Academic literature on the topic 'Copts – Australia – Education'

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BackgroundIn the past twenty years the discourse of the weight-centred health paradigm (WCHP) has attained almost complete dominance in the sphere of public health policy throughout the developed English speaking world. The national governments of Australia and many countries around the world have responded to what is perceived as an ‘epidemic of obesity’ with public health policies and programs explicitly focused on reducing and preventing obesity through so called ‘lifestyle’ behaviour change. Weight-related public health initiatives have been subjected to extensive critique based on ideological, ethical and empirical grounds (Solovay; Oliver; Gaesser; Gard; Monaghan, Colls and Evans; Wright; Rothblum and Solovay; Saguy; Rich, Monaghan and Aphramor; Bacon and Aphramor; Brown). Many scholars have raised concerns about the stigmatising and harmful effects of the WCHP (Aphramor; Bacon and Aphramor; O'Dea; Tylka et al.), and in particular the inequitable distribution of such negative impacts on women, people who are poor, and people of colour (Campos). Weight-based stigma is now well recognised as a pervasive and insidious form of stigma (Puhl and Heuer). Weight-based discrimination (a direct result of stigma) in the USA has a similar prevalence rate to race-based discrimination, and discrimination for fatter and younger people in particular is even higher (Puhl, Andreyeva and Brownell). Numerous scholars have highlighted the stigmatising discourse evident in obesity prevention programs and policies (O'Reilly and Sixsmith; Pederson et al.; Nuffield Council on Bioethics; ten Have et al.; MacLean et al.; Carter, Klinner, et al.; Fry; O'Dea; Rich, Monaghan and Aphramor). The ‘war on obesity’ can therefore be regarded as a social determinant of poor health (O'Hara and Gregg). Focusing on overweight and obese people is not only damaging to people’s health, but is ineffective in addressing the broader social and economic issues that create health and wellbeing (Cohen, Perales and Steadman; MacLean et al.; Walls et al.). Analyses of the discourses used in weight-related public health initiatives have highlighted oppressive, stigmatizing and discriminatory discourses that position body weight as pathological (O'Reilly; Pederson et al.), anti-social and a threat to the viable future of society (White). There has been limited analysis of discourses in Australian social marketing campaigns focused on body weight (Lupton; Carter, Rychetnik, et al.).Social Marketing CampaignsIn 2006 the Australian, State and Territory Governments funded the Measure Up social marketing campaign (Australian Government Department of Health and Ageing "Measure Up"). As the name suggests Measure Up focuses on the measurement of health through body weight and waist circumference. Campaign resources include brochures, posters, a tape measure, a 12 week planner, a community guide and a television advertisement. Campaign slogans are ‘The more you gain, the more you have to lose’ and ‘How do you measure up?’Tomorrow People is the component of Measure Up designed for Indigenous Australians (Australian Government Department of Health and Ageing "Tomorrow People"). Tomorrow People resources focus on healthy eating and physical activity and include a microsite on the Measure Up website, booklet, posters, print and radio advertisements. The campaign slogan is ‘Tomorrow People starts today. Do it for our kids. Do it for our culture.’ In 2011, phase two of the Measure Up campaign was launched (Australian Government Department of Health and Ageing "Swap It, Don't Stop It"). The central premise of Swap It, Don’t Stop It is that you ‘can lose your belly without losing all the things you love’ by making ‘simple’ swaps of behaviours related to eating and physical activity. The campaign’s central character Eric is made from a balloon, as are all of the other characters and visual items used in the campaign. Eric claims thatover the years my belly has ballooned and ballooned. It’s come time to do something about it — the last thing I want is to end up with some cancers, type 2 diabetes and heart disease. That’s why I’ve become a Swapper! What’s a swapper? It’s simple really. It just means swapping some of the things I’m doing now for healthier choices. That way I can lose my belly, without losing all the things I love. It’s easy! The campaign has produced around 30 branded resource items including brochures, posters, cards, fact sheets, recipes, and print, radio, television and online advertisements. All resources include references to Eric and most also include the image of the tape measure used in the Measure Up campaign. The Swap It, Don’t Stop It campaign also includes resources specifically directed at Indigenous Australians including two posters from the generic campaign with a dot painting motif added to the background. MethodologyThe epistemological position in this project was constructivist (Crotty) and the theoretical perspective was critical theory (Crotty). Multimedia critical discourse analysis (Machin and Mayr) was the methodology used to examine the social marketing campaigns and identify the discourses within them. Critical discourse analysis (CDA) focuses on critiquing text for evidence of power and ideology. CDA is used to reveal the ideas, absences and assumptions, and therefore the power interests buried within texts, in order to bring about social change. As a method, CDA has a structured three dimensional approach involving textual practice analysis (for lexicon) at the core, within the context of discursive practice analysis (for rhetorical and lexical strategies particularly with respect to claims-making), which falls within the context of social practice analysis (Jacobs). Social practice analysis explores the role played by power and ideology in supporting or disturbing the discourse (Jacobs; Machin and Mayr). Multimodal CDA (MCDA) uses a broad definition of text to include words, pictures, symbols, ideas, themes or any message that can be communicated (Machin and Mayr). Analysis of the social marketing campaigns involved examining the vocabulary, grammar, sentence structure, visuals and overall structure of the text for textual, discursive and social practices.Results and DiscussionIndividual ResponsibilityThe discourse of individual responsibility is strongly evident in the campaigns. In this discourse, it is ultimately the individual who is held responsible for their body weight and their health. The individual responsibility discourse is signified by the discursive practice of using epistemic (related to the truth or certainty) and deontic (compelling or instructing) modality words, particularly modal verbs and modal adverbs. High modality epistemic words are used to convince the reader of the certainty of statements and to portray the statement-maker as authoritative. High modality deontic words are used to instil power and authority in the instructions.The extensive use of high modality epistemic and deontic words is demonstrated in the following paragraph assembled from various campaign materials: Ultimately (epistemic modality adverb) individuals must take responsibility (deontic modality verb) for their own health, including their and weight. Obesity is caused (epistemic modality verb) by an imbalance in energy intake (from diet) (epistemic modality verb) and expenditure (from activity) (epistemic modality verb). Individually (epistemic modality adverb) we make decisions (epistemic modality verb) about how much we eat (epistemic modality verb) and how much activity we undertake (epistemic modality verb). Each of us can control (epistemic modality) our own weight by controlling (deontic modality) what we eat (deontic modality verb) and how much we exercise (deontic modality verb). To correct (deontic modality verb) the energy imbalance, individuals need to develop (deontic modality verb) a healthy lifestyle by making changes (deontic modality verb) to correct (deontic modality verb) their dietary habits and increase (deontic modality verb) their activity levels. The verbs must, control, correct, develop, change, increase, eat and exercise are deontic modality verbs designed to instruct or compel the reader.These discursive practices result in the clear message that individuals can and must control, correct and change their eating and physical activity, and thereby control their weight and health. The implication of the individualist discourse is that individuals, irrespective of their genes, life-course, social position or environment, are charged with the responsibility of being more self-surveying, self-policing, self-disciplined and self-controlled, and therefore healthier. This is consistent with the individualist orientation of neoliberal ideology, and has been identified in various critiques of obesity prevention public health programs that centralise the self-responsible subject (Murray; Rich, Monaghan and Aphramor) and the concept of ‘healthism’, the moral obligation to pursue health through healthy behaviours or healthy lifestyles (Aphramor and Gingras; Mansfield and Rich). The hegemonic Western-centric individualist discourse has also been critiqued for its role in subordinating or silencing other models of health and wellbeing including Aboriginal or indigenous models, that do not place the individual in the centre (McPhail-Bell, Fredericks and Brough).Obesity Causes DiseaseEpistemic modality verbs are used as a discursive practice to portray the certainty or probability of the relationship between obesity and chronic disease. The strength of the epistemic modality verbs is generally moderate, with terms such as ‘linked’, ‘associated’, ‘connected’, ‘related’ and ‘contributes to’ most commonly used to describe the relationship. The use of such verbs may suggest recognition of uncertainty or at least lack of causality in the relationship. However this lowered modality is counterbalanced by the use of verbs with higher epistemic modality such as ‘causes’, ‘leads to’, and ‘is responsible for’. For example:The other type is intra-abdominal fat. This is the fat that coats our organs and causes the most concern. Even though we don’t yet fully understand what links intra-abdominal fat with chronic disease, we do know that even a small deposit of this fat increases the risk of serious health problems’. (Swap It, Don’t Stop It Website; italics added)Thus the prevailing impression is that there is an objective, definitive, causal relationship between obesity and a range of chronic diseases. The obesity-chronic disease discourse is reified through the discursive practice of claims-making, whereby statements related to the problem of obesity and its relationship with chronic disease are attributed to authoritative experts or expert organisations. The textual practice of presupposition is evident with the implied causal relationship between obesity and chronic disease being taken for granted and uncontested. Through the textual practice of lexical absence, there is a complete lack of alternative views about body weight and health. Likewise there is an absence of acknowledgement of the potential harms arising from focusing on body weight, such as increased body dissatisfaction, disordered eating, and, paradoxically, weight gain.Shame and BlameBoth Measure Up and Swap It, Don’t Stop It include a combination of written/verbal text and visual images that create a sense of shame and blame. In Measure Up, the central character starts out as young, slim man, and as he ages his waist circumference grows. When he learns that his expanding waistline is associated with an increased risk of chronic disease, his facial expression and body language convey that he is sad, dejected and fearful. In the still images, this character and a female character are positioned looking down at the tape measure as they measure their ‘too large’ waists. This position and the looks on their faces suggest hanging their heads in shame. The male characters in both campaigns specifically express shame about “letting themselves go” by unthinkingly practicing ‘unhealthy’ behaviours. The characters’ clothing also contribute to a sense of shame. Both male and female characters in Measure Up appear in their underwear, which suggests that they are being publicly shamed. The clothing of the Measure Up characters is similar to that worn by contestants in the television program The Biggest Loser, which explicitly uses shame to ‘motivate’ contestants to lose weight. Part of the public shaming of contestants involves their appearance in revealing exercise clothing for weigh-ins, which displays their fatness for all to see (Thomas, Hyde and Komesaroff). The stigmatising effects of this and other aspects of the Biggest Loser television program are well documented (Berry et al.; Domoff et al.; Sender and Sullivan; Thomas, Hyde and Komesaroff; Yoo). The appearance of the Measure Up characters in their underwear combined with their head position and facial expressions conveys a strong, consistent message that the characters both feel shame and are deserving of shame due to their self-inflicted ‘unhealthy’ behaviours. The focus on ‘healthy’ and ‘unhealthy’ behaviours contributes to accepted and contested health identities (Fry). The ‘accepted health identity’ is represented as responsible and aspiring to and pursuing good health. The ‘contested health identity’ is represented as unhealthy, consuming too much food, and taking health risks, and this identity is stigmatised by public health programs (Fry). The ‘contested health identity’ represents the application to public health of Goffman’s ‘spoiled identity’ on which much stigmatisation theorising and research has been based (Goffman). As a result of both lexical and visual textual practices, the social marketing campaigns contribute to the construction of the ‘accepted health identity’ through discourses of individual responsibility, choice and healthy lifestyle. Furthermore, they contribute to the construction of the spoiled or ‘contested health identity’ through discourses that people are naturally unhealthy and need to be frightened, guilted and shamed into stopping ‘unhealthy’ behaviours and adopting ‘healthy’ behaviours. The ‘contested health identity’ constructed through these discourses is in turn stigmatised by such discourses. Thus the campaigns not only risk perpetuating stigmatisation through the reinforcement of the health identities, but possibly extend it further by legitimising the stigma associated with such identities. Given that these campaigns are conducted by the Australian Government, the already deeply stigmatising social belief system receives a significant boost in legitimacy by being positioned as a public health belief system perpetrated by the Government. Fear and AlarmIn the Measure Up television advertisement the main male character’s daughter, who has run into the frame, abruptly stops and looks fearful when she hears about his increased risk of disease. Using the discursive practice of claims-making, the authoritative external source informs the man that the more he gains (in terms of his waist circumference), the more he has to lose. The clear implication is that he needs to be fearful of losing his health, his family and even his life if he doesn’t reduce his waist circumference. The visual metaphor of a balloon is used as the central semiotic trope in Swap It, Don’t Stop It. The characters and other items featuring in the visuals are all made from twisting balloons. Balloons themselves may not create fear or alarm, unless one is unfortunate to be afflicted with globophobia (Freed), but the visual metaphor of the balloon in the social marketing campaign had a range of alarmist meanings. At the population level, rates and/or costs of obesity have been described in news items as ‘ballooning’ (Body Ecology; Stipp; AFP; Thien and Begawan) with accompanying visual images of extremely well-rounded bodies or ‘headless fatties’ (Cooper). Rapid or significant weight gain is referred to in everyday language as ‘ballooning weight’. The use of the balloon metaphor as a visual device in Swap It, Don’t Stop It serves to reinforce and extend these alarmist messages. Further, there is no attempt in the campaigns to reduce alarm by including positive or neutral photographs or images of fat people. This visual semiotic absence – a form of cultural imperialism (Young) – contributes to the invisibilisation of ‘real life’ fat people who are not ashamed of themselves. Habermas suggests that society evolves and operationalises through rational communication which includes the capacity to question the validity of claims made within communicative action (Habermas The Structural Transformation of the Public Sphere; Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society). However the communicative action taken by the social marketing campaigns analysed in this study presents claims as uncontested facts and is therefore directorial about the expectations of individuals to take more responsibility for themselves, adopt certain behaviours and reduce or prevent obesity. Habermas argues that the lack or distortion of rational communication erodes relationships at the individual and societal levels (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Structural Transformation of the Public Sphere). The communicative actions represented by the social marketing campaigns represents a distortion of rational communication and therefore erodes the wellbeing of individuals (for example through internalised stigma, shame, guilt, body dissatisfaction, weight preoccupation, disordered eating and avoidance of health care), relationships between individuals (for example through increased blame, coercion, stigma, bias, prejudice and discrimination) and society (for example through stigmatisation of groups in the population on the basis of their body size and increased social and health inequity). Habermas proposes that power differentials work to distort rational communication, and that it is these distortions in communication that need to be the focal point for change (Habermas The Theory of Communicative Action: Reason and the Rationalisation of Society; Habermas The Theory of Communicative Action: The Critique of Functionalist Reason; Habermas The Structural Transformation of the Public Sphere). Through critical analysis of the discourses used in the social marketing campaigns, we identified that they rely on the power, authority and status of experts to present uncontested representations of body weight and ‘appropriate’ health responses to it. In identifying the discourses present in the social marketing campaigns, we hope to focus attention on and thereby disrupt the distortions in the practical knowledge of the weight-centred health paradigm in order to contribute to systemic reorientation and change.ConclusionThrough the use of textual, discursive and social practices, the social marketing campaigns analysed in this study perpetuate the following concepts: everyone should be alarmed about growing waistlines and ‘ballooning’ rates of ‘obesity’; individuals are to blame for excess body weight, due to ignorance and the practice of ‘unhealthy behaviours’; individuals have a moral, parental, familial and cultural responsibility to monitor their weight and adopt ‘healthy’ eating and physical activity behaviours; such behaviour changes are easy to make and will result in weight loss, which will reduce risk of disease. These paternalistic campaigns evoke feelings of personal and parental guilt and shame, resulting in coercion to ‘take action’. They simultaneously stigmatise fat people yet serve to invisibilise them. Public health agencies must consider the harmful consequences of social marketing campaigns focused on body weight.ReferencesAFP. "A Ballooning Health Issue around the World." Gulfnews.com 29 May 2013. 17 Sep. 2013 ‹http://gulfnews.com/news/world/other-world/a-ballooning-health-issue-around-the-world-1.1189899›.Aphramor, Lucy. "The Impact of a Weight-Centred Treatment Approach on Women's Health and Health-Seeking Behaviours." Journal of Critical Dietetics 1.2 (2012): 3-12.Aphramor, Lucy, and Jacqui Gingras. "That Remains to Be Said: Disappeared Feminist Discourses on Fat in Dietetic Theory and Practice." The Fat Studies Reader, eds. Esther Rothblum and Sondra Solovay. New York: New York University Press, 2009. 97-105. Australian Government Department of Health and Ageing. 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Introduction As street protests and clashes between citizens and authorities in places as different as Ferguson, Missouri and Hong Kong in autumn 2014 demonstrate, everyday life in many parts of the world is characterised by conflicting and competing sets of cultural norms, values, and practices. The idea that groups create cultures that stand in contrast to “mainstream” or “dominant culture” is nothing new—sociology’s earliest scholars sought cultural explanations for social “dysfunctions” such as anomie and deviance. Yet our interest in this article is not about the problems that marginalised and non-normative groups face, but rather with the cultures that are created as part of dealing with those problems. Milton Yinger begins his 1982 book, Countercultures: The Promise and Peril of a World Turned Upside Down, by contrasting multiple perspectives on countercultures. Some thinkers have characterised countercultures as not only a mundane feature of social life, but as a necessary one: Countercultures and the many types of intentional communities they commonly create are not social aberrations. For thousands of years there have been attempts to provide alternatives for the existing social order in response to the perennial grounds for dissent: hierarchy and privilege […,] disgust with hedonism and consumerism […, and] a decline in the quality of life. (Yinger, Countercultures 1) Others, however, have discursively delegitimised countercultures by characterising them as something in between naiveté and unschooled arrogance. Speaking specifically about hippies in the 1960s, Bell argued that the so-called counter-culture was a children’s crusade that sought to eliminate the line between fantasy and reality and act out in life its impulses under a banner of liberation. It claimed to mock bourgeois prudishness, when it was only flaunting the closet behavior of its liberal parents. It claimed to be new and daring when it was only repeating in more raucous form […] the youthful japes of a Greenwich Village bohemia of a half century before. It was less a counter-culture than a counterfeit culture. (xxvi-xxvii) If Bell is at all right, then perhaps countercultures may be better understood as subcultures, a term that may not require the idea of opposition (but see Gelder; Williams, Subcultural). To tease this distinction out, we want to consider the value of the counterculture concept for the study of oppositional subcultures. Rather than uncritically assuming what counter means, we take a more analytical view of how “counter,” as similar to other terms such as “resistant” and “oppositional,” has been articulated by social scientists. In doing this, we focus our attention on scholarly works that have dealt explicitly with group cultures “that sharply contradict the dominant norms and values of the society of which that group is a part” (Yinger, Countercultures 3). The Relationship between Counterculture and Subculture Many scholars point to the Chicago School of sociology as developing the first clear articulation of subcultural groups that differed clearly from mainstream society (see for example, Gelder and Thornton; Hannerz, E.; Williams, Youth). Paul G. Cressey, Frederic Thrasher, and later William Foote Whyte each provide exemplary empirical studies of marginal groups that were susceptible to social problems and therefore more likely to develop cultures that were defined as problematic for the mainstream. Robert Merton argued that marginalised groups formed as individuals tried to cope with the strain they experienced by their inability to access the cultural means (such as good education and good jobs) needed to achieve mainstream cultural goals (primarily, material success and social status), but Albert Cohen and others subsequently argued that such groups often reject mainstream culture in favour of a new, alternative culture instead. Within a few years, conceptual distinctions among these alternative cultures were necessary, with counterculture and subculture being disambiguated in American sociology. Yinger originally employed the term contraculture but eventually switched to the more common counterculture. Subculture became most often tied either to the study of religious and ethnic enclaves (Mauss) or to deviance and delinquency (Arnold), while counterculture found its currency in framing the cultures of more explicitly political groups and movements (see for example, Cushman; George and Starr). Perhaps the clearest analytical distinction between the terms suggested that subculture refer to ascribed differences based upon socio-economic status, ethnicity, religion (and so on) in relation to the mainstream, whereas counterculture should refer to groups rooted in an explicit rejection of a dominant culture. This is similar to the distinction that Ken Gelder makes between subcultures based upon marginalisation versus non-normativity. Counterculture became best used wherever the normative system of a group contains, as a primary element, a theme of conflict with the values of the total society, where personality variables are directly involved in the development and maintenance of the group's values, and wherever its norms can be understood only by reference to the relationships of the group to a surrounding dominant culture. (Yinger, Contraculture 629) Even at that time, however, such a neat distinction was problematic. Sociologist Howard S. Becker demonstrated that jazz musicians, for example, experienced a problem shared in many service occupations, namely that their clients did not possess the ability to judge properly the value of the service rendered, yet nevertheless sought to control it. As a consequence, a subculture emerged based on the opposition of “hip” musicians to their “square” employers’ cultural sensibilities. Yet Becker framed their experiences as subcultural rather than countercultural, as deviant rather than political (Becker 79-100). Meanwhile, the political connotations of “counterculture” were solidifying during the 1960s as the term became commonly used to describe aspects of the civil rights movement in the US, hippie culture, and the anti-Vietnam or peace movement. By the end of the 1960s, subculture and counterculture had become analytically distinct terms within sociology. Cultural Studies and the Class-ification of Counterculture The reification of subculture and counterculture as ontologically distinct phenomena was more or less completed in the 1970s through a series of publications on British youth cultures and subcultures (see Hall and Jefferson; Hebdige; Mungham and Pearson). The Centre for Contemporary Cultural Studies (CCCS) in particular expended a great deal of collective mental energy theorising the material base upon which cultures—and in particular spectacular youth subcultures such as mods and punk—exist. As with Marxist analyses of culture more generally, class was considered a key analytic variable. In the definitive theoretical statement on subculture, Clarke, Hall, Jefferson, and Roberts argued that “the most fundamental groups are the social classes, and the major cultural configurations will be […] ‘class cultures’” (13). Subcultures were thus seen as ideological reactions to the material conditions experienced and made meaningful within working class “parent culture.” This is what made youth subcultures sub—a part of the working-class—as well as cultural—the process of expressing their structural position. Given the Marxist orientation, it should go without saying that subcultures, as working-class youth cultures, were seen as naturally in a state of conflict with bourgeois culture. But that approach didn’t account well for counter-currents that emerged from within the middle-class, whose relationship with the means of production was markedly different, and so the concept of counterculture was appropriated to describe a distinctly middle-class phenomenon. The idea that counterculture represented an overtly political response from within the dominant culture itself fitted with work by Theodore Roszak and Frank Musgrove, and later Yinger (Countercultures) and Ulf Hannerz, who each defined counterculture through its political and activist orientations stemming from a crisis within the middle-class. To further differentiate the concepts, the CCCS dismissed the collective aspect of middle-class resistance (see Clarke et al., 58-9, for a list of phenomena they considered exemplary of middle-class counterculture), describing it as more “diffuse, less group-oriented, [and] more individualised” than its working-class counterpart, the latter “clearly articulated [as] ‘near’ or ‘quasi’-gangs” (Clarke et al. 60). And whereas subcultures were centred on leisure-time activities within working-class environments, countercultures were concerned with a blurring of the boundaries between work and leisure. This conceptualisation was problematic at best, not least because it limits counterculture to the middle-class and subculture to the working class. It also gave considerably more agency and consequence to middle-class youths. It seemed that countercultures, with their individualist tendencies, offered individuals and groups choices about what and how to resist, as well as some expectations for social change, while subculturalists, locked within an unfortunate class position, could only resist dominant culture “at the profoundly superficial level of appearances” (Hebdige 17). Beyond the Limits of Class Cultures By 1980 cultural studies scholars had begun disassembling the class-basis of subcultures (see for example, G. Clarke; McRobbie; Griffin). Even though many studies still focused on stylised forms of opposition, subcultural scholarship increasingly emphasised subcultures such as punk as reflecting a more explicitly politicised resistance against the dominant or mainstream culture. Some scholars suggested that “mainstream culture” was used as a contrastive device to exaggerate the distinctiveness of those who self-identity as different (see U. Hannerz; Copes and Williams), while others questioned what subcultures could be seen as existing independently from, or in assumed opposition to (see Blackman; Thornton). In such cases, we can see a move toward reconciling the alleged limits of subculture as a countercultural concept. Instead of seeing subcultures as magical solutions and thus inevitably impotent, more recent research has considered the agency of social actors to overcome social divisions such as race, gender, and class. On the dance floor in particular, youth culture was theorised as breaking free of its class-binding shackles. Along with this break came the rhetorical distancing from CCCS’s definitions of subculture. The attempted development of “post-subculture” studies around the Millennium focused on consumptive behaviours among certain groups of youths and concluded that consumption rather than opposition had become a hallmark of youth culture broadly (see Bennett, Popular; Huq; Muggleton). For these scholars, the rave and club cultures of the 1990s, and others since, represent youth culture as hedonistic and relatively apolitical. “Post-subculture” studies drew in part on Steve Redhead’s postmodern approach to youth culture as found in The Clubcultures Reader and its companion text, From Subcultures to Clubcultures (Redhead). These texts offered a theoretical alternative to the CCCS’s view of oppositional subcultures and recognition that subcultural style could no longer be understood as a representation of ideological strain among working-class youths. Carried forward in volumes by David Muggleton and Rupert Weinzierl,,among others, “post-subcultural” scholarship criticised prior subcultural research for having objectified/reified mainstream/subcultural boundaries and authenticities, echoing Gary Clarke’s remark that the sharp distinction between us and them “rests upon [subculturalists’] consideration of the rest of society as being straight, incorporated in a consensus, and willing to scream undividedly loud in any moral panic” (71). Instead, the mixtures of punk, mod, skinhead and/or hippy styles among club-goers signalled “entirely new ways of understanding how young people perceive the relationship between music taste and visual style…revealing the infinitely malleable and interchangeable nature of the latter as these are appropriated and realised by individuals as aspects of consumer choice” (Bennett, Subcultures 613). Reincorporating the Counter into Subculture Studies The postmodern focus on cultural fluidity, individuality, and consumption highlights to some extent the agency that individuals have to make choices about the cultures in which they participate. To be sure, the postmodern and post-subculture critiques of class-based subculture studies were quite influential in the development of more recent subcultural scholarship, though not necessarily as they were intended. Much of the theoretical rhetoric of post-subculture scholarship (over-)emphasised heterogeneity, contingency, and play, which drew attention away from the collective identities and practices that continue to characterise many subcultures and groups. Fortunately, other scholars over the last decade have been critical of that approach’s failure to deal with perennial concerns related to participation in alternative cultural groups, including consumption (Buckingham), voice (Bae and Ivashkevich), education (Tuck and Yang), and group affiliation (Pilkington), among others. We want to follow this trajectory by explicitly reiterating the continuing significance of the “counter” aspects of subcultures. Two trends in social theory are exemplary in this reiteration. The first trend is a growing interest in re-theorizing resistance to refer to “a contribution to progressive transformations and radical changes in social and cultural structures” (Johansson and Lalander) rather than to a set of styles and practices through which working-class youth impotently rage against the machine. Resistance is qualitatively different from rebellion, which is often framed in terms of unconscious or irrational behaviour (Raby); resistance is first and foremost intentional. Subcultures articulate resistance to mainstream/dominant culture and may be measured across several continua, including passive to active, micro to macro, covert to overt, individual to collective, and local to global (see Williams, Resistance; E. Hannerz). Participants in countercultures see themselves as being more critically aware of what is happening in the world than the average person, believe that they act on that critical awareness in their thoughts, words, and/or deeds, and electively detach themselves from “involuntary or unconscious commitments” (Leary 253) to mainstream culture, refusing to uncritically follow the rules. The concept of resistance thus gives some momentum to attempts to clarify the extent to which members of alternative cultures intentionally break with the mainstream. The links between resistance and counterculture are explicitly dealt with in recent scholarship on music subcultures. Graham St John’s work on electronic dance music culture (EDMC), for example, offers a complex analysis of resistant practices that he conceptualizes as countercultural. Participation in EDMC is seen as more than simple hedonism. Rather, EDMC provides the scripts necessary for individuals to pursue freedom from various forms of perceived oppression in everyday life. At a more macro level, Madigan Fichter’s study of counterculture in Romania similarly frames resistance and political dissent as key variables in the articulation of a counterculture. Some recent attempts at invoking counterculture seem less convincing. Noting that counterculture is a relatively “unpopular term in social scientific research,” Hjelm, Kahn-Harris, and LeVine nevertheless proceed to theorize heavy metal as countercultural by drawing on the culture’s “transgressive” (14) qualities and “antagonistic […] attempts to shock and provoke [as well as] those occasions when metal, by its very presence, is shocking” (15). Other studies have similarly articulated “countercultures” in terms of behaviours that transgress mainstream sensibilities (see for example, Arthur and Sherman; Kolind). It is debatable at best, however, whether hedonism, transgression, or provocation are sufficient qualities for counterculture without concomitant cultural imperatives for both resistance and social change. This leads into a brief comment on a second trend, which is the growing interconnectedness of social theories that attend to subcultures on the one hand and “new” social movements (NSMs) on the other. “Traditional” social movements, such as the civil rights and labour movements, have been typically organised by and for people excluded in some way from full rights to participate in society, for example the rights to political participation or basic economic protection. NSMs, however, often involve people who already enjoy full rights as members of society, but who reject political and economic processes that injure them or others, such as marginalised groups, animals, or the environment. Some movements are contentious in nature, such as the Occupy-movement, and thus quite clearly antagonistic toward mainstream political-economy. NSM theories (see Pichardo), however, also theorize the roles of culture and collective identity in supporting both opposition to dominant processes and strategies for alternative practices. Other NSMs foster lifestyles that, through the minutiae of everyday practice, promote a ground-up reaction to dominant political-economic practices (see Haenfler, Johnson, and Jones). Both contentious and lifestyle movements are relatively diffuse and as such align with traditional conceptualisations of both subculture and counterculture. NSM theory and subcultural theories are thus coming together in a moment where scholars are seeking distinctly cultural understandings of collective lifestyles of resistance and social change. Conclusion Recent attempts to rephrase subcultural theory have combined ideas of the Birmingham and Chicago Schools with more contemporary approaches such as social constructivism and new social movements theory. Together, they recognise a couple of things. First, culture is not the determining structure it was once theorised to be. The shift in understanding subcultural groups as rooted in ascribed characteristics—being naturally different due to class, ethnicity, age, or to location (Park; Cohen; Clarke et al.)—to one in which subcultures are intentional articulations created by people, highlights the agency of individuals and groups to create culture. The break with realist/objectivist notions of culture offers promising opportunities for understanding resistance and opposition more generally. Second, the “counter” continues to be relevant in the study of subcultures. Subcultural participation these days is characterised as much or more by non-normativity than by marginalisation. As such, subcultures represent intentional protests against something outside themselves. Of course, we do not mean to suggest this is always and everywhere the case. 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The emergence of the global economy has forced the Australian government to revise economic strategies and to seek institutional changes. Higher education's new roles in research and human resource development, have been manifested in university commercialization activities. Mindful that Universities are prestige rather than profit maximizers, this study applies Schumpeter's (1942) theoretical model for the survival of a firm under financial stress. The model's responses, extended to education by Leslie and Miller (1973), include new products, new markets, restructuring, increased productivity and new supply factors. University entrepreneurial activities have monetary and non-monetary impacts. The non-monetary costs and benefits of Australian university enterprise were studied by Leslie (1992) and Leslie and Harrold (1993). In this study, academics at Curtin University of Technology (Perth, Western Australia) were selected as entrepreneurial or non-entrepreneurial subjects and surveyed on the non-monetary costs and benefits of entrepreneurial activities affecting Curtin's teaching, research and public service mission. This data were analyzed and subsequently compared with data obtained by Leslie (1992). Differences in academic perceptions were found among the Curtin respondents by gender, academic status, discipline area, entrepreneurship and non-entrepreneurship, and entrepreneurial revenue importance. Using the Leslie data inter-institutional differences were examined and an order of entrepreneurial institutional types proposed, with Curtin University described as a frontier entrepreneurial university. The taxonomy of costs and benefits developed by Leslie (1992) was revised with the addition of personal social costs, stress, networking and professional development. An estimate was made of the dollar value of non-monetary items; non-monetary benefits were three times the dollar value of monetary benefits; non-monetary costs were less than half the monetary cost levels. The ratio of non-monetary costs to benefits was 1:3.5. Academics in the disciplines of engineering and science had more favorable perceptions of entrepreneurial costs and benefits than respondents in business studies. Health science respondents were described as having pessimistic perceptions. Future research may look at the levels of commercial revenue and investigate the effects of the amount of financial success or failure on the entrepreneurial efforts of academics. In university enterprise successes seem to foster success and the favorable perceptions of academics.

This case study reports on the results of a two-year pilot study in blended learning in an undergraduate creative writing program at Southern Cross University in Australia. It documents the development and implementation of a blended delivery model that dispenses with outdated divisions between face-to-face and distance modes of delivery, creating a converged, blended learning experience for all students. Findings from the pilot provided important data in relation to student satisfaction, pedagogical considerations, institutional constraints, teaching technologies, faculty workload issues, and costs associated with blended learning. These findings will contribute to a University-wide move to converged, blended learning in 2009.

This chapter reports on an external evaluation of a statewide Education for Sustainability program conducted in Australia. The Climate Clever Energy Savers Program, conducted by the NSW Department of Education and Communities, invited students in primary and secondary schools (from Years 3 to 10), to participate in projects with their teachers' support, aimed at reducing their school's electricity consumption and costs. The chapter describes the Program in the context of the importance of sustainability development, and the centrality of education in achieving this. The ongoing evaluation investigates outcomes of the school-based projects, as well as teachers' views on the available support. This chapter investigates three case studies of the Program, examining outcomes, commonalities and differences across these sites. It describes the use of the Sustainability Action Process as a framework for guiding projects' progress. The chapter concludes with implications for practice and further research emerging from the case study investigations.

This chapter covers the emerging area of the use of commercial off-the-shelf (COTS) computer games for military, defense and security purposes. A brief background is provided of the historic link between games and military simulation, together with the size and scope of the modern computer game industry. Considerable effort is dedicated to providing a representative sample of the various defense and security usages of COTS games. Examples of current usage are drawn from a range of nations including the United States (U.S.), Australia, Denmark, Singapore and Canada. Coverage is broken into the three chief application areas of training, experimentation and decision-support, with mention of other areas such as recruitment and education. The chapter highlights the benefits and risks of the use of COTS games for defense and security purposes, including cost, acceptance, immersion, fidelity, multi-player, accessibility and rapid technological advance. The chapter concludes with a discussion of challenges and key enablers to be achieved if COTS games are to obtain their true potential as tools for defense and security training, experimentation and decision-support. Aspects highlighted include the dichotomy between games for entertainment and “serious” applications; verification, validation and accreditation; collaboration between the games industry and defense; modifiability, interoperability; quantifying training transfer; and a range of technological challenges for the games themselves.

This chapter covers the emerging area of the use of commercial off-the-shelf (COTS) computer games for military, defense and security purposes. A brief background is provided of the historic link between games and military simulation, together with the size and scope of the modern computer game industry. Considerable effort is dedicated to providing a representative sample of the various defense and security usages of COTS games. Examples of current usage are drawn from a range of nations including the United States (U.S.), Australia, Denmark, Singapore and Canada. Coverage is broken into the three chief application areas of training, experimentation and decision-support, with mention of other areas such as recruitment and education. The chapter highlights the benefits and risks of the use of COTS games for defense and security purposes, including cost, acceptance, immersion, fidelity, multi-player, accessibility and rapid technological advance. The chapter concludes with a discussion of challenges and key enablers to be achieved if COTS games are to obtain their true potential as tools for defense and security training, experimentation and decision-support. Aspects highlighted include the dichotomy between games for entertainment and “serious” applications; verification, validation and accreditation; collaboration between the games industry and defense; modifiability, interoperability; quantifying training transfer; and a range of technological challenges for the games themselves.

Information communications technology (ICT) has been identified as a key enabler in the achievement of regional and rural success, particularly in terms of economic and business development. The potential of achieving equity of service through improved communications infrastructure and enhanced access to government, health, education, and other services has been identified. ICT has also been linked to the aspiration of community empowerment, where dimensions include revitalizing a sense of community, building regional capacity, enhancing democracy, and increasing social capital. In Australia, there has been a vision for online services to be used to open up regional communities to the rest of the world. Government support has been seen “as enhancing the competence levels of local economies and communities so they become strong enough to deal equitably in an increasingly open marketplace” (McGrath & More, 2002, p. 40). In a regional and rural context, the availability of practical assistance is often limited. Identification of the most appropriate online services for a particular community is sometimes difficult (Ashford, 1999; Papandrea & Wade, 2000; Pattulock & Albury Wodonga Area Consultative Committee, 2000). Calls, however, continue for regional communities to join the globalized, online world. These are supported by the view that success today is based less and less on natural resource wealth, labor costs, and relative exchange rates, and more and more on individual knowledge, skills, and innovation. But how can regional communities “grab their share of this wealth” and use it to strengthen local communities (Simpson 1999, p. 6)? Should communities be moving, as Porter (2001, p. 18) recommends (for business), away from the rhetoric about “Internet industries,” “e-business strategies,” and the “new economy,” to see the Internet as “an enabling technology—a powerful set of tools that can be used, wisely or unwisely, in almost any industry and as part of almost any strategy?” Recent Australian literature (particularly government literature) does indeed demonstrate somewhat of a shift in terms of the expectations of ICT and e-commerce (National Office for the Information Economy, 2001; Multimedia Victoria, 2002; National Office for the Information Economy, 2002). Consistent with reflections on international industry experience, there is now a greater emphasis on identifying locally appropriate initiatives, exploring opportunities for improving existing communication and service quality, and for using the Internet and ICT to support more efficient community processes and relationships (Hunter, 1999; Municipal Association of Victoria and ETC Electronic Trading Concepts Pty Ltd., 2000; National Office for the Information Economy, 2002). The objective of this article is to explore whether welldeveloped and well-implemented online services can make a positive contribution to the future of regional and rural communities. This will be achieved by disseminating some of the learning from the implementation of the MainStreet Regional Portal project (www.mainstreet.net.au). To provide a context for this case study, the next section introduces some theory relevant to virtual communities and portals. The concept of online communities is introduced and then literature is reviewed to identify factors that have been acknowledged as important in the success of online community and portal initiatives.

Mobile phones in Australia record one of the world’s highest rates of ownership among children under 18. This paper examines issues of mobile phones and Australian children and the various discourses (systematic frames) used in discussing their effects. These are the optimistic (gains); pessimistic (losses, costs or harms); pluralistic (technology per se is neutral but how it is used matters); historical development (importance and skills learnt); futuristic predictions (promises and dangers); current uses (connectivity, convergence and interactivity); and techno-realist view (as a mixed blessing). Taking the Justification View of Technology that sees technological adoption as a gamble and borrowing from Joshua Meyrowitz, it examines how mobile phones have eroded parental power over how, when, where and with whom their children communicate, while at the same time, becoming a ‘digital leash’ for parents to re-establish their control and an ‘umbilical cord’ of children to remain connected with parents at all times.

The application of the internet to the Human Resource function (e-HR) combines two elements: one is the use of electronic media whilst the other is the active participation of employees in the process. These two elements drive the technology that helps organisations lower administration costs, improve employee communication and satisfaction, provide real time access to information while at the same time reducing processing time. This technology holds out the promise of challenging the past role of HR as one of payroll processing and manual administrative processes to one where cost efficiencies can be gained, enabling more time and energy to be devoted to strategic business issues. The relative quick gains with low associated risk have prompted many Australian companies to realise what can be achieved through the implementation of a business to employee (B2E) model. Employee Self Service (ESS), a solution based on the B2E model enables employees to access the corporate human resource information system 24x7. This paper adopts a case study approach with a view to investigating the benefits and associated issues obtained from an implementation of an ESS in an Australian public sector organisation.Keywords: Employee Self Service, e-Human Resources, B2E, HRMIS, ERP Systems, Australian Case Study

Many older people in Australia sell their family home to fund a long term residential arrangement with a “retirement village”. The contracts are complex. Consumers usually lack the capacity to compare various retirement village contracts with each other or with other arrangements. We have designed a methodology for comparing such contracts via a comparison rent and other metrics. We are working towards developing a free online publicly available calculator and relevant educational material to facilitate informed decision making by consumers. Our proposed calculator will utilise publicly available data on mortality and disability to model survival of resident status. It will compute various metrics that measure the costs, benefits and risks of these contracts. These metrics vary with age, gender, and health characteristics. These freely (soon) available resources are intended to educate both consumers and their advisors / families in statistical, health, and financial literacy when they need to make an important decision towards the end of their lives.

Higher education related to water is a critical component of capacity development necessary to support countries’ progress towards Sustainable Development Goals (SDGs) overall, and towards the SDG6 water and sanitation goal in particular. Although the precise number is unknown, there are at least 28,000 higher education institutions in the world. The actual number is likely higher and constantly changing. Water education programmes are very diverse and complex and can include components of engineering, biology, chemistry, physics, hydrology, hydrogeology, ecology, geography, earth sciences, public health, sociology, law, and political sciences, to mention a few areas. In addition, various levels of qualifications are offered, ranging from certificate, diploma, baccalaureate, to the master’s and doctorate (or equivalent) levels. The percentage of universities offering programmes in ‘water’ ranges from 40% in the USA and Europe to 1% in subSaharan Africa. There are no specific data sets available for the extent or quality of teaching ‘water’ in universities. Consequently, insights on this have to be drawn or inferred from data sources on overall research and teaching excellence such as Scopus, the Shanghai Academic Ranking of World Universities, the Times Higher Education, the Ranking Web of Universities, the Our World in Data website and the UN Statistics Division data. Using a combination of measures of research excellence in water resources and related topics, and overall rankings of university teaching excellence, universities with representation in both categories were identified. Very few universities are represented in both categories. Countries that have at least three universities in the list of the top 50 include USA, Australia, China, UK, Netherlands and Canada. There are universities that have excellent reputations for both teaching excellence and for excellent and diverse research activities in water-related topics. They are mainly in the USA, Europe, Australia and China. Other universities scored well on research in water resources but did not in teaching excellence. The approach proposed in this report has potential to guide the development of comprehensive programmes in water. No specific comparative data on the quality of teaching in water-related topics has been identified. This report further shows the variety of pathways which most water education programmes are associated with or built in – through science, technology and engineering post-secondary and professional education systems. The multitude of possible institutions and pathways to acquire a qualification in water means that a better ‘roadmap’ is needed to chart the programmes. A global database with details on programme curricula, qualifications offered, duration, prerequisites, cost, transfer opportunities and other programme parameters would be ideal for this purpose, showing country-level, regional and global search capabilities. Cooperation between institutions in preparing or presenting water programmes is currently rather limited. Regional consortia of institutions may facilitate cooperation. A similar process could be used for technical and vocational education and training, although a more local approach would be better since conditions, regulations and technologies vary between relatively small areas. Finally, this report examines various factors affecting the future availability of water professionals. This includes the availability of suitable education and training programmes, choices that students make to pursue different areas of study, employment prospects, increasing gender equity, costs of education, and students’ and graduates’ mobility, especially between developing and developed countries. This report aims to inform and open a conversation with educators and administrators in higher education especially those engaged in water education or preparing to enter that field. It will also benefit students intending to enter the water resources field, professionals seeking an overview of educational activities for continuing education on water and government officials and politicians responsible for educational activities

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.