 and p=0.026, respectively), as well as greater sensory enjoyment than those who began smoking at 14-15 years of age (p=0.047). There was a significant overall association between the number of years a respondent smoked and e-cigarette sensory enjoyment (p=0.038). Participants 18-34 years old rated e-cigarettes as being more pleasant compared to 45+ year olds, (p=0.012). Eighty four percent of participants reported the sensation of the vapor as important in quitting CTCs, and 91% believed the sensations accompanying e-cigarette use contributed to their smoking cessation success. Conclusions: For those who failed to quit previously using approved cessation medications to stop smoking cigarettes, sensory experiences associated with e-cigarette use may help smokers quit smoking.

Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services

Background: Health information technology (HIT) use in home- and community-based services (HCBS) has been hindered by inadequate resources and incentives to support modernization. We sought to understand the ways the Medicaid Balancing Incentive Program (BIP) facilitated increased use of HIT to increase access to HCBS. Method: Qualitative analysis of interviews with 30 Medicaid administrators, service agency providers, and consumer advocates. Results: Although stakeholders perceived several benefits to greater HIT use, they highlighted critical challenges to effective adoption within the long-term services and supports (LTSS) system, including lack of extant expertise/knowledge about HIT, the limited reach of HIT among rural and disabled beneficiaries, burdensome procurement processes, and the ongoing resources required to maintain up-to-date HIT solutions. Conclusion: The structural reforms required by BIP gave states an opportunity to modernize their HCBS systems through use of HIT. However, barriers to HIT adoption persist, underscoring the need for continued support as part of future rebalancing efforts.

Sensory Experiences and Cues among E-Cigarette Users

Background and AimsWe characterized the extent and quality of respiratory sensations and sensory related smoking cues associated with e-cigarette use among those who failed to quit combustible tobacco cigarette (CTC) use with traditional FDA approved medications but succeeded in doing so with e-cigarettes. Further, we sought to understand former smokers’ perceptions about the influence of sensory experience with e-cigarette use on CTC cessation outcomes.MethodsA nonrandom purposive sample of 156 participants recruited in the U.S. through the Consumer Advocates for Smoke Free Alternatives Association Facebook page completed an online cross-sectional survey to assess sensory experiences and smoking cues associated with e-cigarette use. Descriptive statistics were calculated, and the ANOVA/Kruskal-Wallis test with post-hoc testing and the two-sample t-test/Wilcoxon rank-sum test, as appropriate based on distribution, were used to assess the association between sample characteristics and sensory experiences and cues using investigator constructed questions, the Modified Cigarette Evaluation Questionnaire (mCEQ) and the Smoking Cue Appeal Survey (SCAS).ResultsWith e-cigarette use, participants reported feeling the vapor in their throats, windpipes, noses, lungs, and on their tongues; reductions in nicotine craving; and enjoyment of their e-cigarette, including tasting, smelling, and seeing the vapor and touching the device. Women had greater craving reduction than men (p=0.023). Those who began smoking at 13 years of age or younger had more smoking satisfaction and had greater sensory enjoyment than those who began smoking at 16-17 years of age (p=0.015 and p=0.026, respectively), as well as greater sensory enjoyment than those who began smoking at 14-15 years of age (p=0.047). There was a significant overall association between the number of years a respondent smoked and e-cigarette sensory enjoyment (p=0.038). Participants 18-34 years old rated e-cigarettes as being more pleasant compared to 45+ year olds, (p=0.012). Eighty four percent of participants reported the sensation of the vapor as important in quitting CTCs, and 91% believed the sensations accompanying e-cigarette use contributed to their smoking cessation success.ConclusionsFor those who failed to quit previously using approved cessation medications to stop smoking cigarettes, sensory experiences associated with e-cigarette use may help smokers quit smoking.