The current study examined the factors that influence Korean adolescents’ drinking refusal self-efficacy, which is known to be associated with alcohol use and drinking intentions. Specifically, this study considered parental monitoring, parent-child communication satisfaction, peer influence, and prior alcohol use as possible antecedents of Korean high school students’ drinking refusal self-efficacy. High school students (n = 538) in South Korea responded to the current study. The data revealed that parent-child communication satisfaction facilitated parental monitoring, and these factors indirectly predicted adolescents’ drinking behavior through peer influence. We also found that prior drinking, parental monitoring, and peer influence were directly associated with drinking refusal self-efficacy, and the self-efficacy, in turn, was associated with drinking intentions. These results not only suggest that drinking refusal self-efficacy are related to drinking behavior and intentions, but they also provide a theoretical explanation for how parental and peer influences are associated with adolescents’ drinking refusal self-efficacy. Research suggests that alcohol is the most widely used drug by adolescents regardless of ethnicity, gender, or race . AdolescAccording to Although numerous scholars have demonstrated the inverse association between drinking refusal self-efficacy and drinking behavior , relativThe notion of self-efficacy affecting people’s behavior is originally proposed by H1: Drinking refusal self-efficacy will be negatively associated with Korean adolescents’ drinking intentions.One key predictor of drinking refusal self-efficacy is individuals’ past alcohol use. Numerous scholars support the idea that adolescents who are already using alcohol would have relatively low drinking refusal self-efficacy than those without an experience of alcohol . ResearcH2: Prior alcohol use will be negatively associated with Korean adolescents’ drinking refusal self-efficacy.Though past drinking may be a predictor of drinking refusal self-efficacy, in order to fully understand the factors that shape adolescents’ drinking refusal self-efficacy, it would be valuable to answer the following inquiry: What is the antecedent of Koeran adolescents’ alcohol use? Identifying the factors that impact the adolescents’ drinking behavior would be helpful in fully understanding the process in which they perceive drinking refusal self-efficacy.et al., 1994), it also moderates the effects of peer influence on drinking behavior . In view of that, communication helps children maintain close relationships with their parents because it promotes children’s cognitive and social competence and results in parent-child satisfaction and more competence in adolescents’ interactions outside the home environment .Five-hundred thirty-eight adolescents  from four high schools in the Seoul metropolitan area in Korea participated in the current study. To provide representation from the different districts, four high schools were selected. Male participants were recruited from four high schools , and female participants were recruited from one of the high schools (n = 174). Because drinking is problematic among boys in Korea, most of the high school principals authorized male students to be the sample for the current study. As a result, male students were recruited from all four schools and female students were recruited from one school. Respondents’ ages ranged from 14 to 17 years, and their mean age was 15.32 years .alpha coefficients of the father-child communication satisfaction scale was .88 , and the mother-child communication satisfaction scale was .86 . In the structural model, parent-child communication satisfaction was a latent variable with father-child and mother-child communication satisfactions subscales.Parent-child communication satisfaction was measured with a modified version of et al.’s (1995) scale. The items for the scale were adopted from the research of alpha coefficient of the peer influence scale was .86 .Peer influence was measured with a modified version of Williams alpha coefficient of .85 . The mean score indicates that respondents, on average, had no more than 2 instances of drinking events in the last year.Respondents’ prior alcohol use was measured by a past alcohol use subscale from alpha coefficient of the scale was .90 .To assess respondents’ drinking refusal self-efficacy, a modified version of alpha coefficient of the scale was .88 .Drinking intentions was measured with a modified version of an alcohol use prospect scale . The scaThe hypotheses were tested by Structural Equation Modeling. The model was built with Amos 18. This procedure was appropriate because structural equation modeling was able to clarify the direct and indirect associations in the test of multivariate hypotheses. Our model was developed by constructing the paths predicted by our hypotheses  = 359.57, p < .001 CMIN/df = 25.68, CFI = .69, RMSEA = .21.All the variables were operationalized as latent variables, since the latent composite approach could “account for unreliability by extracting measurement error from the latent constructs used in the structural model” . Both direct and indirect effects of the related variables were calculated. A bootstrap for each model (number of bootstrap samples is 2000) was performed, and 95% bias-corrected confidence intervals were used to test the significance of the direct and mediation effects. To gauge the fit of the structural equation models, an omnibus model fit was evaluated using the comparative fit index (CFI) and the root mean squared error of approximation (RMSEA). Prior criteria we used were .90 for CFI and .08 for RMSEA. In addition, given the guidelines of Hoyle and Panter (1995), the chi-squared distributed goodness of fit test was also reported. Results of the analysis revealed that our model did not meet the established priori criteria, χSubsequently, we made modifications in the model. First we removed paths one by one based on the Lagrange multiplier test, and afterward, we inserted paths one at a time based on the Wald’s test see : The patpeer pressure, is well established” (p. 863). Given that the drinking refusal self-efficacy measure reflects peer pressure refusal self-efficacy, it is evident that peer pressure may sway individuals’ drinking refusal self-efficacy  = 15.40, p = .17, CMIN/df = 1.40, CFI = .996, RMSEA = .027. Please see H1)  and past drinking on drinking refusal self-efficacy (H2)  were significant. Thus, H1 and H2 were supported. The indirect effect of parental monitoring on drinking behavior, mediated by peer influence was also significant (H3) . The Sobel mediation test was also conducted to examine the mediating role of peer influence between parental monitoring and drinking behavior. The analysis showed that the indirect effect of parental monitoring on adolescents’ drinking was significant . Accordingly, H3 was supported by the current data. We were unable to fully examine H4 since the link between parent-child communication satisfaction and peer influence was removed during the initial stage of the analyses. The revised model, however, suggests that parent-child communication satisfaction is positively associated with parental monitoring . Thus, H4 was not supported. Finally, the total indirect effect of parent-child communication satisfaction on adolescents’ drinking intentions, mediated by parental monitoring, peer influence, prior drinking, and drinking refusal self-efficacy, was significant .After we made these modifications, the revised model was consistent with the data and established priori criteria, χThe current study examined the function of parental influence, peer influence, and prior drinking on Korean high school students’ drinking refusal self-efficacy. The revised model revealed that a number of factors directly influence Korean adolescents’ drinking refusal self-efficacy, including prior drinking, parental monitoring, and peer influence. Consistent with social cognitive theory , adolescIn order to fully identify the factors that influence adolescents’ drinking refusal self-efficacy, we first sought to understand what motivated those adolescents with prior alcohol experience to initiate drinking. Based on a number of theories  that suggest a mediating role of peer influence between parental influence and children’s drinking . By restHowever, parent-child communication satisfaction does not have an effect similar to that of parental monitoring on peer influence. Instead, parent-child communication satisfaction facilitates parental monitoring. In agreement with this result is Stattin and Kerr’s (2000) findings that highlight the effects of good parent-child communication on parental monitoring practices. Our data indicated that parent-child communication satisfaction was another contributor to Korean adolescents’ perceived parental monitoring. Because adolescents are likely to share information about their whereabouts and activities outside the home during communication with the parents, those adolescents who are content communicating with their parents are more likely to believe that their parents know a lot about their daily activities. Consistent with this idea, et al. suggest that peer influence mediates the link between family influence and alcohol use; however, they are mute about the link between peer influence and drinking refusal self-efficacy. Although these findings are conclusive, explanations for the effects of parental monitoring and peer influence on drinking refusal self-efficacy are incomplete. The results of the current study are consistent with social cognitive theory . In traditional Asian families, parents make the decisions for the family, and children are expected to respect these decisions with compliance . As a consequence, parental authority is often viewed as customary. There are a number of practical implications based on this investigation. It is thought that children are heavily influenced by their peers’ deviant behaviors . AlthougA number of limitations of the current research must be recognized. One of these involves the use of retrospective self-reports. Participants may not have accurately recalled or reported their attitudes and behavior . Since aIn conclusion, the main purpose of the present study was to identify the factors that influence Korean adolescents’ drinking refusal self-efficacy. Findings revealed that parental monitoring and peer influence directly and indirectly predicted drinking refusal self-efficacy through adolescents’ alcohol use. We identified the impact of parents and peers on Korean adolescents’ drinking. Furthermore, this study revealed that those factors are antecedents of the adolescents’ drinking refusal self-efficacy, which, in turn, predicts their drinking intentions. Given the results of our study, we are convinced that these constructs should be the key attributes researchers should consider when studying Korean adolescents’ alcohol use.


Several different classifications to characterize estuarine systems have been proposed. In this present paper, one of the most important estuaries in North Africa, the Oued Loukkos (Morocco), forms a case-study for proposing a systematic classification of this particular tidal estuary according to the vertical salinity gradient.This study, conducted using a CTD, shows that the spatial-temporal distribution of salinity depends on the stage of the tide and the upstream distance from the mouth of the river. In this case, it is also evident that the morphology of the bottom was capable of impacting the distribution of salinity by locally changing the water circulation.Based on the vertical salinity gradient measurement, the Oued Loukkos represents an estuarine environment with one section near its mouth that can be characterized as a mixed mesotidal estuary and another section upstream which can be characterized as a stratified mesotidal estuary. Between, there is an intermediate zone with a low vertical gradient of salinity, classified as a partially mixed mesotidal estuary. When the effect of terrestrial inputs is low compared to marine inputs, the river bed topography plays a role in the stratification of salinity by either disrupting the vertical stratification of the water or by changing the lateral distribution of salinity. The proposed classification deepens our hydrological knowledge and provides descriptive labels to the Oued Loukkos estuary. It provides a valid starting point for predicting the environmental impact of future recreational, agricultural and commercial activities on the estuary. As defined by Pritchard  and PeriSince 1980, the estuary of Oued Loukkos, in northwest Morocco, which according to the topographic classification of Pritchard  is a coaAs a case-study, a new hydrographic survey of the Oued Loukkos estuary was undertaken 14–24 October, 2010, and hydrological parameters were measured to assess the characteristics of the water masses throughout the estuary. Profiles of salinity and temperature were collected at different points with a CTD . As a result, this present paper provides a systematic classification according to the salinity gradient and at the same time deepens our hydrological knowledge of the Oued Loukkos estuary, one of the most important estuaries in North Africa.The study area is located between 35.215 and 35.177 degrees North and between −6.17 and −6.1 degrees West Figure , Hayes  and Alle2 with an average altitude of 300 m. Since 1979, the Loukkos basin has had two large dams ensuring the development of water resources in the region of Larache: 1) the great dam of the Oued El Makhazine, whose purpose is to ensure a water supply for drinking and industrial use in urban centers, and to protect against floods, etc., and 2) the Garde dam which has a dual mission to protect the lower valley against the rise of saline water from the sea and enhance/increase the level of water in the river to facilitate pumping for irrigation , sediment intake below the Garde dam is almost nonexistent  tows of the CTD along the main axis of the estuary. Fifty-seven of the CTD casts were co-located with sites throughout the estuary where a uniform distribution of sediment samples was collected from the river bed. Taken as a whole, the CTD data adequately provide evidence to support classification of the Oued Loukkos estuary.The hydrological data analyzed here were acquired during the period 14–24 October, 2010, using a SBE (Sea-Bird Electronics) CTD model 37 SMPAfter acquisition, the raw numerical data from the CTD were converted into physical units for analysis and visualization. Processing was performed using Excel worksheets and oceanography “Ocean-Data-View” Software.The continuous stages of the tide presented in this paper are nominal. They were developed using a half-cycle sinusoidal expansion technique between successive highs and lows predicted for the port of Larache. The predicted heights at high tide varied between 1.3 m and 2.2 m. The predicted heights at low tide varied between 0.0 m and 0.9 m. Neap tide was predicted to occur on 15 October. The expanded tide predictions were determined to be suitable by comparison with 28 hours of recorded CTD data in the port at 10-second intervals Geawhari et al.  and a seThe near-surface temperature measurements in the Oued Loukkos estuary in October 2010 varied between 18.7° and 22.5°C. Small variations in the measured near-surface temperatures, on the order of 0.1°C, were due to speed dependent variations in depth of the near-surface towed CTD measurements. Larger variations in the measured near-surface temperatures were due to changes of insolation throughout the day and changes in the stage of the tide when/where particular near-surface measurements were made.The highest values of near-surface temperature were typically observed during the period between 11:00 and 16:00, local time. A similar observation was made by El Morhit  in the sThe temperature of the water in the estuary decreases with depth, however, only marginally. At both low and high stages of the tide, the difference in water temperature between the near-surface and near-bottom rarely exceeded 1°C. Figure The salinities that were observed over all times and locations in the estuary ranged between 0.7 psu and 36.2 psu. The salinity varied between those two limits, depending on the stage of the tide and the location within the estuary. Lower values of salinity occurred in the upstream reaches of the estuary, 15 km from the mouth. Higher values of salinity occurred near the mouth of the river.Zouhair 3 was still 4 km upstream from the mouth, the near-surface salinity approached a high plateau and remained there until reaching the mouth of the river, at the end of the transect. This observation indicates that on a flood tide, near-surface water from the ocean is capable of advancing virtually unchanged for a considerable distance up into the estuary.The near-surface salinity throughout the survey area exhibited a general horizontal gradient, with salinity decreasing upstream from the mouth of the river. The high near-surface salinity at the mouth of the river appeared to be modulated by the stage of the tide. Figure The low near-surface salinity at the far upstream reach of the survey also appeared to be influenced by the stage of the tide. There the variation with stage of the tide is inferred to range from 0.7 psu at low tide to something greater than 16 psu at high tide, because 0.7 psu was observed there near low tide on 15 October, 7 psu was observed there near a mid-flood tide on 17 October, and 16 psu was observed there near a mid-flood tide on 24 October.The difference between the time required for the upstream and downstream transects Figure  was due In the vertical plane, a gradient of salinity  was generally observed along the study area of the Oued Loukkos. The strength of the gradient varied with the stage of the tide and the distance upstream from the mouth of the river. For example, on 15 October, in the far inland reach of the survey and during an ebbing tide, fresher water was observed overlying more saline water. In this instance, the salinity ranged from 0.7 psu in the near-surface water to greater than 25 psu at a depth of 4 m, with a temperature close to 21°C throughout the entire water column , than the overlaying water and downward movements for water that is more dense  than the underlying water. In our study area, the vertical temperature gradients were low; therefore temperature most likely plays a minimal role in the density stratification. Differences between the salinity of surface and bottom waters can be large, therefore the vertical density structure in the Oued Loukkos estuary is most likely determined by salinity.As previously referenced, there are several classification schemes that may be applied to the characterization of an estuary, including ones based on the tidal range, the relationship between the effects of river flow and the tide, and stratification of saline waters.We propose subdividing that portion of the Oued Loukkos estuary, which lies between the mouth of the river and 15 km upstream from the mouth, into three zones that are based on characteristics of the vertical salinity gradient Figure . , the tidal oscillation of water masses, incoming ocean swells  is also characterized by fresh surface waters being enriched with salt toward the downstream direction, while bottom waters tend to freshen heading in the upstream direction. The existence of a large vertical gradient of salinity in this area may lead to trapping and concentration of suspended sediment to create a turbidity maximum.Because of gaps in time and space in the 103 CTD casts and four continual transects, comprehensive representation of the spatial-temporal evolution salinity and temperature fields in the Oued Loukkos estuary has been difficult. However, it is clear that the characteristics of salinity in the river vary considerably between good homogeneity of salt near the mouth of the river and a significant stratification in the far inland reaches of the river. Near the mouth of the river there is no distinct halocline, or thermocline, while upstream, and especially after the third bend in the river, the differences between surface and bottom salinity can be very high, as evidenced by the presence of a distinct halocline.By combining the subdivision that we propose with different classifications from the literature, one can make a further deduction about each of the three zones.Zone 1 shows the characteristics of a mixed mesotidal estuary with practically low vertical salinity stratification.Zone 2 shows the characteristics of a partially mixed mesotidal estuary. The complex topography of the river bed in this area promotes turbulence and impacts the vertical water stratification.Zone 3 shows strong vertical stratification. This type of stratification is observed mainly in microtidal estuaries (tide range <1 m) Davies , althougThis review of the factors that influence the waters between the mouth of the Oued Loukkos and 15 km upstream has highlighted salinity-related marine influences in the estuary, and it is proposed that classification of the estuary should focus on its salinity gradient.The important characteristics of the salinity distribution in the Oued Loukkos are: 1) variations along the main axis of the estuary exhibit an along stream gradient with salinities decreasing as distance increases upstream from the mouth, and 2) vertical variations which exhibit a greater degree of homogeneity near the mouth of the river, compared to that upstream.Thus, according to the degree of homogeneity along the Oued Loukkos, we conclude that the reach of the estuary near the mouth of the river has the characteristics of a mixed estuary and after passing through an intermediate zone with the characteristics of a partially mixed estuary, the upstream (inland) reaches have the characteristics of a stratified estuary. The tidal characteristic throughout the entire Oued Loukkos estuary is mesotidal. At those times when the effect of terrestrial inputs is low compared to marine inputs, the river bed topography probably plays a role in the stratification of salinity by either disrupting the vertical stratification of the water or by changing the lateral distribution of salinity.In the opinion of the authors, the importance of these conclusions go far beyond that of having applied appropriate descriptive labels to the Oued Loukkos estuary, because it provides a valid starting point for predicting the environmental impact of future sustainable undertakings in the Oued Loukkos estuary, including recreational, agricultural and commercial activities.aFor rainfall data see, http://www.infoclimat.fr/climatologie/globale/12-octobre/larache/60105.html; accessed 9/2014.bAcquired conductivity, temperature, and pressure (depth) data were stored on an internal 64 MB flash card and later transmitted in ASCII to an external computer for processing and analyses. The instrument accuracies are 0.002°C for temperature, 0.0003 S/m for conductivity and 0.1% of full scale range for depth, with resolutions that are one-percent of the accuracies .


If socio‐economic disadvantage is associated with more adolescent smoking, but less participation in tertiary education, and smoking and tertiary education are both associated with heavier drinking, these may represent opposing pathways to heavy drinking. This paper examines contextual variation in the magnitude and direction of these associations.Comparing cohort studies.United Kingdom.n = 15 672), the British birth cohort study  and the West of Scotland Twenty‐07 1970s cohort .Participants were from the 1958 National Child Development Study  and heavy drinking (> 14/21 units in past week) in early adulthood (ages 22–26 years). Parental occupational class  indicated socio‐economic background. Education beyond age 18 was coded as tertiary. Models were adjusted for parental smoking and drinking, family structure and adolescent psychiatric distress.P < 0.001 for both) than respondents from a non‐manual class. Adolescent smokers were more likely to drink weekly in adolescence  and more likely to drink heavily in early adulthood  than adolescent non‐smokers. Respondents who participated in tertiary education were more likely to drink heavily in early adulthood  than respondents with no tertiary education. With some variation in magnitude, these associations were consistent across all three cohorts.Respondents from a manual class were more likely to smoke and less likely to enter tertiary education  despite socio‐economic background being associated in opposite directions with these risk factors. Socio‐economic inequalities in excessive alcohol consumption are inconsistent in both adolescence Young people from a disadvantaged SEP are more likely to smoke, and to start smoking earlier The second pathway examined here is tertiary education . Young people from more advantaged backgrounds are more likely to enter tertiary education Contextual heterogeneity may occur either in the associations between SEP and these mediating factors (smoking and tertiary education) or in the associations between those mediators and drinking. Therefore, these pathways are explored with data from three different cohorts: the UK 1958 National Child Development Study (NCDS58), the 1970 British Birth Cohort Study (BCS70) and the 1970s cohort of the West of Scotland Twenty‐07 Study (T07). NCDS58 and BCS70 include people from across Great Britain born 12 years apart, comparing different historical contexts within the same geographical area. T07 respondents were from approximately the same time‐period as BCS70, but from the specific geographic context in and around Glasgow, a large urban city which had been experiencing rapid deindustrialization.Variation in associations between SEP and mediating factors might be expected in the United Kingdom between the two time‐periods examined, as labour markets shifted from manual to non‐manual occupations Heterogeneity might also be expected in associations between these mediating factors and drinking. Alcohol has become more available in the United Kingdom between the two time‐periods examined a disadvantaged socio‐economic background will be associated with a higher likelihood of adolescent smoking which, in turn, will be associated with heavier drinking in adolescence and early adulthood;an advantaged socio‐economic background will be associated with a higher likelihood of participation in tertiary education which, in turn, will be associated with heavier drinking in early adulthood;socio‐economic background will be associated more strongly with smoking and tertiary education in more recent cohorts, and most strongly in T07; andsmoking and tertiary education will be associated more strongly with drinking in the two more recent cohorts.The aim of this paper is to investigate two pathways (smoking and tertiary education) between SEP and drinking in adolescence and early adulthood. We compare three UK cohorts representing different historical and geographical contexts. Specifically, we hypothesize that:NCDS58 follows children born within Great Britain in 1958 BCS70 is similar to NCDS58, following a cohort born within Great Britain in 1970  was representative of the population within the sampled area n = 1181; mean age = 21.7 years).T07 has followed three cohorts of people from in and around Glasgow for 20 years n = 332). In early adulthood, respondents in all three cohorts reported their past week's drinking, and numbers of alcohol units were derived. Drinking in excess of 14 units for women and 21 units for men Drinking was self‐reported in all cohorts in adolescence and early adulthood. Weekly drinking in adolescence was based on reported alcohol consumption within the last week  or drinking frequency . In BCS70, data from the question on frequency were preferred over past week consumption , but the latter was used if frequency data were missing . For parental drinking: in NCDS58 interviewers at age 7 indicated whether the family suffered from problems with alcoholism; in BSC70 parent or child reports of a parent drinking ‘three or four times a week’ or more or on ‘most days’ were coded as heavy parental drinking; and for T07 either parent consuming more than 14 units (women) and 21 units (men) was coded as heavy parental drinking. Family structure distinguished between single‐ and two‐parent families. Adolescent psychiatric distress was indicated by the 12‐item General Health Questionnaire in BCS70 and T07, with scores of 3 or more indicating psychiatric distress Figure Respondents within each cohort had missing data, so multiple‐imputation and inverse probability weighting were employed Table Response rates in adolescence 81.5–100.0%) and early adulthood (70.7–80.0%) were reasonable. However, additional item‐non‐response among participants in each survey  meant that there were relatively low proportions of respondents with complete data on all analysis variables: 36.2% in NCDS58, 19.5% in BCS70 and 61.7% in T07. Nevertheless, as Table .5–100.0%P‐values are presented in Supporting information, P < 0.05). Results from sensitivity analyses with income or education as measures of SEP were largely consistent .Adolescent smoking was more likely for respondents from manual than non‐manual households. The association was stronger in T07 than in NCDS58 and BCS70 (P < 0.05). Adolescent smoking was associated independently with heavy drinking in early adulthood, but between‐cohort differences in this association were not significant.Adolescent smoking was associated with more adolescent weekly drinking. This association was stronger in BCS70 and T07 than in NCDS58 . Tertiary education was associated with heavier adult drinking, and this association was stronger for females than for males (P < 0.05).Respondents from manual compared to non‐manual households were less likely to participate in tertiary education. The association was strongest in NCDS58 and weakest in BCS70 .Associations between adolescent smoking and drinking are consistent with previous research Associations between tertiary education and heavier drinking are also observed commonly Despite the smoking pathway, results consistently showed more frequent drinking among more advantaged adolescents, prior to entry into tertiary education. This finding suggests that there may be other pathways associated with socio‐economic advantage, besides tertiary education, which lead to heavier drinking. For example, alcohol may be more available in more advantaged homes and families Hypotheses regarding contextual variation in the strength of smoking and tertiary education pathways were only partially verified: differences in the associations between socio‐economic disadvantage and smoking or tertiary education were only present for parental occupational class, and not replicated in analyses using income or parental education. Additionally, even for parental occupational class the association between background SEP and tertiary education was strongest rather than weakest in NCDS58 .There was a stronger association between adolescent smoking and adolescent drinking in the two more recent cohorts, as hypothesized, but if this was due to increases in alcohol availability then it is not clear why a similar difference was not seen for associations with early adult drinking. Perhaps changes in societal availability matter more for those below the legal drinking age, who are generally more constrained in their opportunities for consumption.Measurement differences may account for some of the differences in findings between the cohorts. The self‐report drinking measures were not ideal. They would not have captured the full complexity of drinking patterns (e.g. episodic binge drinking might not have been well represented), and may have led to under‐reporting. T07, where reports were given in the home (but not with parents present) had lower prevalence of adolescent drinking than NCDS58 and BCS70 where adolescent measures were administered in schools. Age differences in reporting may be important as heavy drinking in early adulthood, especially among students, can be age‐limited, with recovery to moderate levels within a few years Interventions focused on reducing excess drinking during tertiary education may be effective at reducing the prevalence of heavy drinking in early adulthood but target a population with more advantaged socio‐economic backgrounds, while ignoring those who drink heavily outside tertiary education . Interventions focused on pathways common to smoking and drinking may tend to benefit more disadvantaged young people. Further research might explore a wider range of pathways and contexts in order to understand more clearly the pathways that lead to heavy drinking in different socio‐economic circumstances, and lead towards designing interventions tailored to people's different backgrounds. Pathways for further study might include: availability of alcohol (within the home and society more broadly); family drinking practices; the role of social norms; externalizing behaviour; and challenges associated with transitions into adulthood.None.Table S1 Drinking and Smoking questions by cohort.Table S2 Additional measures included in imputation models.Table S3 Probit Coefficients, standard errors, 95% confidence intervals and P‐Values from models with Parental Occupation.Table S4 Probit Coefficients, standard errors, 95% confidence intervals and P‐Values from models with Parental Education.Table S5 Probit Coefficients, standard errors, 95% confidence intervals and P‐Values from models with Income.Supporting info itemClick here for additional data file.Supporting info itemClick here for additional data file.Supporting info itemClick here for additional data file.Supporting info itemClick here for additional data file.Supporting info itemClick here for additional data file.


With optimal conditions, the proposed probe P showed good selectivity to Mg2+ compared to other common metal ions, and worked in a wide linear range of 5.0 × 10−7–6.0 × 10−6 M with a detection limit of 1.7 × 10−7 M Mg2+ in ethanol-water solution .A new Mg Before spectroscopic measurements, the solution was freshly prepared by diluting the high concentration stock solution to the corresponding desired concentration. For all measurements, excitation and emission slit widths were 10 nm, excitation wavelength was 385 nm.Metal ions and probe 3.3.1.P to Mg2+. As shown in P can be negligible in the range pH 4–11. After the addition of Mg2+ to the solution of probe P in the range of pH 4–11, the emission intensity at 460 nm rapidly increased to a maximum. For pH values smaller than 8.0, the emission intensity was significantly less than that for the high pH values, indicating poor stability of the Mg2+-P complexes at low pH. The pH-control emission measurements revealed that probe P showed the best respond to Mg2+ at pH 10.0. Therefore, further UV-vis and fluorescent studies were carried out in ethanol-water solution .A pH titration experiment was performed first to investigate a suitable pH range for the sensing of probe 3.2.2+ to the solution of P (10 μM) in ethanol-water solution  caused an obvious spectra change in the UV region  of P (10 μM) were investigated in ethanol-water solution  with the addition of respective metal ions (100 μM)  . Study s2+ and P, a fluorescence titration experiment was carried out. The result showed that the fluorescence intensity of P was enhanced upon addition of various amounts of Mg2+ in ethanol-water solution  as depicted in P was employed at 10 μM level, the fluorescent intensity of P was proportional to the concentration of Mg2+ in the range of 1.3 × 10−6 to 1.0 × 10−5 M with a detection limit of 4.2 × 10−7 M Mg2+. This clearly demonstrated that probe P could sensitively detect environmentally relevant levels of Mg2+.To further investigate the interaction of Mg3.4.P with Mg2+, the Job's plot experiment was carried out, and the result indicated that a P-Mg2+ complex was formed in 1:1 stoichiometry  mechanism and greatly enhanced the fluorescence of the proposed probe.Thus, according to the obtained results, the reaction mechanism between 4.2+ in ethanol-water solution . We believe that these observations should serve as the platform to develop new probes for other metal ions.In summary, a simple structure probe was synthesized facilely. This new fluorescent probe showed significant fluorescence enhancement in presence of Mg


Analyses of inpatients' accounts have shown that participants endorse complex and conflicting attitudes toward their experiences in eating disorders wards, yet the apparent ambivalence that characterizes inpatient experiences has not been subject to critical examination. This paper examines the narrated experiences of 13 participants  with past or present anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified, who had been hospitalized in an inpatient eating disorders ward for adults in central Israel. The interviews, which took place in 2005–2006, and again in 2011, were part of a larger longitudinal study exploring the subjective experiences of eating disorders and recovery among Israeli adults. Employing qualitative analysis, this study finds that the participants' accounts were concerned with dynamics of difference and belonging, as they played out in various aspects of inpatient care, including diagnosis, treatment, relationships with fellow patients and staff, and everyday life in hospital. Notably, participants simultaneously defined themselves as connected to, but also distinct from, the eating disordered others who formed their reference group at the ward. Through negotiating a protectively ambivalent positioning, participants recognized their eating disordered identities and connected with others on the ward, while also asserting their non-disordered individuality and distancing themselves from the potential dangers posed by ‘excessive’ belonging. The paper suggests that this ambivalent positioning can usefully be understood through the anthropological concept of  Dedicated inpatient care for eating disorders has profound impact on patients' embodied practices and lived realities. Marked by the strict regulation of patients' dietary intake and physical activity, the routine measurement of patients' physiological markers , and the continuous surveillance of patients' engagement in seemingly mundane activities (e.g. nursing staff observing patients as they watch television programmes in the common room), inpatient treatment for eating disorders alters patients' everyday ways of being-in-the-world.A number of qualitative studies have analyzed the treatment experiences of women and adolescent girls who had been hospitalized in inpatient eating disorders wards. Some studies focused on specific elements of treatment, such as mealtime  . The 13 participants comprised a subset of the total purposive sample, which targeted people who had eating disorders, regardless of treatment experiences. All 13 participants were hospitalized in the same inpatient eating disorders ward for adults in central Israel. One additional participant was also hospitalized in the same ward; however, since this participant said she was traumatized by her multiple hospitalization, the author chose not to pursue further discussion of her inpatient experiences, and therefore excluded her from this subsample. Of the 13 participants included in the present paper, nine were interviewed again in 2011; two of the participants interviewed in 2011 were hospitalized between the two phases of the study. There was no notable difference in hospitalization-related themes between the four participants who were interviewed only in 2005–2006, and those who were interviewed again 2011.DSM-IV-TR) . Twelve participants were hospitalized with a diagnosis of anorexia nervosa or its subclinical variants . The author contacted these participants after they had given their initial agreement to the key participant, explaining the study to them and what it would entail, and asking them afterwards whether they would agree to participate. The participants who were recruited through the discussion board were not approached directly. The author posted three public messages concerning the study, inviting anyone who would like additional information to send a confidential message to her through the discussion board's private messaging system. The first phase of the study was approved by the University of Oxford's Social Sciences and Humanities Inter-Divisional Research Ethics Committee , and was also approved by the Israeli Kupat Holim  Helsinki Ethics Committee (August 2005). The second phase of the study received approval from the University of Oxford's Social Sciences and Humanities Inter-Divisional Research Ethics Committee (February 2011), and did not require separate Helsinki Ethics Committee approval. In order to ensure informed consent, the author explained the study to all potential participants before asking them whether they wished to participate, and provided detailed information sheets and consent forms at the beginning of each interview, either in Hebrew or in English. The participants provided written consent for this study. All names used in this paper are pseudonyms, and identifying details have been concealed or altered to ensure confidentiality.Data for the study were collected through in-person semi-structured interviews. The majority of initial interviews during the first round of fieldwork opened with the same question (‘when and how did it begin?'), which framed the participants' narratives. The author then followed with questions that further explored each participant's initial narrative, with emphasis on sensory experience (e.g. ‘how did you feel when you ate?’) and meaning-making (e.g. ‘why do you think you expressed yourself through food?’). During the second round of fieldwork, the author opened each interview by asking each participant what she remembered about the time in her life when the first interview took place; the interviews then focused on exploring the unfolding of recovery and chronicity processes over the intervening years, and the meanings thereof. Interviews ranged in length according to each participant's preferences and availability, ranging from approximately 30 minutes to 4 hours in length. However, some participants were interviewed more than once within the same interview cycle, such that, for example, the participant whose first interview lasted 30 minutes was then interviewed two weeks later for an additional hour.The study was designed to include people outside inpatient settings, and most interviews were thus retrospective, taking place months or years following hospitalization. Accordingly, the majority of interviews took place either in participants' homes or in public places of their choice (cafes and parks). However, two participants had been hospitalized in the eating disorders ward during the period of the study, and the author met with them on site. As both had multiple experiences of hospitalization at the ward, their narratives included a mix of retrospection and immediacy.The interviews were digitally recorded and supplemented with written notes; the author transcribed the recordings, and translated the transcripts from Hebrew to English; during the process of translation, the author noted Hebrew-specific phrasings  to make sure that interpretations accurately reflected locally nuanced meanings.For this paper, the author used a modified form of interpretative phenomenological analysis (IPA) to explore the participants' subjective experiences of inpatient care  revealed that only two new subthemes were introduced in the last two sets of interviews. Notably, one of these subthemes concerned hospitalization after giving birth – a unique experience in this sample. As the majority (∼80%) of subthemes occurred in interviews with the first seven participants, and given the relative homogeneity of the group , it is possible to conclude that saturation was reached , dynamics within the inpatient community (‘seeing the self in others’ and ‘dangerous others’), and boundaries vis-a-vis the ‘outside’ world and one’s own illness (‘sheltering boundaries’ and ‘oppressive boundaries’) ; and much like an academic degree, her eating disorder had to be certified by an authoritative body. Turning to the author, she said,As narrated by the participants, the sense of legitimacy and recognition conferred by clinical authorities encompassed both the Just like you, you know, worked really hard, [and] with blood, sweat, and tears got those two degrees of yours, [then] I'm not worthy of this title, I didn't spend enough on it… not enough blood, not enough tears, not enough suffering. (Vered)Although eating disorder ‘titles’ could be conferred by any clinical authority, admission into inpatient care provided substantial recognition. For those participants who had been hospitalized, inpatient hospitalization itself emerged as a form of ‘naming’ and recognition of their eating disorder and their suffering. Narrating her initial admission into the eating disorders ward, Tali said that, after receiving her notice of ‘acceptance’,I told my mom I didn't want to eat, so I would come [to the ward] as thin as possible… because what if they don't accept me? What if I gained a kilo? This quote underscores both the tenuousness of Tali's perceived status as a ‘legitimate’ anorectic, and the extent to which she sought the recognition provided by inpatient care. Along similar lines, when the author asked Emily if she defined herself as anorexic, she used the fact of inpatient treatment to quell her doubts about being a ‘good anorexic’, employing the clinicians’ judgment as arbiter of truth:… on the one hand, I'm not thin enough/don't starve myself enough/don't-know-what enough to be anorexic.... [but] on the other hand you say, well, there's no way I'm doing this, like, on purpose… and, after all, I was hospitalized twice at [the eating disorders ward], so there's probably something there. And then you say, alright, maybe I am. (Emily)Eating disordered identities were subject to constant negotiation. They were ‘slippery’ identities – not simply achieved and established, but dependent on continuous justification and work. Hospitalization became part of this identity work.While admission into inpatient care provided authoritative recognition, a sense of legitimized identity involved the continuous acknowledgment of the patient as an individual – not merely as a bearer of an eating disorder diagnosis. For Grace, who had been hospitalized for five months continuously, the sense that clinical staff tacitly understood her was part of this legitimizing process:They knew about me much more than I knew about myself… things that even I wasn't aware of, but that they could see from the outside.... It always gave me a good feeling – that I don't have to talk and they still know. (Grace)Like the other participants who provided positive descriptions of care at the ward, Grace alluded to interactions with staff in which she received individualized care. In part, she said, the clinical staff's understanding of her as an individual was informed by their understanding of her as a sufferer of anorexia nervosa and obsessive-compulsive disorder. However, as other participants' accounts revealed, such diagnostically-informed understandings were also associated with experiences of being de-legitimated. Specifically, in those accounts, the sense of being treated as part of a collective rather than as an individual emerged as critical component. When Zoey explained why she deemed her hospital stay unsuccessful, she said she felt lumped together with other patients:The specifics, they don't relate to in [the ward]…. The specifics of the individual experience that you are having as a person. They take you as like, you know, you have the symptoms here, you all have them. (Zoey)Elsewhere in her narrative, Zoey related the sense of validation she felt at intake, when clinicians at the ward told her she was diagnosed as anorexic. However, during treatment, she felt the diagnosis overshadowed who she was as a person. Critiquing the staff's lack of attention to ‘specifics’, Zoey drew parallels between the binaries of collective (eating disordered) versus individual (self), and superficial (symptom-focused) versus deep (experience-focused) treatment.For some participants, the sense of being treated as part of an eating disordered collective and de-legitimated as an individual became tangible in specific episodes of treatment. Danielle, who had a gastrointestinal emergency while hospitalized for her eating disorder, expressed frustration at having been mistrusted when she first complained to staff:When I was at [the ward] and I had a [GI condition] and it was really painful, and they told me, no, it's psychological because they raised your [calorie intake].... They didn't believe me until they found me, fainted.... That's what annoys me, that they don't trust you. (Danielle)Danielle said that, in hospital, she felt her entire experience – physical and psychological – had been subsumed under the umbrella of her eating disorder: having been told that her disorder was ‘talking’ Use of nasogastric feeding was part of the treatment protocol for those underweight patients who could not consume the necessary amount of calories otherwise. But, for Emily, the clinicians' decision to resort to the nasogastric tube was a sign of misalignment between who she was as an individual and how she was perceived as a patient, a contrast between her goal of living (‘learn[ing] to live with’ her eating disorder and pursuing her studies) and the clinicians' encouragement that she focus on surviving.The participants expressed ambivalence about the unique social environment constructed by the ward, where they shared their everyday lives with twenty other people with eating disorders. Although participants said they found social belonging on the ward, they also spoke of this belonging as putting them at risk for over-identification and intensified illness.The experience of encountering, interacting, and indeed living with a group of people with eating disorders was central to participants' accounts of inpatient settings. As participants described it, being hospitalized alongside fellow sufferers was a formative experience, one in which the previous solitude of living with an eating disorder was replaced by community. For some participants, the inpatient community functioned as a core element of treatment. As Alon explained,[g]etting there, and sitting in groups, and hearing people talking about things that you're also going through – there's something very powerful in this, in this sense of ‘I'm not alone'… [we] feel like, we're all dealing here with a similar demon, and there's some sense of shared destiny. (Alon)The power of this patient community, however, went beyond group therapy. For Alon, as for other participants, inpatient treatment provided a space for making close and lasting friendships that continued for years after his time at the ward. Such friendships were created and cultivated through a sense of camaraderie – forged not only by the shared experience of inpatient experience, but also, and more importantly, through the shared practices, perceptions, and sensations of eating disorders:I always said that when you're sitting at the dining hall and you're spreading a bit of your cheese on the edge of the plate… a person who has an eating disorder will notice and understand it. And that is what I loved so much there, that everyone spoke my language…. Beforehand, I felt so alone, because I felt that no one understood what I was feeling, no one understood what I was saying, no one thought like I did. (Grace)With this seemingly mundane dining hall scene, Grace conveyed a sense of connection with the patient community that extended beyond speech and toward embodied practice – a shared way of being-in-the-world. Recognizing her own experience in the gestures and words of others, Grace said she felt mutual understanding and belonging for the first time in her adolescent and adult life.Central to the sense of connection participants found at the ward was the experience of seeing the self in others. For Alon, this experience inhered in a sense of ‘shared destiny’; for Grace, it was in shared embodied practice. While other studies on eating disorders discussed the importance of finding connections within an eating disordered community, whether in clinical settings Other patients were not merely ‘mirrors’ to Emily's own reality. Rather, she was able to recognize shared practices and experiences, and then situate herself apart from them. The presence of other women with eating disorders allowed Emily to alter her own positioning, to become an observer of the ‘other’ – and, by extension, of the self-as-other – and thereby begin to think of her eating disorder as a condition to externalize.Seeing the self in others, however, did not always promote a sense of wellbeing; for some participants, the very ‘others’ with whom they were linked posed a source of danger from within. More than half of the participants said they felt triggered by being in close proximity to very ill people, observing their appearance, and witnessing their everyday practices. For some, this triggering effect was expressed in the acquisition of new eating disordered practices. Aya, who had been hospitalized for anorexia nervosa, restricting type, described herself as ‘relatively normal’ compared to her fellow patients, and said she ‘learned’ food-related ritualistic behaviours at the ward, ‘because you see everyone making rituals and I felt very strange’. After she was discharged, she began vomiting to purge herself – a development she also related to the patient community: ‘it's something I learned… there was a reason that it seemed kind of alright to try [it] when I got out of there'.Whereas Aya related her acquisition of eating disordered practices to striving for belonging in the patient community, other participants said the community triggered disorder-supportive desires. Natalie, who was hospitalized for anorexia nervosa, said she felt triggered by the very sight of emaciated patients:When you reach a condition that's relatively healthy and fine and you're halfway there… suddenly a girl who weighs 20 kilos shows up… I don't want to see it…. It's not that it's the sick side [of me], it's like – it's the side I never had. So why do I need to get acquainted with it? Earlier in her narrative, Natalie said that, while she used to think her thoughts and practices were unique, upon entering treatment, she discovered that others had lived through the exact same experiences. She also said she developed close friendships with some of her fellow patients. Yet, the same connections which brought together the patient community also implicated kinship between Natalie and the critically ill – a kinship which Natalie felt endangered her own drive to recovery by suggesting possibilities, and indeed awakening desires for extremes of eating disorder which she had not yet experienced.Like Natalie, other participants said they felt deeply unsettled when confronted with the varieties (particularly the extremes) of the eating disordered experience. As the ward provided patients with a reference group, it also, by extension, provided them with a new range of possibilities for eating disordered practice. For example, Danielle said she felt endangered in the group when other women spoke of suicide attempts and desire for eating disorders: ‘I felt I was being dragged back more than going forward’. Vered said she felt her own claim to illness was de-legitimized when one patient told her of a former patient who worked as a fitness instructor while starving herself, but continued to feel strong: ‘I suddenly began to feel jealous, like, it's not enough that I reached this weight and did all that, now I have another goal, I also have to mortify myself and feel strong despite everything'. And Yif'at, who said eating disorder concepts were ‘dripping into [her] brain unconsciously', said that being exposed to a variety of motivations for eating disorders at the ward allowed her to change her own motivations – from desire for disappearance to desire for slimness – and thereby sustain her practice by adopting a concept of eating disorder more commensurate with her current lifestyle. The participants, notably, did not say they actively sought out ‘tips and tricks' from other patients As Alon described it, the ward's dietary regime provided a ‘clear’ anchor, a means of letting go of obsessive engagements with food. His eating disordered practice, then, was displaced away from his daily routine and into a designated space with its own rules. Alon added, however, that months after completing his hospital stay, when facing the choice of whether or not to be hospitalized a second time, he decisively chose outpatient treatment in the community.For other participants, it was not only the ward's regime that provided comfort, but also the ward's very separation from the outside world – spatially, temporally, and relationally. Tali, who continued to reminisce about her time on the ward years after she had been hospitalized, said:I didn't want to leave, I didn't want to leave, no one wanted to leave… as difficult as it was, there were many difficult things, but – but it was sort of a greenhouse. In Israel, the word ‘greenhouse’ is a commonly used descriptor for places or situations that care for, and perhaps overprotect, their (often young) charges. In using ‘greenhouse’ to describe the ward, Tali alluded to its status as a bubble, bounded and sheltering from the outside world, yet not sustainable for the long term. Notably, although Tali said she did not want to leave, elsewhere in her narrative, she also related an anecdote of a threat she had made, early in her hospitalization, to leave the ward – after which, Tali said, she chose to remain in hospital. Along similar lines, when Grace described the ward, she chose the word ‘lab’:It was a little lab like that, that you could be inside…. A lab in the sense that it was very sterile, it was – very very exact and measured conditions, and – you knew that you, it's not like the real world, so it eased [our burden]. (Grace)Through its precision, regimented living, and inward-looking ethos, the ward, for Grace, provided a time and space apart. At the same time, Grace said she kept her suitcase packed for the entire duration of her inpatient stay: ‘I was always with one foot out’. Like Grace and Tali, Meital, who had been hospitalized twice, said she did not want to leave the ward following her first inpatient stay. Meital, however, described the ward neither as a ‘greenhouse’ nor as a ‘lab’, but as a platform for maturing and individuating:The first hospitalization (laughs) – it funny to say but I enjoyed it. Like, suddenly I had friends, and it was really pleasant, and it was also, somehow, [a way of] getting out of home, something that I wanted. I wanted my privacy and my independence and I had it there. The ward, as Meital described it, provided a space and time for accelerated growth; within its walls, she found not only a group of friends, but also boundaries from her family home.While some participants cited the ward's boundaries as providing shelter and comfort, those same boundaries also emerged as oppressive in other accounts. As discussed above, Meital described her first hospitalization as a positive experience that provided her with space for growth. When she returned to the ward a second time, however, her sense of the ward's boundaries had inverted:The second hospitalization, in comparison, was very traumatic. I felt really bad there. I couldn't find myself… Being in a closed ward with very tough discipline, very clear rules, where they decide for you when you'll eat, when you'll have time for breaks, like – it didn't suit me anymore. I needed my freedom, to decide on my own structure. Although the ward itself had remained the same, what changed, according to Meital, was her emerging desire for freedom. The independence she had craved – and which she felt the first hospitalization provided her – now led her to experience the ward as oppressive. Indeed, some participants' perceptions of ward life were linked to their sense of maturity. For example, Zoey, who was in her 30 s when she entered the ward, explained that, unlike other patients, she had ‘achieved things’ and ‘somehow had combined doing my adult life and being sick’; when she described her experience of ward regimes, she said: ‘[i]t was a horrible programme for me – forcing me to do anything is not good for me’. It should be noted, however, that Zoey chose to complete her treatment programme in full.Like Zoey, Meital, and other participants, Vered described the rules of the ward, and the ward's very confines, as disempowering. Vered, who had an infant daughter, said she felt dispirited and exhausted by the treatment regime:Even though I feel that I progress a lot and such, I'm really sick of this.… It's very very difficult for me, this distance from [my daughter], from my home…. Being here, eating this diet, I have no strength anymore, I'm tired already.(Vered)Unlike some of the younger patients, Vered felt strongly linked and committed to the outside world through her daughter, such that the ward's regime, and her abiding by it, became oppressive, alien, and even absurd – ‘eating this diet’ juxtaposed to separation from her infant child.The participants expressed ambivalence about the identities, social environment, and regimented living constructed by the ward. In their narrated experiences of inpatient care, participants described clinical recognition of one's eating disorder as both affirming and reductive, fellow patients as both supportive and dangerous, and the boundaries of the ward as both protective and oppressive. These themes were consistent with findings from previous studies on the experiences of inpatients in eating disorders wards. This is particularly notable given that this study is the first to examine inpatient experiences in Israel, with previous studies having been situated in the United Kingdom. Gooldin 2002  argues tWhile this study supports findings from other published studies, the analysis of ambivalence as embedded in the social and institutional setting of the inpatient ward highlights the patients' central concern with difference and belonging – a concern that has not been addressed previously. Colton and Pistrang 2004 , Offord liminality – being ‘betwixt and between’  and existential , has been analyzed as liminal – set apart from the ‘outside’ world, located at the margins of defined being. Several analyses have explored how the hospital, as a liminal space, creates distinct land- and sound-scapes of clinical care – alternative sensory worlds that permeate one's own experience and self-definition as a patient , the participants were confronted daily with a reference group defined by clinical authorities. This group, as their accounts demonstrated, was a source of ambivalent engagement, at once compelling and dangerous: promising recognition but also threatening one's individuality, potentiating friendship and de-marginalization but also the possibility of further illness and disconnection from the ‘outside’.part of, and apart from, the patient community – was expressed in their experiences of treatment. While being recognized as eating disordered was a validating aspect of treatment, being treated as part of an eating disordered collective was not. Likewise, while participants spoke positively of finding connections on the ward, seeing the self in eating disordered others could pose dangerous possibilities for illness. And while the ward's structure and rules could offer positive detachment from the exigencies of daily life, those same structures and rules could be oppressive when they trampled on an individual's sense of independence and connectedness with the outside world.The participants' negotiation of liminal identities – both a Conflicting attitudes toward treatment, then, reflected more than patients' capacities for or ambivalence toward recovery (Williams and Reid, 2010 The study had several limitations. With the great majority of participants, interviews took place years after their treatment at the inpatient ward had ended, such that their narrated experiences of hospitalization were retrospective. Moreover, as inpatient hospitalization was not the central focus of the study, and as the interview style allowed for variations according to each participant's engagement, the length and depth of the participants' accounts of inpatient experience varied; two of the 13 participants provided only cursory accounts of their inpatient experiences, and the narratives of the other eleven participants had to be privileged in the analysis. In addition, while all participants in the subsample of 13 had been hospitalized in the same adult eating disorders ward, there were considerable variations in their length of stay, number of past hospitalizations, and other experiences of inpatient and outpatient care. And, while the ward provided inpatient treatment for the entire spectrum of eating disorders, including bulimia nervosa and binge eating disorder, all but one of the 13 had been hospitalized for anorexia nervosa or its subclinical variants. It should also be noted that the author was acquainted with one of the thirteen participants before beginning this research project – a common occurrence in anthropology. Although the author did not know the details of this participant's eating disorder experience prior to the study, this participant's interview process may have been influenced by some foreknowledge. Finally, it is important to highlight that the data collection and analysis were conducted by a lone researcher; while this is an accepted and widespread practice in anthropology, it does preclude validity checking through intercoder reliability.This study examined the narrated experiences of 13 people who had been hospitalized in a dedicated eating disorders ward for adults in central Israel. Focusing on inpatient experiences of ambivalence as embedded in the social and institutional setting of the ward, the analysis highlighted the participants' central concern with difference and belonging. The participants simultaneously defined themselves as part of, but also distinct from, the eating disordered patients who formed their reference group at the ward. Through this ambivalent positioning, participants could affirm their eating disordered identities and connect with others on the ward, while also asserting their non-disordered individuality and distancing themselves from the potential dangers posed by ‘excessive’ belonging. The findings suggest that future research should explore inpatients' ambivalence as potentially protective, rather than disruptive, and that directly acknowledging and normalizing inpatients' feelings of ambivalence might benefit patient-provider communication and treatment programme completion.


Evidence supporting performance enhancing effects of kinesiotape in sports is missing. The aims of this study were to evaluate effects of kinesiotape applications with regard to shooting and throwing performance in 26 amateur soccer and 32 handball players, and to further investigate if these effects were influenced by the players’ level of performance. Ball speed as the primary outcome and accuracy of soccer kicks and handball throws were analyzed with and without kinesiotape by means of radar units and video recordings. The application of kinesiotapes significantly increased ball speed in soccer by 1.4 km/h (p=0.047) and accuracy with a lesser distance from the target by −6.9 cm (p=0.039). Ball velocity in handball throws also significantly increased by 1.2 km/h (p=0.013), while accuracy was deteriorated with a greater distance from the target by 3.4 cm (p=0.005). Larger effects with respect to ball speed were found in players with a lower performance level in kicking  and throwing  compared with higher level soccer and handball players . In conclusion, the applications of kinesiotape used in this study might have beneficial effects on performance in amateur soccer, but the gain in ball speed in handball is counteracted by a significant deterioration of accuracy. Subgroup analyses indicate that kinesiotape may yield larger effects on ball velocity in athletes with lower kicking and throwing skills. In recent years a novel concept of kinesiotape (KT), also known as dynamic or medical taping, has gained interest in sports and many areas of general medicine as well as physiotherapy. For various competitive and recreational sports such as soccer, handball, volleyball or baseball, KT represents an additional part of prevention, rehabilitation, exercise therapy and performance optimization . SimilarIn sports like soccer and handball, muscle strength is a key component that determines physical performance of an athlete, with shooting and throwing velocity and accuracy being most important for success. For example, maximizing the hip flexor and knee extensor moment seems to be an important factor for increasing foot velocity on impact and thus, allows to attain maximum ball speed in soccer . SimilarEvidence for facilitating effects of KT applications both in the lower and upper extremity in healthy subjects remains controversial, as recent studies failed to demonstrate any changes in peak torque and surface electromyography (sEMG) activity of the quadriceps muscle in women , non-injIn contrast, some studies reported a significant increase in peak torque by KT both in the lower  and uppeIn addition to a potential increase in muscle tone, only few studies evaluated the potential impact of KT in sports specific performance. Though facilitation effects could be demonstrated in the calf muscles, these did not result in an increased height in vertical jumps  or perfoA total of 58 skilled male athletes were asked to participate and all of them were enrolled in this study, including 26 active soccer players aged 23.9 ±5.6 years with 15.5 ±7.1 years of playing experience, and 32 handball players at the age of 27.3 ±8.5 years with an average training experience of 13.8 ±1.2 years .Soccer players were competing in the mid-level of German amateur leagues. They participated in approximately 2–3 training sessions per week and 26–30 match days during the season. Seventeen soccer players had not previously had any experience with tape applications. Two players had experience with kinesiotape, six participants were experienced with white athletic tapes, and one player was experienced with both types of tapes.Handball players were competing in the mid-level of German amateur leagues. They practiced approximately 1–3 days per week and participated in approximately 26 match days during the season. Eighteen handball players already had prior experience with tape applications. Ten of them were experienced with kinesiotape, four of them with white athletic and four were experienced with both types of tape.All procedures of the study were in accordance with the ethical principles for medical research involving human subjects as published by the World Medical Association in the Declaration of Helsinki. Informed written consent was obtained from each person prior to the participation in this study. Exclusion criteria were acute injuries, trauma within the previous three months and any current painful conditions. During the test all participants wore their normal sportswear. Soccer players wore indoor shoes, as all tests were carried out indoor to prevent irregularities from the ground and wind.Examinations were held at the usual times of the team training between 7 and 10 pm. During the test procedure constant room temperature was guaranteed. Furthermore, participants were advised not to undergo any further tests or strenuous workouts on the day before and the day of the examination.All participants were randomly assigned to one of two groups. Randomization was performed by means of picking lottery numbers immediately before the start of the examination. This procedure prevented that the test subjects could prepare themselves for the upcoming performance with or without KT application. The first group performed the tests after application of KT and repeated them after a recreational phase of at least 60 min without KT. The second group passed the trials in reverse order.® kinesiotape  was used. All tape arrangements were put on the hairless or shaven skin by one KT-experienced physiotherapist and sports scientist. In order to achieve an increase in the muscle tone, KT was applied with a stretch of 20–30% of its original length from the anatomical origin to the insertion of the muscle. The muscles m. tibialis anterior, m. quadriceps femoris and m. iliopsoas, being active during the whole movement of shooting , measuring 1 × 1 m, was used as a target and fastened in the right upper corner of the goal. A crosshair in the center of this target was surrounded by four circles within a distance of 10 cm. Again, 7 throws were analyzed.http://www.virtualdub.org) allowed for a one-by-one picture analysis of the video recordings in order to locate the ball contact in the Perspex target or the soft floor mat and the wooden plank. The video image showing the impact of the ball was subsequently analyzed digitally to determine the distance from the target to the nearest centimeter.Ball velocity (km/h) in soccer and handball was determined by means of a radar device . For accuracy analysis in soccer and handball, shots and throws were recorded with the help of a video camera . The "VirtualDub" software . Statistical analyses were performed using the IBM SPSS Statistics version 22  and included testing for normal distribution and homoscedasticity by means of the Shapiro-Wilk and Levene’s test, respectively. As the requirements of normal distribution and homogeneity of variance were met, statistical analyses were performed using the t-test for paired samples. The alpha-level for significance was set at Reliability of velocity and accuracy parameters with and without KT were estimated by calculating intra-class correlation coefficients  . TherefoFor soccer and handball, the attempt with the lowest ball speed and the corresponding value for accuracy performance was excluded from data analysis, if the sum of this shot and the standard deviation of all trials in the taped or the untaped condition was less than the attempt with the second lowest ball speed, in order to eliminate confounders, e.g. a slight but not obvious slip or a tumble before the goal shot. This resulted in 161 and 164 data sets in soccer, as well as in 183 and 183 data sets in handball for the KT and no tape condition, respectively. For each player, a mean value was calculated for velocity and accuracy in the taped and untaped condition and analyzed for evaluation of KT application effects. For distinguishing players with low or high ball speeds in shooting and throwing, the median value for the attempts in the untaped condition was calculated. Depending on these results, players were either assigned to the low or high performance group.d (d). The pooled standard deviation of both groups was calculated by the formula:Furthermore, effect statistics were calculated in order to differentiate between a beneficial, trivial or harmful effect between the taped und untaped condition according to d . To discThe probability that an effect of KT application was a decrease, trivial or an increase of the observed parameter was expressed as: <0.5% = most unlikely or almost certainly not; 0.5–5% = very unlikely; 5–25% = unlikely or probably not; 25–75% = possibly; 75–95% = likely or probably; 95–99.5% = very likely; >99.5% = most likely or almost certainly . Values Shooting and throwing with maximal velocity demonstrated good to excellent reliability in soccer (ICC=0.89 with KT and ICC=0.93 without KT) and handball (ICC=0.98 with KT and ICC=0.97 without KT). Shooting and throwing accuracy revealed generally poor reliability in soccer (ICC=0.36 with KT and ICC=−0–27 without KT) and handball (ICC=0.59 with KT and ICC=−0.34 without KT). The majority of participants felt the tapes to be pleasant or at least neutral. The players’ perceptions of the KT application on the skin are presented in In amateur soccer players, KT applications induced a significant increase in ball speed of 1.4 ±3.5 km/h with 16 of the 26 players (=62%) achieving higher average velocities . FurtherKT applications in amateur handball players significantly increased ball speed by 1.2 ±2.5 km/h with 23 of the 32 handball players (=72%) achieving higher values. The likelihood of a positive effect of kinesiotape applications was 88% , while accuracy performance simultaneously decreased with a significantly greater distance from the target of 3.4 ±6.4 cm, indicating a very likely negative effect (95%).Median ball speed without KT was 78.3 km/h in soccer and 74.8 km/h in handball players. These values were used as a distinguishing criterion for the allocation to the groups with high and low performance athletes. Low performing athletes demonstrated significant gains in ball velocities after KT applications compared with non-significant gains in high performing athletes . The oppThe purpose of this study was to evaluate the effects of kinesiotape (KT) applications on shooting and throwing performance in amateur soccer and handball players, respectively, compared to a no-tape condition. Ball velocities were considerably lower in comparison with previously published data of professional athletes for soccer kicks with 29 m/s or 104 km/h  and handCurrently, research lacks scientific support for beneficial effects of KT with regard to muscle facilitation in the upper and lower extremity in healthy subjects , being aOn the other hand, the gain in ball speed was accompanied by a questionable effect on accuracy in soccer, but a significant increase in ball speed in handball was counteracted by a very likely negative effect (95%) on accuracy performance, outweighing the benefits of increased throwing ball velocities. Due to the importance of accuracy especially in shots/throws from a larger distance, the loss of accuracy is more relevant when shots/throws from a larger distance have to be taken. Thus, a decision to use KT could be different e. g. for pivots or back players. In this context, different roles of proximal joints like the shoulder, determining the trajectory of the hand in space, and distal joints like the fingers releasing the ball have to be considered . We therThe present results indicate that especially players with lower kicking and throwing skills may benefit from KT applications in terms of ball velocity gains. To our knowledge, there is no study that had previously picked up this idea of investigating the effect of KT in different levels of performance. As the mode of action of muscular KT applications is primarily of proprioceptive nature , we assuIn this context, the application of KT in healthy amateur and professional players aiming at athletic performance enhancement has to be questioned. These athletes presumably present reasonable muscle strength levels and athleticism, where KT has little benefit. Hence, we rather assumed that KT might be a promising supportive approach in injury rehabilitation or musculoskeletal disorders, where muscle weakness and strength imbalances were common conditions. However, as we included only healthy participants, the potential benefits of KT in prevention and rehabilitation has to be addressed in future studies.Lastly, the effectiveness of a technical support like KT depends on its perception to a large extent, i.e. comfort of the tapes. A supportive technique that is uncomfortable will not be accepted by an athlete in the long run and is therefore unlikely to be implemented in the athlete’s routine, independent of a potential performance improvement. Hence, it is essential to note that only two participants in this study reported an adverse perception of KT after its application. However, subgroups were too small for further statistical analyses to evaluate the effect of KT perception on kicking or throwing performance.ICCs prove high reliability for velocity measurement in soccer and handball. In contrast, reliability for accuracy measurements is weak, reflecting the common problems with assessments of accuracy in ball games, when the aim is to shoot/throw fast and precise . InteresThe results of the present investigation demonstrate that KT applications may improve ball speed in male amateur athletes in soccer and handball. While the beneficial effect of KT on ball speed was not counteracted by a deteriorated accuracy performance in kicking with maximum effort and therefore appears worthwhile, the gain in handball throwing velocity is likely at the expense of accuracy. Thus, amateur soccer players might benefit from KT. Due to the conflicting results in the throwing performance, handball players have to balance the gain in velocity and the loss in accuracy when deciding to use KT.


The study of video games is expanding, and so is the debate regarding their possible positive and deleterious effects. As controversies continue, several researchers have expressed their concerns about substantial biases existing in the field, which might lead to the creation of a skewed picture, both in the professional and in the lay literature. However, no study has tried to examine this issue quantitatively.The objective of our study was to examine possible systematic biases in the literature, by analyzing the publication trends of the medical and life sciences literature regarding video games.We performed a complete and systematic PubMed search up to December 31, 2013. We assessed all 1927 articles deemed relevant for their attitude toward video games according to the focus, hypothesis, and authors’ interpretation of the study results, using a 3-category outcome . We assessed the prevalence of different attitudes for possible association with year of publication, location of researchers, academic discipline, methodological research, and centrality of the publishing journals.P<.001 for all). Moreover, representation of different attitudes differed according to centrality of the journals, as measured by their impact factor (P<.001).The attitude toward video games presented in publications varied by year of publication, location, academic discipline, and methodological research applied (The results suggest that context, whether scientific or social, is related to researchers’ attitudes toward video games. Readers, both lay and professional, should weigh these contextual variables when interpreting studies’ results, in light of the possible bias they carry. The results also support a need for a more balanced, open-minded approach toward video games, as it is likely that this complex phenomenon carries novel opportunities as well as new hazards. Playing video games is a worldwide, significant social phenomenon with possible effects on life and health. Two main attitudes, often polarized, have dominated the interpretation of the consequences of playing video games on well-being since the early days of research in this field , with thMany possible applications of video games, either commercial or goal-oriented (“serious games”), in the fields of health and medicine were studied in the literature: promoting health behaviors ,15, motoThese dichotomous views of video games may drive professionals to choose a dichotomous stance, either positive or negative, on video games. These stances have a major impact, especially among physicians, as they may be transmitted, in turn, to their patients and students.As video game variety, usage, content, and context are widely diverse and have become a part of modern life, Bavelier and Green stated that “One can no more say what the effects of video games are, than one can say what the effects of food are,” implying that “the devil is in the details” .Ideally, we look for science to bring forth results and data that will reveal the costs and benefits of this practically universal behavior. However, this optimistic view overlooks the fact that research only answers the hypothesis suggested. Thus, when studying new, emotion-provoking phenomena, the biases of researchers, on which the basic hypotheses are based, might affect and skew the focus of research and the interpretation of its results.Such biases have been suggested in the literature concerning video games, which might cause a disconnect between the studies’ findings and their interpretations in the public and professional literatures -26. AlonIn this study, we set forth to examine trends and possible bias in the medical literature focusing on video games, by examining trends by time of publication, country of origin, medical discipline, and research methodology. Revealing such trends may raise awareness of researcher bias, thus helping to formulate a clearer understanding of the interpretation of studies evaluating the risks and rewards of video games. We set forth to examine such biases by examining the researchers’ attitudes reflected in the study publication. By attitude, we mean “A settled way of thinking or feeling about something” .We conducted a systematic search on the PubMed database for all articles published up to December 31, 2013, using synonyms for video games : videogames, video games, “video games”[MeSH] (major and subtypes), electronic games, and “computer games.”We classified all results according to the following parameters: year of publication, publishing journal, and country of origin (based on the affiliations of the first author). Using the ISI Web of Knowledge (now the Web of Science), we added subject categories to each record, as well as the impact factor of the publishing journal. We then manually accessed each article and read all possible abstracts. If an abstract was not available, or not coherent, we accessed and read the article itself. That process allowed 3 fields to be added to each record: (1) relevance of the article was assessed (relevant/not relevant), based on the role computer games had in the study, because articles may describe video gamers as a control group or as the placebo task for a cognitive test, (2) article type was determined , and (3) attitude was assessed on a 3-category variable , based on the focus, hypothesis, and the article authors’ interpretation of the study results and conclusions. Studies hypothesizing that video games increase aggressiveness would be considered to have a negative attitude, but negative results in such a study and a conclusion encouraging doubts about the concept of video game-induced aggressiveness would be considered neutral. On the other hand, a study examining the contribution of active video games to balance rehabilitation would be classified as positive. Similarly, a study examining this issue and reporting a negative result and urging caution when implementing video games in balance rehabilitation would also be classified as neutral.We divided the process of determining the attitude of the article and ensuring interrater reliability into several steps. Initially, 4 classifiers  classified 150 articles, each of which was also examined by the lead researcher (AS); all of the researchers discussed conceptual questions. Next in the classification, each of the classifiers worked alone, while every question that arose was discussed with the lead researcher. If considerations about the classification process seemed to have generalization potential, the discussion was relayed to the other classifiers.After finishing the classification, and to ascertain reliability, a different classifier, who was blinded to the previous categorization, reanalyzed 10% of the sample, randomly selected by computer. These decisions were compared in order to examine agreement.Statistical analysis was performed using IBM SPSS version 16 software (IBM Corp). First, we examined each variable of interest. Spearman correlation examined trends over time. For categorical variables , we used chi-square analysis with a follow-up post hoc 2×3 chi-square for each of the subcategories of variables.We retrieved 3223 articles in total, of which 170 were duplicates, leaving 3053 articles. For 230 of those (7.53%), we gathered the information from the article itself, as the article had no abstract, or we deemed the abstract not to be informative enough for classification. Only 75 articles (2.46%) had no abstract and the article itself was unattainable, leaving only the title, affiliations, and PubMed’s medical subject headings (MeSH) to rely on for classification. In those cases, if the information was not sufficient, we excluded the article from the analysis. For all other articles , we based classification on the abstract. We deemed 1126 articles to be irrelevant, as video games were not the focus of the article, leaving 1927 articles, published in 300 different journals, from 64 different countries.P<.001). Furthermore, virtually all of the disagreements were either positive versus neutral or negative versus neutral. Only 1 study of the 186 in the verification process was assigned a contrasting attitude (negative-positive); thus, agreement regarding attitude direction was almost perfect .Blinded agreement between researchers on the article’s attitude was substantial  as negative-attitude publications, 301 (15.62%) as neutral, and 814 (42.24) as positive-attitude publications.r=.946, P<.001), from the first and only publication in 1980, to 312 articles in 2013 , from 1 out of 279,486 (0.00049%) in 1980, to 312 out of 1,136,703 (0.027%) in 2013, for growth by a factor of 55.1 , while the number of positive and neutral publications increased  , we excluded these years from this specific analysis only, as even a single article would create a major shift in the said year. As the years progressed, the proportion of negative publications dropped (ctively) .As we excluded the first 19 years of video game studies due to the scarcity of articles each year, we analyzed those years in 2 large fragments: 1980–1989 and 1990–1998.Over the first 10 years of research, 34 articles were published, 19 (56%) of them with positive attitude, and 11 (32%) with negative attitude. Over the next 9 years (1990-1998), an additional 67 articles were published, 25 (37%) of them with positive attitude and 32 (48%) with negative attitude.P<.001). A post hoc test of 2×3 chi-square revealed a significant increase in positive articles  in the United States (P<.001) and Canada (P=.045) and a decrease in positive articles  in Asia (P<.001) (P=.05).As 64 different countries contributed to the pool of articles dealing with video games, we grouped countries according to location . We combined groups of countries that contributed fewer than 100 articles into 1 group, leaving 6 regions: Australia, Canada, Europe, Asia, United States, and other. A chi-square test revealed a significant association between attitude distribution  and the region from which the article originated ((P<.001) . In EuroUsing subject categories, as defined by the Journal Citation Reports , we classified articles by discipline according to the journal in which they were published. Thus, we classified a portion of the 1927 articles in more than 1 domain: 1352 publications (70.16%) were classified to 1 discipline, 490 (25.43%) to 2 disciplines, 38 (1.97%) to 3 disciplines, and 4 (0.21%) to 4 disciplines. We did not assign 43 publications (2.23%) to any discipline, as the publishing journals were not listed in ISI and we could not unequivocally derive the journal discipline from the name of the journal.The 8 defined disciplines were pediatrics, psychiatry and psychology, neurology, basic sciences, nonmedical and technology, public health and environment, rehabilitation, and internal and general medicine . Other than general and internal medicine, the most prominent field was psychiatry and psychology, with 572 (29.68%) of all publications in the field of video games. The next most prominent field was pediatrics , followed by public health and environment .P<.001).A chi-square test revealed a significant association between attitude distribution and disciplines (P<.001), an increased number of positive articles  in general and internal medicine (P=.001), an increased number of positive articles  both in rehabilitation and in nonmedical and technology domains (P<.001 for both), an increased number of negative articles  in pediatrics (P<.001), and an increased number of negative articles  in public health and environment (P<.001). No correlation was found for neurology and basic sciences  in psychiatry and psychology .As methodological requirements and evidence-based approaches have shifted greatly since 1980, we examined the correlation between study methodology and the year of publication.r=–.75, P=.001) and that of interventional studies increased . No correlation was found with the number of aggregation-based articles . We then examined whether there was an association between the research methodology and attitude. The correlation was significant (P<.001): positive articles increased in interventional studies (P<.001), with a reciprocal decline in negative articles, while negative articles increased in observational studies, with a reciprocal decline in positive articles . The low impact factor group tended to publish more positive articles  (P<.001), whereas both the medium and high impact factor groups tended to publish fewer positive articles, with a reciprocal increase in neutral articles in the medium group (P<.001) and a reciprocal increase in negative articles in the high impact factor group (P=.008) , we divided the journals into 3 groups: lower impact factor (ranging from 0 to 2.0 or nonlisted), medium impact factor (ranging from 2.001 to 4.0), and high (≥4.001). The groups comprised, respectively, 908 (47.12%), 668 (34.67%), and 351 (18.21%) of the 1927 publications. A chi-square test revealed a significant association between the impact factor group and attitude of the articles ((P=.008) .The number of articles reporting studies of video games is increasing rapidly. It seems that the attitude toward video games is affected by the year of publication, the region of origin of the lead researcher, the discipline from which the article stems, and the research method applied. Moreover, it seems that the representation of different attitudes varies according to the centrality of the journal, as measured by its impact factor.Surprisingly, in the early years of video games research, while opinion leaders were speaking against video games and their deleterious effects , most arThe assessment based on the country of origin supports the “acquaintance” hypothesis : articleAmong the different medical disciplines, most of the findings can seem trivial. One could assume that basic science, by its very nature, would tend to lack a polarized attitude. Also, it is not surprising that the field of rehabilitation, which seeks a measure of improvement, would be positively biased. The same bias would be very plausible in the technological disciplines. Public health, though, a discipline that tends to look for risk factors and prevention measures, would understandably be biased toward the more negative attitudes. Neurology seems to be balanced. This leaves 2 disciplines with an intriguing tendency toward the negative: psychiatry and psychology, and, even more so, pediatrics. One can hypothesize that the rapid dissemination of and increase in the number of video games used in the field of pediatrics, along with a more protective and more pronounced generation gap, could be a possible explanation. Another possible explanation would be a specific “toxic” effect specific to early development and mental health. This view is in accord with when video games are being considered as a type of behavioral addiction. However, the positive-attitude studies published in the educational field, as well as in neurology and cognitive rehabilitation, strengthen the suspicion of a negative-attitude bias both in pediatrics and in psychiatry and psychology research.The methodological partition results may not be surprising. Observational studies are often directed toward negative outcomes , while interventional studies usually seek benefits .The results of this study suggest a possible publication bias as a factor in the basic attitude of the article: negative-attitude articles are more likely to get published in a high impact factor journal. When studying a common phenomenon, such as video games, observational studies  offer access to large populations, thus enabling stronger methodology. This might explain the bias of the higher impact factor journals toward publishing studies with a negative attitude. One can expect that, in the coming years, as the technological possibilities of interventional studies improve and as the mass of interventional studies increases, more methodologically robust interventional studies will find their way to more influential journals.Though the study covered the entire literature indexed in PubMed, our scope was limited to medical and life sciences-related publications. As such, we cannot attest to attitudes in other academic branches dealing with video games, such as education or communications. However, as few such articles have been indexed in PubMed, and consequently analyzed in this study, the general approach toward computer games seems to be more positive. It should be noted that, as the study focused on attitudes in the medical literature, we searched only the PubMed database. Furthermore, we might have captured additional studies dealing with video games by using different keywords in our search strategy.Diagnostic and Statistical Manual of Mental Disorders [An additional limitation that should be noted is that we coded attitudes manually, according to human judgment, which is vulnerable to mistakes and disagreements. However, as the blinded agreement between the authors was very high, it is not likely that misclassification of articles interfered with the results. We chose to focus in this study on video games rather than social media or the internet as a whole, as the topic of video games is grounds for even greater disagreement. As internet use and email can be considered an essential part of the normal modern world , video games are considered “avoidable” and not a necessity, and thus their costs and benefits should be studied more carefully. Although we chose to focus on video games, in reality, the line between social media and video games has become blurred, because, unlike in the past , video gisorders ,33.As suggested in the literature -26, bias