Academic literature on the topic 'Cigarette habit Australia'

Although cigarette smoking rate has declined consistently in the past four decades in Australia, the smoking habit remains popular among some groups. From a marketer’s vantage point, this slowed reduction portrays the less effective implementation of anti-smoking campaigns in Australia. Ideally, each anti-smoking intervention ought to break the chain of marginal utility and lead to a sharp or stepped decline of smoking prevalence. This paper explores the inadequacies of fear factored anti-smoking campaigns and some prevailing reasons why young adult smokers continue to smoke. This paper begins with a review and categorisation of the different reasons of why young adults continue to smoke. These reasons draw on addiction, stress, habit, social-economic factors, self-identity and peer pressure. The rationale for studying these anti-smoking initiatives is to evaluate if these initiatives address the issues of smoking amongst young adults. This paper is significant for formulating effective anti-smoking messages and policy developments in Australia.

Cigarette smoking has been causally linked with a range of detrimental health consequences. Following the introduction of population-wide anti-smoking measures there has been an overall reduction in the prevalence of smoking to about 25% of the Australian population. These results, however, do not apply across the board as one of the most disadvantaged groups in our community, people with schizophrenia, do not appear to be receiving benefit from these public health measures. Further, the quality of life and even the ability to live independently in the community for this group might be compromised by these very same public health measures. Approximately 75% of people with schizophrenia smoke and those who have a psychiatric disability on average spend about 30% of their income on this habit. Recent research suggests that at least for some of these people, smoking is not simply a vice, but a means of obtaining a medication necessary for symptomatic relief of their disorder. Public health measures are required which take into account the evidence concerning the specific needs and social situations of people with schizophrenia.

Age-related macular degeneration (AMD) is a multifactorial disease that represents the most common cause of irreversible visual impairment among people over the age of 50 in Europe, the United States, and Australia, accounting for up to 50% of all cases of central blindness. Risk factors of AMD are heterogeneous, mainly including increasing age and different genetic predispositions, together with several environmental/epigenetic factors, that is, cigarette smoking, dietary habits, and phototoxic exposure. In the aging retina, free radicals and oxidized lipoproteins are considered to be major causes of tissue stress resulting in local triggers for parainflammation, a chronic status which contributes to initiation and/or progression of many human neurodegenerative diseases such as AMD. Experimental and clinical evidences strongly indicate the pathogenetic role of immunologic processes in AMD occurrence, consisting of production of inflammatory related molecules, recruitment of macrophages, complement activation, microglial activation and accumulation within those structures that compose an essential area of the retina known as macula lutea. This paper reviews some attractive aspects of the literature about the mechanisms of inflammation in AMD, especially focusing on those findings or arguments more directly translatable to improve the clinical management of patients with AMD and to prevent the severe vision loss caused by this disease.

Abstract Introduction Western militaries have consumption rates of alcohol and tobacco which are higher than the associated civilian populations, and are concerned about the negative effects on health, wellbeing, and military performance that such high rates may have. Materials and Methods A survey questionnaire which collected nonidentifiable data was distributed to all accessible members of an Australian Army Combat Brigade over the annual induction training and prefield exercise period between January and March 2019. The survey was composed of personal and demographic questions, followed by questions concerning the personal consumption habits of alcohol and tobacco. 1,606 complete and valid surveys were returned, representing 55.3% of the Brigade’s posted strength. Ethical clearance for this project was provided by the Australian Defence Force Joint Health Command Low Risk Ethics Panel (18-012). Results Almost one quarter of the Combat Brigade exceeded the Australian daily risk guideline for alcohol consumption, and over three quarters exceeded the occasion risk guideline; with 6.1% of soldiers drinking alcohol daily. 24.3% identified as tobacco smokers, with 15.9% smoking daily. Smoking rates and volumes were higher when deployed on field training exercises and on international training and operational deployments; as was the consumption of roll-your-own cigarettes. Overall, the main determinants of the negative consumption behaviors were gender (male) and age (under 25). Conclusions This study confirmed that the members of an Australian Army Combat Brigade have higher negative health consumption behaviors concerning alcohol and tobacco than the general civilian population. The results also identified a cohort of Senior Non-Commissioned Officers and Warrant Officers (E5–E9) between the ages of 35 and 44 who had high negative consumption behaviors which could result in poor health outcomes. This could be a suitable cohort for a targeted campaign to reduce tobacco and alcohol consumption and to assist to make healthy life changes.

Abstract Background: Smoking increases the risk of Philadelphia-chromosome negative myeloproliferative neoplasm (MPN) development as well as increases the risk of thrombotic complications, the major cause of mortality in this population (Blood 2017 130:4199). Guidelines suggest that management of more indolent forms of MPNs include the assessment and mitigation of cardiovascular risk, which includes the management of smoking-related risks (NCCN Guidelines. 2017). In this analysis we sought to examine smoking outcomes and opinions from the perspective of the MPN patient, with the goal of helping to guide MPN patient care. Methods: The internet-based survey was developed by a team of MPN investigators and administered via Mayo Clinic's REDCap. Online recruitment was facilitated via multiple MPN-related webpages including the MPN Forum, MPN Net, MPN Research Foundation, and MPN Voice during June of 2018. Surveyed data included disease demographics such as thrombosis, medications, and smoking history. MPN-specific symptoms were assessed utilizing the MPN-10 (Blood. 2011 Jul 14;118(2):401-8). Data: Participant Demographics: Of the 607 patients who clicked the survey link, 435 patients were eligible for the survey and completed the questions regarding smoking history. Of these, 254 (58%) reported no history of tobacco use, 161 (37%) reported being ex-tobacco users, and 20 (5%) reported being current users. Among those who reported current tobacco use, 50% used premade cigarettes, 27% used self-rolled cigarettes, 20% reported vaping, and 3% reported chewing tobacco or snuff use. Respondents were most often from the US (67%), Australia (12%), the UK (6%) or Canada (6%). The distribution of respondents included 28% with myelofibrosis, 44% with polycythemia vera and 27% with essential thrombocythemia. Over one quarter (26%) of patients had experienced a prior thrombosis, with the most frequent thrombosis types being DVT (9%), stroke or transient ischemic attack (8%), abdominal vein thrombosis (5%), myocardial infarction (2%) and cerebral vein thrombosis (2%). When comparing current/former smokers to never smokers, no significant difference in thrombotic frequency was observed. Smoking Correlates: When evaluating MPN symptoms, current/former smokers reported higher severity of fatigue (mean 5.6 vs 5.0, p=0.02) and inactivity (mean 4.0 vs 3.1, p=0.03) compared to nonsmokers. Additionally, current/former smokers were more likely to experience early satiety (69% vs 58%, p=0.03), inactivity (80% vs 71%, p=0.04), concentration difficulties (82% vs 73%, p=0.04), and reduced quality of life (mean 6.1 vs 6.5, p=0.03) compared to nonsmokers. Although not significant, a trend of higher symptomatology was observed for former/current smokers compared to nonsmokers (MPN-10 total symptom score [TSS] mean 30.4 vs 27.0, p=0.07). Former/current smokers were also more likely than nonsmokers to report heavy alcohol consumption (>7 drinks per week in 9.6% vs 4.0%, p=0.03) and using opioids for pain management (24% vs 11%, p=0.001). Smoking Opinions and Care: As shown in Table 1, less than half of current/former smokers (43%) reported having their physician discuss tobacco use with them. Less than 40% of MPN current or previous smokers were aware of the risk of MPN development due to smoking, although the majority (83%) were aware of the increased thrombotic risk. Less than one quarter (43/181) of current/former smokers reported having utilized pharmacologic therapy to aid cessation. Conclusions MPN patients with current or previous tobacco use demonstrate significantly higher symptom burden than non-smoking counterparts. In terms of patient care, less than half of patients who are current or previous smokers recall having a physician discuss their smoking habits with them. These results highlight the need for enhanced MPN patient counseling by health care providers, both regarding the risks of smoking and available methods to aid cessation. Disclosures Scherber: Orphan Pharmaceuticals: Honoraria; Incyte: Consultancy. Dueck:Phytogine: Employment; Pfizer: Honoraria; Bayer: Employment. Palmer:Novartis: Research Funding. Mesa:Incyte: Research Funding; Galena: Consultancy; Gilead: Research Funding; Ariad: Consultancy; Celgene: Research Funding; Novartis: Consultancy; CTI: Research Funding; Promedior: Research Funding.

IntroductionThis article is about the transformation of coffee, from having no place in the everyday lives of the people of Bangladesh, to a new position as a harbinger of liberal values and Western culture. The context is a group of Australian photojournalism students who embarked on a month-long residency in Bangladesh; the content is a Nescafé advertisement encouraging the young, middle-class Bangladesh audience to consume coffee, in a marketing campaign that promotes “my first cup.” For the Australian students, the marketing positioning of this advertising campaign transformed instant coffee into a strange and unfamiliar commodity. At the same time, the historic association between Bangladesh and tea prompted one of the photographers to undertake her own journey to explore the hidden side of that other Western staple. This paper explores the tradition of tea culture in Bangladesh and the marketing campaign for instant coffee within this culture, combining the authors’ experiences and perspectives. The outline of the Photomedia unit in the Bachelor of Creative Industries degree that the students were working towards at Edith Cowan University (ECU) in Australia states that:students will engage with practices, issues and practicalities of working as a photojournalist in an international, cross cultural context. Students will work in collaboration with students of Pathshala: South Asian Institute of Photography, Dhaka Bangladesh in the research, production and presentation of stories related to Bangladeshi society and culture for distribution to international audiences (ECU). The sixteen students from Perth, living and working in Bangladesh between 5 January and 7 February 2012, exhibited a diverse range of cultures, contexts, and motivations. Young Australians, along with a number of ECU’s international students, including some from Norway, China and Sweden, were required to learn first-hand about life in Bangladesh, one of the world’s poorest and most densely populated countries. Danielle Fusco and ECU lecturer Duncan Barnes collaborated with staff and students of Pathshala, South Asian Media Institute (Pathshala). Their recollections and observations on tea production and the location are central to this article but it is the questions asked by the group about the marketing of instant coffee into this culture that provides its tensions. Fusco completed a week-long induction and then travelled in Bangladesh for a fortnight to research and photograph individual stories on rural and urban life. Barnes here sets the scene for the project, describing the expectations and what actually happened: When we travel to countries that are vastly different to our own it is often to seek out that difference; to go in search of the romanticised ideals that have been portrayed as paradise in films, books and photographs. “The West” has long been fascinated with “The East” (Said) and for the past half century, since the hippie treks to Marrakesh and Afghanistan, people have journeyed overland to the Indian sub-continent, both from Europe and from Australia, yearning for a cultural experience they cannot find at home. Living in Perth, Western Australia, sometimes called the most isolated capital city in the world, that pull to something “different” is like a magnet. Upon arrival in Dhaka, you find yourself deliciously overwhelmed by the heavy traffic, the crowded markets, the spicy foods and the milky lassie drinks. It only takes a few stomach upsets to make your Western appetite start kicking in and you begin craving things you have at home but that are hard to find in Bangladesh. Take coffee for example. I recently completed a month-long visit to Bangladesh, which, like India, is a nation of tea drinkers. Getting any kind of good coffee requires that you be in what expatriates call “the Golden Triangle” of Dhaka city—within the area contained by Gulshan-Banani-Baridhara. Here you find the embassies and a sizeable expatriate community that constitutes a Western bubble unrepresentative of Bangladesh beyond these districts. Coffee World is an example of a Western-style café chain that, as the name suggests, serves coffee beverages. It has trouble making a quality flat white. The baristas are poorly trained, the service is painfully slow, yet the prices are comparable to those in the West. Even with these disadvantages, it is frequented by Westerners who also make use of the free WiFi. In contrast, tea is available at every road junction for around 5 cents Australian. It’s ready in seconds: the kettle is always hot due to a constant turnover of local customers. It was the history of tea growing in Bangladesh, and a desire to know more about a commodity that people in the West take for granted, that most attracted Fusco’s interest. She chose to focus on Bangladesh’s oldest commercial tea garden (plantation) Sylhet, which has been in production since 1857 (Tea Board). As is the case with many tea farms in the Indian sub-continent, the workers at Sylhet are part of Bangladesh’s Hindu minority. Fusco left Dhaka and travelled into the rural areas to investigate tea production: Venturing into these estates from the city is like entering an entirely different world. They are isolated places, and although they are close in distance, they are completely separate from the main city. Spending time in the Khadim tea estate amongst the plantations and the workers’ compounds made me very aware of the strong relationship that exists between them. The Hindu teaching of Samsara refers to the continuous cycle of repeated birth, life, death and rebirth [Hinduism], which became a metaphor for me, for this relationship I was experiencing. It is clear that neither farm [where the tea is grown] nor village [which houses the people] could live without each other. The success and maintenance of the tea farm relies on the workers just as much as the workers rely on the tea gardens for their livelihood and sustenance. Their life cycles are intertwined and in synch. There are many problems in the compounds. The people are extremely poor. Their education opportunities are limited, and they work incredibly hard for very little money for their entire lives. They are bound to stay and work here and as those generations before them, were born, worked and died here, living their whole lives in the community of the tea farm. By documenting the lives of the people, I realised I was documenting the process of the lives of the tea trees at the same time. This is how I met Lolita.Figure 1. Bangladeshi tea worker, Lolita, stands in a small section of the Khadim tea plantation in the early morning. Sylhet, Bangladesh (Danielle Fusco, Jan. 2012). This woman emulated everything I was seeing and feeling about the village and the garden. She spoke about the reliance on the trees, especially because of the money and, therefore, the food, they provide for her and her husband. I became aware of the injustice of this system because the workers are paid so little while this industry is booming. It was obvious that life here is far from perfect, but as Lolita explains, they make do. She has worked on the tea estate for decades. As her husband is no longer working, she is the primary income earner. They are able, however, to live in relative comfort now their children have all married and left and it is just the two of them. Lolita describes that money lies within these trees. Money for her means that she can eat that day. Money for the managers means industrial success. Either way, whether it is in the eyes of the individual or the industry, tea always comes down to Taka [the currency of Bangladesh]. Marketing Coffee in a Culture of Tea and Betel Nut With such a strong culture of tea production and consumption and a coffee culture just existing on the fringe, a campaign by Nescafé to encourage Bangladeshi consumers to have “my first cup” of Nescafé instant coffee at the time of this study captured the imagination of the students. How effective can the marketing of Nescafé instant coffee be in a society that is historically a producer and consumer of tea, and which also still embraces the generations-old use of the betel nut as an everyday stimulant? Although it only employs some 150,000 (Islam et al.) in a nation of 150 million people, tea makes an important contribution to the Bangladesh economy. Shortly after the 1971 civil war, in which East Pakistan (now Bangladesh) became independent from West Pakistan (now Pakistan), the then-Chairman of the Bangladesh Tea Board, writing in World Development, commented:In the highly competitive marketing environment of today it is extremely necessary for the tea industry of Bangladesh to increase production by raising the per acre yield, improve quality by adoption of finer plucking standards and modernization of factories and reduce per unit cost of production so as to be able to sell more of our teas to foreign markets and thereby earn higher amounts of much needed foreign exchange for the country as well as generate additional resources within the industry for ploughing back for further development (Ali 55). In Bangladesh, tea is a cash crop that, even in the 1970s following vicious conflicts, is more than capable of meeting local demand and producing an export dividend. Coffee is imported commodity that, historically, has had little place in Bangladeshi life or culture. However important tea is, it is not the traditional Bangladesh stimulant. Instead, over the years, when people in the West would have had a cup of tea or coffee and/or a cigarette, most Bangladeshis have turned to the betel nut. A 2005 study of 100 citizens from Araihazar, Bangladesh, conducted by researchers from Columbia University, found that coffee consumption is “very low in this population” (Hafeman et al. 567). The purpose of the study was to assess the impact of betel quids (the wad of masticated nut) and the chewing of betel nuts, upon tremor. For this reason, it was important to record the consumption of stimulants in the 98 participants who progressed to the next stage of the study and took a freehand spiral-drawing test. While “26 (27%) participants had chewed betel quids, 23 (23%) had smoked one or more cigarettes, [and] 14 (14%) drank tea; on that day, only 1 (1%) drank caffeinated soda, and none (0%) drank coffee” (Hafeman et al. 568). Given its addictive and carcinogenic properties (Sharma), the people who chewed betel quids were more likely to exhibit tremor in their spiral drawings than the people who did not. As this (albeit small) study suggests, the preferred Bangladeshi stimulant is more likely to be betel or tobacco rather than a beverage. Insofar as hot drinks are consumed, Bangladesh citizens drink tea. This poses a significant challenge for multinational advertisers who seek to promote the consumption of instant coffee as a means of growing the global market for Nescafé. Marketing Nescafé to Bangladesh In Dhaka, in January 2012, the television campaign slogan for Nescafé is “My first cup”, with the tagline, “Time you started.” This Nescafé television commercial (NTC) impressed itself upon the Australian visitors, both in terms of its frequency of broadcast and in its referencing of Western culture and values. (The advertisement can be viewed at http://www.youtube.com/watch?v=2E8mFX43oAM). The NTC’s three stars, Vir Das, Purab Kohli, and leading Bollywood actress Deepika Padukone, are highly-recognisable to young Bangladeshi audiences and the storyline is part of a developing series of advertisements which together form a mini-soap opera, like that used so successfully to advertise the Nescafé Gold Blend brand of instant coffee in the West in the 1980s to 1990s (O’Donohoe 242; Beale). The action takes place in Kohli’s affluent, Western-style apartment. The drama starts with Das challenging Kohli regarding whether he has successfully developed a relationship with his attractive neighbour, Padukone. Using a combination of local language with English words and sub-titles, the first sequence is captioned: “Any progress with Deepika, or are you still mixing coffee?” Suggesting incredulity, and that he could do better, Das asks Kohli, according to the next subtitle, “What are you doing dude?” The use of the word “dude” clearly refers to American youth culture, familiar in such movies as Dude, where’s my car? This is underlined by the immediate transition to the English words of “bikes … biceps … chest … explosion.” Of these four words only “chest” is pronounced in the local tongue, although all four words are included as captions in English. Kohli appears less and less impressed as Das becomes increasingly insistent, with Das going on to express frustration with Kohli through the exclamation “u don’t even have a plan.” The use of the text-speak English “u” here can be constructed as another way of persuading young Bangladeshi viewers that this advertisement is directed at them: the “u” in place of “you” is likely to annoy their English-speaking elders. Das continues speaking in his mother tongue, with the subtitle “Deepika padukone [sic] is your neighbour and you are only drinking coffee,” with the subsequent subtitle emphasising: “Deepika and only coffee.” At this point, Padukone enters the apartment through the open door without knocking and confidently says “Hi.” Kohli explains the situation by responding (in English, and subtitled) “my school friend, Das”. Padukone, in turn, responds in a friendly way to both men (in English, and subtitled) “You guys want to have coffee?” Instead of responding directly to this invitation, Das models to Kohli what it is to take the initiative in this situation: what it is to have a plan. “Hello” (he says, in English and subtitled) “I don’t have coffee but I have a plan. You and me, my bike, right now, hit the town, party!” Kohli looks down at the floor, embarrassed, while Padukone looks quizzically at him over Das’s shoulder. Kohli smiles, and points to himself and Padukone, clearly excluding Das: “I will have coffee” (in English, and subtitle). “Better plan”, exclaims Padukone, “You and me, my place, right now, coffee.” She looks challengingly at Das: “Right?,” a statement rather than a request, and exits, with Kohli following and Das left behind in the apartment. Cue voice-over (not a subtitle, but in-screen speech bubble) “[It’s] time you started” (spoken) “the new Nescafé” (shot change) “My first cup” (with an in-screen price promotion). This commercial associates coffee drinking with Western values of social and personal autonomy. For young women in the traditional Muslim culture of Bangladesh, it suggests a world in which they are at liberty to spend time with the suitors they choose, ignoring those whom they find pushy or inappropriate, and free to invite a man back to “my place, right now” for coffee. The scene setting in this advertisement and the use of English in both the spoken and written text suggests its target is the educated middle class, and indicates that sophisticated, affluent, trend-setters drink coffee as a part of getting to know their neighbours. In line with this, the still which ends the commercial promotes the Facebook page “Know your neighbours.” The flirtatious nature of the actors in the advertisement, the emphasis on each of the male characters spending time alone with the female character, and the female character having both power and choice in this situation is likely to be highly unacceptable to traditional Bangladeshi parental values and, therefore, proportionately more exciting to the target audience. The underlying suggestion of “my first cup” and “time you started” is that the social consumption of that first cup of coffee is the “first step” to becoming more Western. The statement also has overtones of sexual initiation. The advertisement aligns itself with the world portrayed in the Western media consumed in Bangladesh, and the implication is that—even if Western liberal values are not currently a possible choice for all—it is at least feasible to start on the journey towards these values through drinking that first cup of coffee. Unbeknownst to the Bangladesh audience, this Nescafé marketing strategy echoes, in almost all material particulars, the same approach that was so successful in persuading Australians to embrace instant coffee. Khamis, in her essay on Australia and the convenience of instant coffee, argues that, while in 1928 Australia had the highest per capita consumption of tea in the world, this had begun to change by the 1950s. The transformation in the market positioning of coffee was partly achieved through an association between tea and old-fashioned ‘Britishness’ and coffee and the United States: this discovery [of coffee] spoke to changes in Australia’s lifestyle options: the tea habit was tied to Australia’s development as a far-flung colonial outpost, a daily reminder that many still looked to London as the nation’s cultural capital: the growing appeal of instant coffee reflected a widening and more nuanced cultural palate. This was not just ‘another’ example of the United States postwar juggernaut; it marks the transitional phase in Australia’s history, as its cultural identity was informed less by the staid conservativism of Britain than the heady flux of New World glamour (219). Coffee was associated with the USA not simply through advertising but also through cultural exposure. By 1943, notes Khamis, there were 120,000 American service personnel stationed in Australia and she quotes Symons (168) as saying that “when an American got on a friendly footing with an Australian family he was usually found in the kitchen, teaching the Mrs how to make coffee, or washing the dishes” (168, cited in Khamis 220). The chances were that “the Mrs”—the Australian housewife—felt she needed the tuition: an Australian survey conducted by Gallup in March 1950 indicated that 55 per cent of respondents at that time had never tried coffee, while a further 24 per cent said they “seldom” consumed it (Walker and Roberts 133, cited in Khamis 222). In a newspaper article titled, “Overpaid, Oversexed and Over Here”, Munro describes the impact of exposure to the first American troops based in Australia during this time, with a then seven year old recalling: “They were foreign, quite a different culture from us. They spoke more loudly than us. They had strange accents, cute expressions, they were really very exotic.” The American troops caused consternation for Australian fathers and boyfriends. Dulcie Wood was 18 when she was dating an American serviceman: They had more money to spend (than Australian troops). They seemed to have plenty of supplies, they were always bringing you presents—stockings and cartons of cigarettes […] Their uniforms were better. They took you to more places. They were quite good dancers, some of them. They always brought you flowers. They were more polite to women. They charmed the mums because they were very polite. Some dads were a bit more sceptical of them. They weren’t sure if all that charm was genuine (quoted in Munro). Darian-Smith argues that, at that time, Australian understanding of Americans was based on Hollywood films, which led to an impression of American technological superiority and cultural sophistication (215-16, 232). “Against the American-style combination of smart advertising, consumerism, self-expression and popular democracy, the British class system and its buttoned-up royals appeared dull and dour” writes Khamis (226, citing Grant 15)—almost as dull and dour as 1950s tea compared with the postwar sophistication of Nescafé instant coffee. Conclusion The approach Nestlé is using in Bangladesh to market instant coffee is tried and tested: coffee is associated with the new, radical cultural influence while tea and other traditional stimulants are relegated to the choice of an older, more staid generation. Younger consumers are targeted with a romantic story about the love of coffee, reflected in a mini-soap opera about two people becoming a couple over a cup of Nescafé. Hopefully, the Pathshala-Edith Cowan University collaboration is at least as strong. Some of the overseas visitors return to Bangladesh on a regular basis—the student presentations in 2012 were, for instance, attended by two visiting graduates from the 2008 program who were working in Bangladesh. For the Australian participants, the association with Pathshala, South Asian Media Institute, and Drik Photo Agency brings recognition, credibility and opportunity. It also offers a totally new perspective on what to order in the coffee queue once they are home again in Australia. Postscript The final week of the residency in Bangladesh was taken up with presentations and a public exhibition of the students’ work at Drik Picture Agency, Dhaka, 3–7 February 2012. Danielle Fusco’s photographs can be accessed at: http://public-files.apps.ecu.edu.au/SCA_Marketing/coffee/coffee.html References Ali, M. “Commodity Round-up: Problems and Prospects of Bangladesh Tea”, World Development 1.1–2 (1973): 55. Beale, Claire. “Should the Gold Blend Couple Get Back Together?” The Independent 29 Apr 2010. 8 Apr. 2012 ‹http://www.independent.co.uk/news/media/advertising/should-the-gold-blend-couple-get-back-together-1957196.html›. Darian-Smith, Kate. On the Home Front: Melbourne in Wartime 1939-1945. 2nd ed. Melbourne: Melbourne UP, 2009. Dude, Where’s My Car? Dir. Danny Leiner. Twentieth Century Fox, 2000. Edith Cowan University (ECU). “Photomedia Summer School Bangladesh 2012.” 1 May 2012 .Grant, Bruce. The Australian Dilemma: A New Kind of Western Society. Sydney: Macdonald Futura, 1983. Hafeman, D., H. Ashan, T. Islam, and E. Louis. “Betel-quid: Its Tremor-producing Effects in Residents of Araihazar, Bangladesh.” Movement Disorders 21.4 (2006): 567-71. Hinduism. “Reincarnation and Samsara.” Heart of Hinduism. 8 Apr. 2012 ‹http://hinduism.iskcon.org/concepts/102.htm›. Islam, G., M. Iqbal, K. Quddus, and M. Ali. “Present Status and Future Needs of Tea Industry in Bangladesh (Review).” Proceedings of the Pakistan Academy of Science. 42.4 (2005): 305-14. 8 Apr. 2012 ‹http://www.paspk.org/downloads/proc42-4/42-4-p305-314.pdf›. Khamis, Susie. “It Only Takes a Jiffy to Make: Nestlé, Australia and the Convenience of Instant Coffee.” Food, Culture & Society 12.2 (2009): 217-33. Munro, Ian. “Overpaid, Oversexed and Over Here.” The Age 27 Feb. 2002. 8 Apr. 2012 ‹http://www.theage.com.au/articles/2002/02/26/1014704950716.html›. O’Donohoe, Stephanie. “Raiding the Postmodern Pantry: Advertising Intertextuality and the Young Adult Audience.” European Journal of Marketing 31.3/4 (1997): 234-53 Pathshala. Pathshala, South Asian Media Academy. 8 Apr. 2012 ‹http://www.pathshala.net/controller.php›. Said, Edward. Orientalism. New York: Pantheon Books, 1978. Sharma, Dinesh. “Betel Quid and Areca Nut are Carcinogenic without Tobacco.” The Lancet Oncology 4.10 (2003): 587. 8 Apr. 2012 ‹http://www.lancet.com/journals/lanonc/article/PIIS1470-2045(03)01229-4/fulltext›. Symons, Michael. One Continuous Picnic: A History of Eating in Australia. Ringwood, Vic: Penguin, 1984. Tea Board. “History of Bangladesh Tea Industry.” Bangladesh Tea Board. 8 Apr. 2012 ‹http://www.teaboard.gov.bd/index.php?option=HistoryTeaIndustry›. Walker, Robin and Dave Roberts. From Scarcity to Surfeit: A History of Food and Nutrition in New South Wales. Sydney: NSW UP, 1988.

Workplace wellness programs raise the question: Who owns the health and sickness of the employee? Once, they belonged to the person and his/her doctor, in a kind of binary health relationship. Now companies have made it a triangular relationship. But actually, it's rectangular - the government is also shaping this relationship by occupying a fourth corner. As Nikolas Rose (1989) points out in his exploration of the place of individual in the corporate state, history suggests that it might be the government whose corner is dominant. Rose notes that "Taylorism", the scientific pursuit of maximum efficiency of human labour which was fashionable early last century, is now seen not just as the creation of industrialists like Henry Ford. Much more broadly, it reflected a philosophy current in the western industrialised nations like the US, UK and Germany. Achieving optimum output from men and machines was "part of a wide family of political programmes that sought to use scientific knowledge to advance national efficiency through making the most productive use of material and human resources." Reflecting prevailing political climates, national governments had already begun to introduce legislation which regulated the relationship between capital and labour. Ostensibly, these laws were intended to protect the rights of workers, but Rose suggests that their ultimate motivation was to ensure the nation received social dividends from the labour market. That was then. Now, social dividends from employment may be different but governments are still pursuing them. It was a labour government in Australia in the 1980s which first required employees to fund their own aged pensions (by trading off pay increases for superannuation). In another manifestation of their worry about the costs of an ageing population, governments are now prodding workers to become their own health managers, through the agency of wellness programs at work. Wellness programs really began to flourish in the last 20 years, most visibly in the Unites States where pressure from the employee health insurance system and high participation targets set by the Federal Government have made them the rule. "As a result, work-site health promotion programs are becoming increasingly prevalent. In 1985, 65 percent of work sites with 50 or more employees offered at least one health promotion activity. The [Government's] Healthy People 2000 goals aim to increase this proportion to 85 percent and to increase employee participation in these programs." (Meurer et al. 1997, p. 384) In other countries, pressure from insurance/litigation may be weaker, but employers have increasingly seen workplaces as suitable locations for health campaigns targeted at their employees, and governments have become supportive of such programs because of the public health benefits and convenience. They might be viewed as privatised community health promotion. In Australasia: "The idea of using workplaces as sites to promote health is attractive from a public health point of view. It provides an opportunity for adults to gain access to health promotion initiatives and enables them to participate in programs planned according to their needs in a familiar physical and social setting. It also provides an opportunity for health promotion efforts to extend to the worker's home and involve his/her family." (Williams 1991, p. 490) From an employer's perspective, workers' sickness has always been a matter of interest because of the duty of care. In the distinctive social environment of work, their health has belonged at least partly to the company, but the wellness programs may be further stripping away the autonomy of health. Moral philosopher R S Downie and his co-writers (1990) believe that health promotion is not value-free. "It endeavours to persuade people to adopt certain lifestyles.") It attempts to transfer to the employees values held by the organisation, promoting a particular lifestyle - in this case, a healthy one. Participation in wellness programs provides benefits which flow in two directions. The company donates the resources which allow the employees to avoid sickness and to live healthier lives. The employees donate a longer and more productive working life to the company and society. In this way, these programs conform with the dominant current management philosophy describing the relationship between employee and employer. Just as Hirschhorn (1988) describes how workers won social freedoms in exchange for psychological "unfreedoms" (the work ethic) in the industrial revolution , so Rose describes how modern, caring management practice is all about "aligning the wishes, needs and aspirations of each individual who works for the organisation with the successful pursuit of its objectives". A win-win situation? In some organisations, some employees may not see it that way. The fact that wellness programs are declared "voluntary" may not necessarily rectify a perception of compulsion. Employees may believe that nothing is truly voluntary at work. With these concerns in mind, Stokols et al. (1995) advocate ethical guidelines to prevent job discrimination based on health status and related potential conflicts of interest. They say that the bottom-line benefits to management of health-promotion campaigns cannot legitimately include discriminating against employees who refuse to make healthy lifestyle choices. Discrimination might exist on another level. What is the company to make of workers who choose to continue an unhealthy lifestyle which may put them at greater risk of a succumbing to a health hazard at work? The most well-known of such consequences is the predisposition to bronchial illness caused by smoking. Of course, there are two sources of sickness at work; self-induced and work-induced. Smoking cigarettes may cause self-induced sickness. Mining asbestos may cause work-induced sickness. If it was once clear who was responsible for which sickness, the advent of workplace wellness programs has reduced the clarity. Such health promotion can make it seem that the employer has taken responsibility for both self-induced and work-induced sickness, or perhaps the worker has. Wellness programs are culturally ambiguous. Their very introduction signifies the employer's care for employees' health, but the function of the program is to teach the employees how to take responsibility for it. So Blewett and Shaw (1995) wonder whether health promotion programs change the balance of responsibility between employer and employee. The origin of this issue, they suggest, is in the World Health Organisation's 1986 Ottawa Charter for Health Promotion, which describes health promotion as "the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health." (cited in Blewett & Shaw 1995, p. 462) The writers argue that the health promotion rhetoric is increasingly focused on promoting 'self-responsibility' for health in the workplace, and the skills of health self-care. If governments value wellness programs, and business likes them, is the workplace a conducive cultural setting for wellness to be marketed? Do workplace health promotion programs obviate the well-documented communication barriers from which community programs suffer? It seems they might. "Worksites afford a high degree of leverage for influencing the health of the population," according to Stokols et al. (1995, p. 1136) "Leverage" is a reference to the big percentage of the population (the employed) they reach, as well as the power of persuasion in a workplace. The persuasion can derive from the corporate culture which employers strive to create in their organisations - a mono-culture whose values are aligned with those of all members. It can also derive from company rules - all members of the organisation, whether value-sharers or value-rejectors, are captured by the requirement to conform with wellness objectives. Thus, in western industrial democracies, where smoking is banned it is usually because they are places of work. It is necessary to ask the question: Do employees exposed to health promotion at work make good use of self-care skills. Williams (1991) notes that the uptake of health promotion campaigns, not at work but in the broad community, is greatest among those who least need the benefits - that is, it correlates with socio-economic status. Wellness programs in industrial settings provide opportunities for health promotion to reach lower-paid trades and "blue-collar" employees not well served by these community campaigns. However, poor health behaviours are based on life-long habits, usually reinforced by people's lifestyles, reference groups and family structure. These habits take time and persistence to counteract. It is only in the long term that participation gives employees positive benefits, and therefore positive reinforcement for their healthy efforts. Noblet and Murphy (1995, p. 18) report that "early workplace programs relied heavily on behaviour change techniques as their health promotion strategy." Therefore, many failed to produce lasting change because they did not take advantage of the complex social and cultural structure that exists within each workplace. The writers suggest that recently "activities have expanded beyond risk reduction strategies to a settings approach that addresses the social, organisational, environmental and cultural factors." (Noblet and Murphy 1995, p. 18) In conclusion, it is likely that the motivation for companies to run health promotion campaigns will increase, but wellness may be a concept which fits somewhat awkwardly in the employer-employee relationship. Perhaps care for employees is the factor which will bring outcomes beneficial to all. Farnell (1987) expresses such care this way: An organisation's health comprises three components, its financial health, its organisational health (openness, trust, morale, etc) and the personal health of its members. No employer should consider the organisation in good shape without addressing each component. References Blewett, V. and Shaw, A. "Health promotion, handle with care." Journal of Occupational Health and Safety Australia and New Zealand 11 (1995): 461-5. Downie, R., Fyfe, C. and Tannahill, A. Health Promotion - Models and Values, Oxford UP: Oxford,1990. Farnell, L."Corporate culture change - the healthy way." Journal of Occupational Health and Safety Australia and New Zealand 3 (1987): 46-52. Hirschhorn, L. The workplace within: psychodynamics of organizational life. Cambridge, Mass: M.I.T. Press,1988. Leigh, J. and Harrison, J. "Reduction of Ischaemic heart disease risk factors following direct probabilistic risk communication in the workplace.", Journal of Occupational Health and Safety Australia and New Zealand 7 (1991): 467-72. Meurer, L., Meurer, J. and Holloway, R. "New models of health care in the home and in the work site.", American Family Physician 56 (1997): 384-7. Noblet, A.J. and Murphy, C. "Adapting the Ottowa Charter for Health Promotion to the Workplace Setting." Health Promotion Journal of Australia 5 (1995): 18-22. Rose, N. Governing the soul: the shaping of the private self. London: Routledge, 1989. Stokols, D., Pelletier, K. and Fielding, J. "Integration of medical care and worksite health promotion.", Journal of the American Medical Association 273 (1995): 1136-42. Williams, P. 1991, "Planning factors contributing to on-going health promotion programs." Journal of Occupational Health and Safety Australia and New Zealand 7 (1991): 489-94.

By the 12th century, coffee was extensively cultivated in Yemen, and qawha and cahveh, hot beverages made from roast and ground coffee beans, became popular in the Islamic world over the next 300 years. Commercial production of coffee outside Yemen started in Sri Lanka in the 1660s, Java in the 1700s, and Latin America in 1715, and this production has associations with histories of colonial expansion and slavery. Introduced to Europe in the 17th century, coffee was described by Robert Burton in the section of his 1628 Anatomy of Melancholy devoted to medicines as “an intoxicant, a euphoric, a social and physical stimulant, and a digestive aid” (quoted in Weinberg and Bealer xii). Today, more than 400 billion cups of coffee are consumed each year. Coffee is also an ingredient in a series of iconic dishes such as tiramisu and, with chocolate, makes up the classic mocha mix. Coffee production is widespread in tropical and sub-tropical countries and it is the second largest traded world commodity; second only to oil and petroleum. The World Bank estimates that more than 500 million people throughout the world depend on coffee for their livelihoods, and 25 million of these are coffee farmers. Unfortunately, these farmers typically live and work in substandard conditions and receive only a small percentage of the final price that their coffee is sold for. The majority of coffee farmers are women and they face additional challenges, frequently suffering from abuse, neglect, and poverty, and unable to gain economic, social, or political power in either their family’s coffee businesses or their communities. Some farm coffee under enslaved or indentured conditions, although Fair Trade regimes are offering some lessening of inequalities. At the opposite end of the scale, a small, but growing, number of high-end producers market gourmet sustainable coffee from small-scale, environmentally-aware farming operations. For many in the West today, however, coffee is not about the facts of its production; coffee is all about consumption, and is now interwoven into our contemporary cultural and social habits. Caffeine, found in the leaves, seeds, and fruit of the coffee tree, is an addictive psychoactive substance, but has overcome resistance and disapproval around the world and is now unregulated and freely available, without licence. Our gastronomic sophistication is reflected in which coffee, brewing method, and location of consumption is chosen; our fast-paced lifestyles in the range of coffee-to-go options we have; and our capitalist orientation in the business opportunities this popularity has offered to small entrepreneurs and multinational franchise chains alike. Cafés and the meeting, mingling, discussions, and relaxing that occur there while drinking coffee, are a contemporary topic of reflection and scholarship, as are the similarities and differences between the contemporary café and its earlier incarnations, including, of course, the Enlightenment coffee house. As may be expected from a commodity which has such a place in our lives, coffee is represented in many ways in the media—including in advertising, movies, novels, poetry, songs and, of course, in culinary writing, including cookbooks, magazines, and newspapers. There are specialist journals and popular serials dedicated to expounding and exploring the fine grain detail of its production and consumption, and food historians have written multiple biographies of coffee’s place in our world. So ubiquitous, indeed, is coffee, that as a named colour, it popularly features in fashion, interior design, home wares, and other products. This issue of M/C Journal invited contributors to consider coffee from any relevant angle that makes a contribution to our understanding of coffee and its place in culture and/or the media, and the result is a valuable array of illuminating articles from a diverse range of perspectives. It is for this reason that we chose an image of coffee cherries for the front cover of this issue. Co-editor Jill Adams has worked in the coffee industry for over ten years and has a superb collection of coffee images that ranges from farmers in Papua New Guinea to artfully shot compositions of antique coffee brewing equipment. In making our choice, however, we felt that Spencer Franks’s image of ripe coffee cherries at the Skybury Coffee Plantation in Far North Queensland, Australia, encapsulates the “fruitful” nature of the response to our call for articles for this issue. While most are familiar, moreover, with the dark, glossy appearance and other sensual qualities of roasted coffee beans, fewer have any occasion to contemplate just how lovely the coffee tree is as a plant. Each author has utilised the idea of “coffee” as a powerful springboard into a fascinating range of areas, showing just how inseparable coffee is from so many parts of our daily lives—even scholarly enquiry. In our first feature article, Susie Khamis profiles and interrogates the Nespresso brand, and how it points to the growing individualisation of coffee consumption, whereby the social aspect of cafés gives way to a more self-centred consumer experience. This feature valuably contrasts the way Starbucks has marketed itself as a social hub with the Nespresso boutique experience—which as Khamis explains—is not a café, but rather a club, a trademarked, branded space, predicated on highly knowledgeable and, therefore, privileged patrons. Coffee drinking is also associated with both sobriety and hangover cures, with cigarettes, late nights, and music. Our second feature, by Jon Stewart, looks at how coffee has become interwoven into our lives and imaginations through the music that we listen to—from jazz to blues to musical theatre numbers. It examines the influence of coffee as subject for performers and songwriters in three areas: coffee and courtship rituals, the stimulating effects of caffeine, and the politics of coffee consumption, claiming that coffee carries a cultural and musicological significance comparable to that of other drugs and ubiquitous consumer goods that are often more readily associated with popular music. Diana Noyce looks at the short-lived temperance movement in Australia, the opulent architecture of the coffee palaces built in that era, what was actually drunk in them, and their fates as the temperance movement passed into history. Emma Felton lyrically investigates how “going for a coffee” is less about coffee and more about how we connect with others in a mobile world, when flexible work hours are increasingly the norm and more people are living alone than any other period in history. Felton also introducess a theme that other writers also engage with: that the café also plays a role in the development of civil discourse and civility, and plays an important role in the development of cosmopolitan civil societies. Ireland-based Máirtín Mac Con Iomaire surveys Dublin—that tea drinking city—and both the history of coffee houses and the enduring coffee culture it possesses; a coffee culture that seems well assured through a remarkable win for Ireland in the 2008 World Barista Championships. China has also always been strongly associated with tea drinking but Adel Wang introduces readers to the emerging, and unique, café and coffee culture of that country, as well as some of the proprietors who are bringing about this cultural change. Australia, also once a significant consumer of tea, shifted to a preference for coffee over a twenty year period that began with the arrival of American Servicemen in Australia during World War II. Jill Adams looks at the rise of coffee during that time, and the efforts made by the tea industry to halt its market growth. These strong links between tea and coffee are reflected in Duncan Barnes, Danielle Fusco, and Lelia Green’s thought-provoking study of how coffee is marketed in Bangladesh, another tea drinking country. Ray Oldenberg’s influential concept of the “third place” is referred to by many authors in this collection, but Anthony McCosker and Rowan Wilken focus on this idea. By using a study of how Polish composer, Krzysztof Penderecki, worked in his local café from 9 in the morning to noon each day, this article explores the interrelationship of café space, communication, creativity, and materialism. Donna Lee Brien brings us back to the domestic space with her article on how the popular media of cookery books and magazines portray how coffee was used in Australian cooking at mid-century, in the process, tracing how tiramisu triumphed over the trifle. By exploring the currently fashionable practice of “direct trade” between roasters and coffee growers Sophie Sunderland offers a fresh perspective on coffee production by powerfully arguing that feeling (“affect”) is central to the way in which coffee is produced, represented and consumed in Western mass culture. Sunderland thus brings the issue full circle and back to Khamis’s discussion, for there is much feeling mobilised in the marketing of Nespresso. We would like to thank all the contributors and our generous and erudite peer reviewers for their work in the process of putting together this issue. We would also like to specially thank Spencer Franks for permission to use his image of coffee cherries as our cover image. We would lastly like to thank you the general editors of M/C Journal for selecting this theme for the journal this year.References Oldenburg, Ray, ed. Celebrating the Third Place: Inspiring Stories about the “Great Good Places” At the Heart of Our Communities. New York: Marlowe & Company 2001.Weinberg, Bennett Alan, and Bonnie K Bealer. The World of Caffeine. New York and London: Routledge, 2001.

Scenario: You are exhausted after a long day at work and collapse in front of the television for some mindless entertainment. One of your favourite comedy shows is on. You begin to relax. You laugh a couple of times. There's a commercial break. You watch the first ad for a hardware store, giving it only half your attention. And then there's another ad, something about a father and son in a car together and then ". WOOOMPH! A truck slams into the car. The message is "Speed kills!" Or there are people playing and sunbathing on a beach, happy holidays, and then vultures descend and surround them. The message is "Slip! Slop! Slap! Don't die in the sun this summer". Or someone is shown smoking a cigarette and the caption reads : "Give up now. You'll soon stop dying for a cigarette". This might be accompanied by scenes of a post-mortem, dissections of human lungs or brain. Context Threat appeals are used frequently in health and road safety promotion. Many use the threat of death as the consequence of undesirable behaviours, for example, "Quit smoking or you'll die' (Henley and Donovan). ("Non-death threats' appeal to other consequences such as "Quit smoking or your skin will age'.) There is an implicit notion of premature death threat, although this is rarely stated explicitly. When reminded of our risk of premature death, we are reminded by extension of the ultimate inevitability of our death. An understanding of the philosophy of existentialism can help us understand why consumers may, quite reasonably, tune out, or literally switch off health promotion messages that remind them of their own death. This paper explores the effect on consumers of these mass media invocations of the fear of death, or "death threats'. Verbatim comments are included from six focus groups conducted on fear and health promotion. Groups were delineated by age (16-20 years, 21-29 years and 30-49 years), gender, and socio-economic status (blue collar/white collar) (Henley). What is existential dread? Fear is one of the primary human emotions (along with anger, sadness, love, joy and surprise) and "dread' is one of the emotion names associated with fear (Shaver et al. 1067). We do not need to learn how to feel fear. We have to learn what to fear, however. Despite the joke about death and taxes, death is uniquely inevitable. (Some people do manage to avoid taxes!) In his definitive work, Denial of Death, Becker stated his belief that knowledge of our own death is the source of 'man's peculiar and greatest anxiety' (70); it's what makes us human. Existentialists think that knowing about the inevitability of our own death can be overwhelming, arousing the worst fear imaginable, "existential dread' (Bugental 287). Existential philosophers and psychologists believe that part of this anxiety stems from the existential dread of "not being'. Discussing Heidegger's analysis of the meaning of death in Being and Time, Barrett put it this way: The point is that I may die at any moment, and therefore death is my possibility now. It is like a precipice at my feet. It is also the most extreme and absolute of my possibilities: extreme, because it is the possibility of not being and hence cuts off all other possibilities; absolute, because man can surmount all other heartbreaks, even the deaths of those he loves, but his own death puts an end to him (201). The essence of existential philosophy is this idea that we are all deeply, terribly afraid of death. Fear of death can be seen even in very young children (Anthony, The child's; Anthony, The discovery; Nagy) who express considerable anxiety about death, but quickly learn from their parents and others how to deny it (Yalom). Existential psychologists have suggested that the fear of our own death is the cause of much of our psychopathology (Yalom). Existentialists believe that the most common response to existential anxiety is to deny it, creating in oneself a 'state of forgetfulness of being' as far as possible. Weisman described three levels of denial in terminally ill patients: "first-order denial' of the facts of illness; "second-order denial' of the implications of the illness; and "third-order denial' of death itself. He noted that often a patient moves from first and second order denial into "middle knowledge' (i.e., acceptance of near death), but then relapses. Weisman remarked that this relapse is often the signal that the terminal phase has begun. This aspect of denial is a complicated factor in the complex measurement of death anxiety. When people say they are not afraid of death, who can say whether they are denying fear or truly not afraid? In either case, health promotion appeals that threaten death may not be effective, either because the fear is denied or because there is no fear. In focus groups exploring people's concepts of death (Henley 111), few people acknowledged being afraid of their own death and many specifically stated that they were not afraid of their own death. One woman voiced the universal difficulty of truly conceiving what it might be like "not to be' (Kastenbaum and Aisenberg) when she said: 'death seems like such an unrealistic proposition'. People did acknowledge fears about death, such as dying painfully, so health promotion messages that threaten these other dimensions of death anxiety may be more effective. Health promotion practitioners frequently use these related death fears. The fear of causing death, for example, is used in road safety advertisements. However, this discussion on existential fear is limited to threat appeals of death per se. Death threats in health promotion Is arousing existential dread an effective way to market healthy behaviours? At first sight, it seems logical that the threat of death would be more persuasive than lesser threats and yet it may not be the most effective approach. There is some evidence that lesser threats may be more effective for some groups of adolescents and young adults for smoking (Donovan and Leivers), and for road safety behaviours (Donovan et al.). For example, for some 18 year old males, the threat of being caught drinking and driving, of losing their driving licence and, thus, their new-found independence may be a more effective deterrent than the threat of dying in a car accident (Donovan et al.). The humiliation of being arrested and charged for drink-driving may be the most powerful persuader for adults of all ages (Bevins). For men attending the Jerusalem Centre for Impotency and Fertility, impotence was reported a more persuasive threat than death: 78% of men who were told that smoking causes impotence quit smoking, compared to 40% who quit when told that smoking causes heart attacks ("No smoking tip"). One woman in a focus group said, 'you tend to think short-term, "can I afford a $100 fine?" rather than long-term, "this is my life." If I stop to think about it, obviously I'm more afraid of dying than $100 [fine], but that's not what I think about' (Henley 95). This makes sense in the context of forgetfulness, the denial of death. We don't want to be reminded of our death so we switch off the death message. Lesser threats may be more easily internalised. Does arousing existential dread do any harm? Perhaps. Job suggested that fear arousal is likely to be effective only for specific behaviours that successfully reduce the level of fear arousal and that high-fear messages may actually increase behaviours that people employ to reduce anxiety, such as smoking and alcohol consumption. People high in anxiety are hypothesised to be hypersensitive to threats and likely to employ a restricted range of self-soothing coping behaviours to reduce negative affect (Wickramasekera and Price). Death threat appeals such as "Quit smoking or you'll die' may arouse defensive, counter-productive responses, at least in some people, because it is impossible to identify any specific behaviour that could successfully reduce the particular, unique fear of death per se. Firestone identified a number of psychological defences against death anxiety, including self-nourishing and addictive habits, such as smoking and overeating. Ironically, these same behaviours are frequently the subject of health promotion campaigns. If such campaigns arouse death anxiety in an effort to curb defensive responses to death anxiety, there clearly could be an increase rather than a decrease in those defensive responses. Arousing death anxiety might contribute to fatalistic thinking. Job described some people's defenses against very high fear, for example, "...you've got to go sometime' or "...when your number's up, your number's up'. In focus groups, people commented, 'if an accident is going to happen, it's going to happen' and 'what's the point of giving up [unhealthy behaviours] if you get run over by a bus tomorrow?' (Henley 95, 108). Rippetoe and Rogers found that fatalistic thinking occurred when subjects did not believe that the recommended behaviour would avert the threat. That is, people may realise that quitting smoking could avert lung cancer and even some causes of premature death but that nothing can avert death itself. Fatalism may be one of the most maladaptive responses because the threat is acknowledged but rendered ineffective (Rippetoe and Rogers). Social marketers can make some of their persuasive communications more effective if they are more mindful of consumers' existential fears. A sensitivity to consumers' psychological defences against existential fear may result in more effective use of threat appeals in health promotion. Mindfulness Mindful that the title of this paper itself may arouse some existential dread, I end with a comment on the existentialist alternative to denial. Existentialists advocate a state of 'mindfulness of being' or 'ontological mode' (Heidegger, quoted in Yalom 31) in which "one remains mindful of being, not only mindful of the fragility of being but mindful, too ... of one's responsibility for one's own being." (Yalom 31). The existentialist strives to be as mindful, as present in the moment, and therefore as authentic as possible. This involves the acceptance of existential anxiety as an appropriate and reasonable response to the human condition (Bugental). Some focus group participants wanted to know in advance that they were going to die, 'so you can fit things in you'd want to do and say goodbye'. Others thought it was better not to know or 'you'd start having regrets'. One person pointed out that we do know in advance: 'you know you're going to die sometime!'. This last comment was followed by a sober, almost shocked silence suggesting that, even while we are freely discussing death on one level, the full meaning of death may still elude us. As consumers of health promotion messages, we are exposed to many reminders of our finite existence. If we sit mindlessly in front of the television receiving these messages, we may feel some unresolved discomfort. People talk about looking away, or switching channels when particularly shocking ads are shown. The existentialist alternative response would be to embrace these reminders and use them to sustain a state of mindfulness. With this state of mindfulness comes a heightened sense of responsibility for one's own being. It is in this ontological mode that we are most likely to adopt the healthy behaviours recommended in health promotion messages. By hearing the death threat openly, and acting to protect ourselves from at least those causes of premature death that may lie within our control, we may be able to discover a fuller experience of what it means to be alive. References Anthony, Sylvia. The Child's Discovery of Death. New York: Harcourt, Brace & World, 1940. Anthony, Sylvia. The Discovery of Death in Childhood and After. Harmondsworth, Middlesex: Penguin Education, 1973. Barrett, W. Irrational Man, A Study in Existential Philosophy. London: Heinemann, 1958. Becker, Ernest. The Denial of Death. New York: The Free Press, 1973. Bevins, John. "Using Advertising to Sell and Promote Health and Healthy Products". Paper presented at the ACHPER Health Products and Services Marketing Seminar. Kuring-gai College, Sydney, 1987. Bugental, J. F. T. The Search for Authenticity: An Existential-analytic Approach to Psychotherapy. New York: Holt, Rinehart and Winston, Inc., 1965. Donovan, Robert J., and Sue Leivers. Young Women and Smoking. Report to Commonwealth Department of Human Services and Health. Perth: Donovan Research, 1988. Donovan, Robert J., Nadine Henley, Geoffrey Jalleh, and Clive Slater. Road Safety Advertising: An Empirical Study and Literature Review. Canberra: Federal Office of Road Safety, 1995. Firestone, Robert W. "Psychological Defenses against Death Anxiety." Death Anxiety Handbook: Research, Instrumentation, and Application. Series in Death Education, Aging, and Health Care. Ed. Robert A. Neimeyer. Washington, DC: Taylor & Francis, 1994. 217-241. Henley, Nadine R. "Fear Arousal in Social Marketing: Death vs Non-death Threats." Doctoral Dissertation, University of Western Australia, Perth, 1997. Henley, Nadine and Robert J. Donovan. "Threat Appeals in Social Marketing: Death as a "Special Case'". International Journal of Nonprofit and Voluntary Sector Marketing, 4.4 (1999): 300-319. Job, R. F. Soames. "Effective and Ineffective Use of Fear in Health Promotion Campaigns." American Journal of Public Health, 78 (1988): 163-167. Kastenbaum, R., and R. Aisenberg. The Psychology of Death. London: Duckworth, 1974. Nagy, Maria H. "The Child's View of Death." The Meaning of Death. Ed. Herman Feifel. New York: McGraw-Hill Book Company, 1959. 79-98. "No Smoking Tip for Lovers". Daily Telegraph, (1994, September 24): p. 4. Rippetoe, P.A. and Rogers, R.W. "Effects of components of protection-motivation theory on adaptive and maladaptive coping with a health threat." Journal of Personality and Social Psychology, 52.3 (1987): 596-604. Shaver, P., J. Schwartz, D. Kirson, and C. O'Connor. "Emotion Knowledge: Further Exploration of a Prototype Approach." Journal of Personality and Social Psychology, 52.6 (1987): 1061-1086. Weisman, A.D. On dying and denying: A psychiatric study of terminality. New York: Behavioral Publications, 1972. Wickramasekera, Ian and Daniel C. Price. "Morbid Obesity, Absorption, Neuroticism, and the High Risk Model of Threat Perception." American Journal of Clinical Hypnosis, 39 (1997): 291-301. Yalom, I. D. Existential Psychotherapy. New York: Basic Books, 1980. Citation reference for this article MLA Style Henley, Nadine. "You will die! " M/C: A Journal of Media and Culture 5.1 (2002). [your date of access] < http://www.media-culture.org.au/0203/youwilldie.php>. Chicago Style Henley, Nadine, "You will die! " M/C: A Journal of Media and Culture 5, no. 1 (2002), < http://www.media-culture.org.au/0203/youwilldie.php> ([your date of access]). APA Style Henley, Nadine. (2002) You will die! . M/C: A Journal of Media and Culture 5(1). < http://www.media-culture.org.au/0203/youwilldie.php> ([your date of access]).

"Doctor, will I live longer if I give up alcohol and sex?" "No, but it will seem like it." The paradigm of the self as it is conceptualised in Western society includes an implicit assumption that one of the primary activities of the self is to engage in protective behaviours. This is a basic assumption in mass media promotion of healthy behaviours: 'Quit smoking' to protect yourself from lung cancer; 'Work safe' to protect yourself from injury, etc. Mass media social marketing campaigns inform the general population of the dangers to the self's existence of smoking, drink-driving, unsafe sex, over-eating, under-exercising and so on. These campaigns are based on models such as the Health Belief Model (Janz and Becker), the Fear Drive paradigm (Janis; McGuire), the Parallel Response Model (Leventhal), Thayer's Arousal Model, Roger's Protection Motivation Theory (Rogers & Mewborn; Maddux & Rogers), Ordered Protection Motivation Theory (Tanner, Hunt and Eppright) and the Extended Parallel Process Model (Witte). Fundamental to all these models is the assumption that people are motivated to protect themselves from harm. Information is provided that warns of the severity and likelihood of consequences of unhealthy behaviours. In some cases this information does motivate people to give up harmful behaviours and adopt safer options. However, worldwide, we see an increasing prevalence of diseases such as heart disease, diabetes and cancer that are related to preventable causes such as obesity, smoking and a sedentary lifestyle. To meet this challenge, the media strategy has generally focused on how to get health information across more effectively, that is, by making it more persuasive, more vivid, more salient, more imminent, more probable, and so on. Media exhortations to: 'say no to drugs', 'Quit because you can!', 'Respect yourself' etc. do not always achieve the desired change and may increase frustration, hopelessness and even depression (Henley & Donovan). It may be helpful to consider that this protection motivation paradigm does not take into account the prevalence of paradoxical behaviours, that is, behaviours that are harmful to the self (Apter). When talking about health, I think it is useful to divide paradoxical behaviours into two categories: thrill-seeking behaviours such as sky-diving and bungie-jumping where the individual enjoys the experience of being at risk without (usually) craving it; craved or 'addictive' behaviours (using the term loosely), such as smoking, binge-drinking, over-eating, drug-taking, where the individual craves a certain sensation and the gratification of the craving supersedes protective impulses. In both cases, the individual knows the behaviour is potentially harmful but chooses to engage in it. In the first case, there is a conscious choice that the enjoyment of the thrill experience outweighs the risk. The person feels in control of the decision (even if the decision is to abandon oneself to the feeling of being temporarily out of control). In the second case, there is a need to gratify the craving, regardless of the risk. The person is fully aware that it is not in their long term self-interest but feels out of control of the decision (Lowenstein). This second category of paradoxical behaviours consists of many unhealthy behaviours targeted by health practitioners. This paper discusses 1) the concept of the self in Western society; 2) the concept of paradoxical behaviour, distinguishing it from deviant behaviour; and 3) the suggestion that people may engage in addictive paradoxical behaviours to satisfy the 'empty self' (Cushman). Finally, the paper suggests that this attention to the empty self may be in a perverse way protective (though not healthy), and calls for a health promotion approach that directly addresses the needs of the 'empty self'. Concept of Self The concept of the self varies across cultures and time. Cushman (599) defined the concept of the self as 'the concept of the individual as articulated by the indigenous psychology of a particular cultural group.... the self embodies what the culture believes is humankind's place in the cosmos: its limits, talents, expectations, and prohibitions'. The Eastern concept of self extends 'beyond one's physical and psychosocial identity to include all other people in the world' (Westman & Canter 419) while the concept of self as it has developed in Western society 'has specific psychological boundaries, an internal locus of control, and a wish to manipulate the external world for its own personal ends' (Cushman 600). This Western concept of the self has been traced to Augustine's Confessions, identified by Weintraub (cited in Freeman 26) as the first reflective, autobiographical review of a life history in which selfhood is examined and understood. The concept of self encapsulates the most profound sense of cosmic place, worth and meaning. One of the aspects of the Western concept of self is a sense of mastery, of being able to act upon the world. Paradoxical vs Deviant Behaviour Apter makes a distinction between deviant behaviour, which is defined by social norms, and paradoxical behaviour, which is defined as any behaviour potentially harmful either to the individual or to society. Parachuting would be an example of behaviour potentially harmful to the individual, while celibacy, by threatening the survival of the social group, would be behaviour potentially harmful to society. Neither of these behaviours would be regarded as 'deviant'. Apter (10) calls this sort of behaviour paradoxical 'because it has the opposite effect to that which, from a biological and evolutionary point of view, one would expect behaviour to have'. While there will be considerable overlap in practice between deviant and paradoxical behaviour - child abuse, vandalism, drug and alcohol abuse, suicide, etc. would all be both deviant and paradoxical - there is a distinction in perspective between these two terms. Deviant behaviour, by definition, is always regarded by a society as anti-social (and therefore is often harmful); paradoxical behaviour is, by definition, always regarded by the individual's self-concept as harmful or potentially harmful (and therefore is also often anti-social). As our self-concept is socially learned, it is difficult to arrive at a true separation of these definitions but the following example may clarify the distinction: smoking was a widespread, socially acceptable activity in the 1950s, even glamorised by Hollywood. When the scientific evidence showed that it was harmful to the individual's health, that is, paradoxical behaviour, many people were sufficiently motivated to quit. Since the dangers of passive smoking have been highlighted and smoking is becoming regarded as socially unacceptable, that is, deviant behaviour, many more people are trying to stop, and succeeding. For many people, motivation for change is successful when an activity is recognised as both deviant and paradoxical. Social marketing campaigns have targeted these two areas for years, informing of health risks and dispelling the glamorous image. Yet, people still smoke, even when they know the health dangers and daily experience the open disapproval of others. At the extreme is the person who lies in a hospital bed with both legs amputated, being told and believing that continued smoking will result in the loss of remaining limbs, but who is still not motivated sufficiently to quit; this person is clearly exhibiting extreme paradoxical behaviour. It is useful to call this behaviour paradoxical rather than deviant because it is defined primarily by the extreme injury to the individual rather than the degree to which it departs from social norms. Why an individual would persist in such irrational behaviour is a seemingly unanswerable question. As Menninger has said, 'the extraordinary propensity of the human being to join hands with external forces in an attack upon his own existence is one of the most remarkable of biological phenomena' (cited in Apter 10). In trying to understand it, we look at three alternatives: 1) what people say their reasons may be; 2) how people defend against knowledge of risk; and 3) the role of visceral influences. Van Deurzen-Smith (165-6), an existential counsellor, gives some insight into the complexity of one of her patient's reasons for smoking: The dangers of heart disease or lung cancer had, far from making her want to give up smoking, been a real secret attraction which had been hard to give up. She had experienced smoking as playing with fire and that was highly enjoyable.... smoking in this sense had represented her experience of her body as concretely her own. Inhaling smoke was like breathing fire and feeling extra-alive; exhaling smoke was like seeing her own body's power being projected out of her mouth. Carrying cigarettes and fire on her every minute of the day used to give her a sense of oneness with the substances of the natural world; it was like possessing the secret power of some magical ritual. When smoking she was in command of the physical world, she was master of her own destiny. In other words, smoking had become an integral part of this person's self-concept. An alternative viewpoint is that smokers simply defend against knowledge of the health risks. In an examination of 'psychic defences against high fear appeals', Stuteville identified three techniques which people use to reduce fear-arousal: a) they deny the validity of the information; b) they unconsciously assert 'I am the exception to the rule - it won't happen to me'; and c) they defuse the danger by making it laughable or ridiculous. He suggested that campaigns can be more effective if they involve a threat to significant others, especially children, or are made to seem 'offensive to small group norms' (45), that is, seen as deviant rather than paradoxical. Lowenstein attempted to understand the discrepancies between what people do and what it is in their self-interest to do by postulating the operation of 'visceral factors', drive states relating to hunger, fear, pain, sex and emotions. He suggested that the need to satisfy these drives can supersede virtually all other needs, and that people consistently fail to recognise the strength of the influence of visceral factors in themselves and in others, despite all previous experience and evidence to the contrary. One of the characteristics of visceral factors is the effect of time-shortening so that immediate gratification outweighs long-term goals. Attempts to exercise self-control are made when thinking long-term and usually at the expense of short-term gratification (Lowenstein 288). Although this concept of visceral influences explains some irrational behaviour, Lowenstein made little attempt to explain why some people seem to be more at the mercy of visceral factors than others. For this, it may be helpful to explore Cushman's concept of the 'empty self'. The Hungry 'Empty Self' Cushman (600) identified the configuration of the concept of self in the United States as having developed into an 'empty self ... a self that experiences a significant absence of community, tradition, and shared meaning. It experiences these social absences and their consequences 'interiorly' as a lack of personal conviction and worth, and it embodies the absences as a chronic, undifferentiated emotional hunger'. It is this notion of emotional hunger that may have particular relevance to a discussion of paradoxical behaviours generated by cravings. Cushman referred to a strong desire for consumer products to assuage this hunger, but it may be useful when thinking of health to consider the hunger more literally, as a need to ingest substances (drugs, alcohol, food etc) and experiences (shopping, sex, speed, etc) to fill up the emptiness. Emotional hunger may lead to a number of self-destructive but self-nourishing and addictive habits, identified by Firestone as psychological defences against anxiety. Cushman identified advertising as one of the two professions responsible for healing the empty self (the other was psychotherapy), while recognising that it is also one of the professions that perpetuates and profits from the psychopathology. Perhaps the responsibility falls to social marketing which is concerned with the marketing of ideas, attitudes and beliefs, including health and safety lifestyle issues. At present, it could be said that health promotion tends to make people feel bad (Henley & Donovan), with an emphasis on the dire consequences of unhealthy behaviours. Is it reasonable to suggest that social marketing could be used to try to heal the empty self? Interestingly, this is already happening to some extent. Mental health is a priority issue and a recent mental health campaign in Victoria, Australia, 'Together We Do Better', stresses the need for community and social connection. Western Australia is exploring whether to undertake a similar campaign. The campaign includes messages relating to friendship, parenting, talking about problems, bullying, sledging, and inter-generational communication (Campaign materials). The overall aim is to work towards a more inclusive, caring, connected and tolerant society. Conclusion This paper has discussed the apparent limitation of the current paradigm in health promotion that people are primarily motivated to protect themselves by considering the prevalence of paradoxical behaviours, that is behaviours that are harmful to the self, especially those that are generated by a need to satisfy cravings. One explanation for such paradoxical behaviours is that they are motivated by visceral factors relating to physical and emotional drives. However, this does not explain why some people are more susceptible than others. Cushman's concept of the hungry, empty self, alienated from community and disconnected from social traditions and meaning, may go further to explain why some people are more susceptible to cravings than others. Social marketing could play a helpful role in healing people's sense of isolation in mental health campaigns such as VicHealth's 'Together We Do Better'. Finally, it may be more intuitive to understand apparently paradoxical behaviour as an urgent attempt to heal the empty self. This would make it in a perverse way protective, though not healthy. This way, people are seen as doing the best they can to protect themselves against the most immediate threat to the self, a sense of hollowness and isolation. If so, the fact that this need is able to supersede other major health needs suggests that it is one of the most urgent imperatives of the self. References Apter, M.J. 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