Food insecurity in children and young people in Scotland

The aim of this review is to highlight the key issues in relation to food insecurity among children and young people living in Scotland. It provides an overview of the current context of food insecurity more generally within the UK and specifically in Scotland. Food insecurity has risen in Scotland evidenced through responses to national surveys and the dramatic increase in households relying on emergency food provision. Food insecurity is highest among young people, single parent families and single men. The key drivers of food insecurity include insufficient income, welfare reform, food inflation and geo-political events. Evidence suggests that food insecurity is negatively related to sufficient nutritional intake, and the implications for physical and mental health are profound. Policy actions implemented to mitigate the impact of food insecurity on children and young people include the introduction of the Scottish Child Payment, food voucher schemes, free school meals, and holiday food provision. Further evidence is required to evaluate the success of these policies in reducing or mitigating food insecurity. The review concludes by considering the ways in which a rights-based approach to food might benefit children and young people living in Scotland, and argues that wider systemic change is required.

Young people's perspectives on addressing UK health inequalities: utopian visions and preferences for action

INTRODUCTION

It is increasingly recognised by UK researchers and population health advocates that an important impetus to effective policy action to address health inequalities is activation of public dialogue about the social determinants of health and how inequalities might be addressed. The limited body of existing scholarship reaches varying conclusions on public preferences for responding to health inequalities but with consensus around the importance of tackling poverty. Young people's perspectives remain underexplored despite their increasingly visible role in activism across a range of policy issues and the potential impact of widening inequalities on their generation's health and wellbeing.

METHODS

Six groups of young people (39 in total) from two UK cities (Glasgow and Leeds) were engaged in online workshops to explore views on health inequalities and potential solutions. Inspired by calls to employ notions of utopia, artist-facilitators and researchers supported participants to explore the evidence, debating solutions and imagining a more desirable society, using visual and performance art. Drawing together data from discussions and creative outputs, we analysed participants' perspectives on addressing health inequalities across four domains: governance, environment, society/culture and economy.

FINDINGS

Proposals ranged from radical, whole-systems change to support for policies currently being considered by governments across the United Kingdom. The consensus was built around embracing more participatory, collaborative governance; prioritising sustainability and access to greenspace; promoting inclusivity and eliminating discrimination and improving the circumstances of those on the lowest incomes. Levels of acceptable income inequality, and how best to address income inequality were more contested. Individual-level interventions were rarely presented as viable options for addressing the social inequalities from which health differences emanate.

CONCLUSION

Young people contributed wide-ranging and visionary solutions to debates around addressing the enduring existence of health inequalities in the United Kingdom. Their reflections signal support for 'upstream' systemic change to achieve reductions in social inequalities and the health differences that flow from these.

PUBLIC CONTRIBUTION

An advisory group of young people informed the development of project plans. Participants shaped the direction of the project in terms of substantive focus and were responsible for the generation of creative project outputs aimed at influencing policymakers.

Participatory and deliberative processes in the UK related to income insecurity: a scoping review

BACKGROUND

Democratising decision making related to socioeconomic policy is an area of growing interest in health inequalities research; however, there is a recognised gap between the democratic theory and practical application at a macro socioeconomic level. This gap is notable in the current UK policy context defined by over a decade of austerity, rising income insecurity, and an increase in health inequalities. Underpinned by theories related to participatory, deliberative, and economic democracy, particularly those concerned with democratic innovations, this scoping Review investigates how, when, and where participatory and deliberative processes have been used to influence socioeconomic policy over the past 15 years in the UK and how this influence might inform any so-called democratic rejuvenation moving forward.

METHODS

This Review, presenting the interim findings, is structured in accordance with the Joanna Briggs Institute's guidance for conducting systematic scoping reviews and applies the PRIMSA-Scoping Review checklist. Key search terms included "public policy", "economic policy", "income insecurity", "poverty", "public participation" "decision-making", and "democratic innovation". Searches were conducted in EconLit, SOC Index, Sociological Abstracts, and MedLine, as well as grey literature sources, including BASE database, government, third sector, and thinktank websites for articles related to participatory and deliberative processes (informed by theories of associative and direct democracy as well as Fung's Democracy Cube of public participation) in socioeconomic policy making in the UK, in English, from January, 2007, until June, 2022. A combined framework of democratic goods and typology of interventions to tackle health inequalities were applied for analysis.

FINDINGS

14 articles were included in the final review (three peer-reviewed and 11 grey literature) with a concentration of results in Scotland (six articles) and in local government (five articles). Interim findings suggest a multiplicity of activities exist under the banner of participatory and deliberative processes; however, there are few, if any, examples that influence typically closed macro socioeconomic policy making and instead disperse participatory decision-making across less empowered spaces.

INTERPRETATION

Ambitions for a democratic rejuvenation to tackle the upstream socioeconomic drivers of health inequalities require critical reflection on the locus of decision-making power, as well as the fractured and challenging nature of participatory policy making.

FUNDING

This study is part of a PhD studentship with the Medical Research Council and Chief Scientist Office, Social and Public Health Sciences Research Unit at the University of Glasgow. The studentship is funded by the Medical Research Council (MC_UU_00022/3) and Chief Scientist Office of the Scottish Government Health Directorates (SPHSU18). KS is funded by the Medical Research Council (MC_UU_12017/11 and MC_UU_00022/3) and Strategic Award (MC_PC_13027) and Chief Scientist Office of the Scottish Government Health Directorates (SPHSU18). GF is funded through the UK Medical Research Council (MC_ UU_00022/2) and the Chief Scientist Office of the Scottish Government Health Directorates (SPHSU17).

Public understandings of potential policy responses to health inequalities: Evidence from a UK national survey and citizens' juries in three UK cities

A substantial body of research describes the distribution, causes and potential reduction of health inequalities, yet little scholarship examines public understandings of these inequalities. Existing work is dominated by small-scale, qualitative studies of the experiences of specific communities. As a result, we know very little about what broader publics think about health inequalities; and even less about public views of potential policy responses. This is an important gap since previous research shows many researchers and policymakers believe proposals for 'upstream' policies are unlikely to attract sufficient public support to be viable. This mixed methods study combined a nationally representative survey with three two-day citizens' juries exploring public views of health inequalities and potential policy responses in three UK cities (Glasgow, Manchester and Liverpool) in July 2016. Comparing public opinion elicited via a survey to public reasoning generated through deliberative processes offers insight into the formation of public views. The results challenge perceptions that there is a lack of public support for upstream, macro-level policy proposals and instead demonstrate support for proposals aiming to tackle health inequalities via improvements to living and working conditions, with more limited support for proposals targeting individual behavioural change. At the same time, some macro-economic proposals, notably those involving tax increases, proved controversial among study participants and results varied markedly by data source. Our analysis suggests that this results from three intersecting factors: a resistance to ideas viewed as disempowering (which include, fundamentally, the idea that health inequalities exist); the prevalence of individualising and fatalistic discourses, which inform resistance to diverse policy proposals (but especially those that are more 'upstream', macro-level proposals); and a lack of trust in (local and national) government. This suggests that efforts to enhance public support for evidence-informed policy responses to health inequalities may struggle unless these broader challenges are also addressed.

Policy congruence and advocacy strategies in the discourse networks of minimum unit pricing for alcohol and the soft drinks industry levy

BACKGROUND AND AIM

Public health policy development is subject to a range of stakeholders presenting their arguments to influence opinion on the best options for policy action. This paper compares stakeholders' positions in the discourse networks of two pricing policy debates in the United Kingdom: minimum unit pricing for alcohol (MUP) and the soft drinks industry levy (SDIL).

DESIGN

Discourse analysis was combined with network visualization to create representations of stakeholders' positions across the two policy debates as they were represented in 11 national UK newspapers.

SETTING

United Kingdom.

OBSERVATIONS

For the MUP debate 1924 statements by 152 people from 87 organizations were coded from 348 articles. For the SDIL debate 3883 statements by 214 people from 175 organizations were coded from 511 articles.

MEASUREMENTS

Network analysis techniques were used to identify robust argumentative similarities and maximize the identification of network structures. Network measures of size, connectedness and cohesion were used to compare discourse networks.

FINDINGS

The networks for both pricing debates involve a similar range of stakeholder types and form clusters representing policy discourse coalitions. The SDIL network is larger than the MUP network, particularly the proponents' cluster, with more than three times as many stakeholders. Both networks have tight clusters of manufacturers, think-tanks and commercial analysts in the opponents' coalition. Public health stakeholders appear in both networks, but no health charity or advocacy group is common to both.

CONCLUSION

A comparison of the discourse in the UK press during the policy development processes for minimum unit pricing for alcohol and the soft drinks industry levy suggests greater cross-sector collaboration among policy opponents than proponents.

"The state They're in": Unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities

Globally, it is recognised that the fundamental causes of iniquitous health outcomes lie within unequal distributions of wealth and power. Internationally, however, policies and interventions persist in individualising the inequalities problem and targeting individual behaviours as the main solution. This approach has been argued to represent 'Fantasy Paradigms'. This paper explores one example of such 'Fantasy' intervention from the perspective of health practitioners. Further, it explores opportunities for deepening practitioner understandings of the socio-political determination of health. Data were collected through in-depth interviews with 47 professionals involved in delivering a social prescribing programme in poor areas of Glasgow, Scotland. Data were analysed thematically across and within transcripts. Narratives highlighted different explanatory types concerning how the intervention could tackle health inequalities including: firm commitment to individualised approaches; hopeful pessimism; the social-determinants-of-health as an unpoliticised and nondeterministic backdrop to poor health; and finally, incomplete understanding of the social gradient as a population concept. Disrupted narratives of the social determination of health were also evident. This paper contributes new insights to existing debates on health inequalities discourse. These are conceptually important and identify opportunities for sharpening practitioner understanding of the social determinants of health which could in turn contribute to better, non-stigmatising primary care. It argues that re-engaging communities of practice with what is meant by determination of health is necessary and that there is a need to de-couple the policy aim of reducing health inequalities from the delivery of structurally competent and equality-focused public services.

A comparison of stakeholder networks across two pricing policy debates using discourse analysis

Background

Public health policy development is subject to a large number of stakeholders seeking to influence government thinking on policy options. One approach is via the news media. We compare the competing discourse coalitions evident in the UK public debate across two pricing policies, Minimum Unit Pricing (MUP) for alcohol and the Soft Drinks Industry Levy (SDIL).

Methods

Existing discourse network analyses (DNA) for MUP and SDIL were harmonised in Visone to allow direct comparison. We applied a common tie-weight threshold to reduce ties to robust argumentative similarities and to maximise the identification of both network structures. We used network measures (size, density and EI index) to compare the two networks and principal coalitions.

Results

Both networks involve a similar range of stakeholder types and form two discourse coalitions representing proponents and opponents of the policies. The SDIL network is larger, particularly the proponents coalition with over three times as many nodes and a lower EI index. Both networks show tight discourse coalitions of manufactures and commercial analysts acting in opposition to policy supporters. The only actors that appear in both debates are politicians, government advisors, commercial analysts and supermarkets. While public health actors appear in both debates they appear siloed in their interests.

Conclusions

DNA enabled direct comparison of the discourse coalitions across two highly contested pricing policy debates, visualising the complex network of actors and relationships operating to influence policy-making via the media. Use of comparative DNA across policy debates shows promise for better understanding the common tactics of different unhealthy commodity industries (UCIs) to disrupt public health policies. Public health actors could improve their response to UCIs by seeking to work across policy and commodity arenas.

Key messages

We compared the competing discourse coalitions across two pricing policy debates, MUP and SDIL. Public health advocates could improve their response by working across policy arenas.

A discourse network analysis of the public media debate on the UK Soft Drinks Industry Levy

Background

On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a policy designed to reduce population level sugar consumption and related illnesses. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative.

Methods

Media content analysis was employed to build a data set of relevant articles from UK national newspapers. Articles were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the stakeholder network and coalitions evident in the debate, leading up to and following the announcement of the SDIL.

Results

We identified 3,883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Visualisations revealed a complex network of stakeholders with two discourse coalitions. Polarisation arose from 3 factors: (i) differences in political ideology; (ii) position on the specific policy option; (iii) interpretation of the evidence. Industry stakeholders appeared less united before the SDIL announcement. Some industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver was a dominant supportive stakeholder, suggestive of his role as a policy entrepreneur.

Conclusions

This study illustrates the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Public health advocates seeking to gain support for future upstream regulation to promote population health would benefit from tailoring their communication to take advantage of sources of polarisation. Vocal celebrity policy entrepreneurs may be instrumental to facilitate alignment of stakeholders around a clear ideology.

Key messages

This study provides a novel insight into the network of stakeholders involved in public debates on food policies. Public health advocates may benefit by identifying and aligning with a clear ideology.

A discourse network analysis of UK newspaper coverage of the "sugar tax" debate before and after the announcement of the Soft Drinks Industry Levy

BACKGROUND

On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a mechanism designed to address increasing prevalence of obesity and associated ill health by reducing sugar consumption. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative.

METHODS

Media content analysis was used to build a dataset of relevant newspaper articles, which were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the network of stakeholders and coalitions evident in the debate as it was presented in UK newspapers, in the lead up to and following the announcement of the Soft Drinks Industry Levy in the UK, from May 2015 to November 2016.

RESULTS

Coding identified 3883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Network visualisations revealed a complex network of stakeholders with clear sceptical and supportive coalitions. Industry stakeholders appeared less united in the network than anticipated, particularly before the SDIL announcement. Some key industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver appeared as a dominant stakeholder, firmly embedded with public health advocates.

CONCLUSION

This study highlights the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Polarisation of stakeholders arose from differences in ideology, focus on a specific policy and statements about the weight of evidence. Vocal celebrity policy entrepreneurs may be instrumental in gaining public and policy makers' support for future upstream regulation to promote population health, to facilitate alignment around a clear ideology.

Mapping discourse coalitions in the minimum unit pricing for alcohol debate: a discourse network analysis of UK newspaper coverage

BACKGROUND AND AIMS

Minimum unit pricing (MUP) for alcohol was introduced in Scotland on 1 May 2018, and is now on the policy agenda in other devolved administrations and at Westminster. Previous research has explored the arguments deployed for and against MUP, but the congruence between actors in the MUP debate has not been sufficiently examined. This study identified and mapped the discourse coalitions that emerged in the UK MUP debate through an analysis of actors' use of arguments in media coverage of the policy debates.

DESIGN

A sample of print media coverage of MUP was obtained from the LexisNexis newspaper database. The resulting sample was imported into discourse network analysis (DNA) software for coding and subsequent visualization of actor networks.

SETTING

United Kingdom.

OBSERVATIONS

A total of 348 articles from eight UK-wide and three Scottish newspapers from an 18-month period, ending in November 2012, were analysed.

MEASUREMENTS

Actors' arguments were coded to generate structured data for conversion into a weighted actor network where ties represent similarities among actors in terms of arguments in support of or opposition to MUP.

FINDINGS

Two polarized discourse coalitions, Opponents and Proponents of MUP, emerged in media coverage. The Proponents coalition consisted mainly of health advocacy groups, charities, political parties and academic institutions. In the Opponents coalition, the networks were formed of key alcohol manufacturers and economic think-tanks. While producer organizations were central to the Opponents coalition, some commercial actors were more favourable to MUP, highlighting divisions within the industry overall.

CONCLUSIONS

Media coverage of minimum unit pricing (MUP) in Scotland from June 2011 to November 2012 showed alignment between the policy positions of (1) alcohol producers and think-tanks opposed to MUP; and (2) public health advocates and health charities in favour of the policy. Some alcohol industry actors were supportive of MUP indicating divisions among the industry. Discourse network analysis may be usefully applied to study other highly contested policy issues in health and beyond.

The Social Functionality of Humor in Group-Based Research

Citizens' juries provide deliberative fora within which members of the public can debate complex policy issues. In this article, we reflect on our experience of undertaking three citizens' juries addressing health inequalities, to explore the positive and facilitative role that humor can play within group-based research focusing on sensitive health policy issues. We demonstrate how both participants and researchers engaged in the production of humor in ways which troubled prevailing power dynamics and facilitated positive relationships. We conclude by recommending that researchers, particularly health policy researchers and those pursuing the kind of lengthy group-based fora associated with deliberative research, consider the positive role humor can play when engaged reflexively. In so doing, we make a major contribution to extant literature on both deliberative fora (which is yet to consider humor's facilitative capacities) and the role of humor in qualitative (health) research (which rarely explores researcher complicity in humor production).

Right Here Right Now (RHRN) pilot study: testing a method of near-real-time data collection on the social determinants of health

BACKGROUND

Informing policy and practice with up-to-date evidence on the social determinants of health is an ongoing challenge. One limitation of traditional approaches is the time-lag between identification of a policy or practice need and availability of results. The Right Here Right Now (RHRN) study piloted a near-real-time data-collection process to investigate whether this gap could be bridged.

METHODS

A website was developed to facilitate the issue of questions, data capture and presentation of findings. Respondents were recruited using two distinct methods - a clustered random probability sample, and a quota sample from street stalls. Weekly four-part questions were issued by email, Short Messaging Service (SMS or text) or post. Quantitative data were descriptively summarised, qualitative data thematically analysed, and a summary report circulated two weeks after each question was issued. The pilot spanned 26 weeks.

RESULTS

It proved possible to recruit and retain a panel of respondents providing quantitative and qualitative data on a range of issues. The samples were subject to similar recruitment and response biases as more traditional data-collection approaches. Participants valued the potential to influence change, and stakeholders were enthusiastic about the findings generated, despite reservations about the lack of sample representativeness. Stakeholders acknowledged that decision-making processes are not flexible enough to respond to weekly evidence.

CONCLUSION

RHRN produced a process for collecting near-real-time data for policy-relevant topics, although obtaining and maintaining representative samples was problematic. Adaptations were identified to inform a more sustainable model of near-real-time data collection and dissemination in the future.

Content analysis of UK newspaper and online news representations of women's and men's 'binge' drinking: a challenge for communicating evidence-based messages about single-episodic drinking?

OBJECTIVES

In the UK, men's alcohol-related morbidity and mortality still greatly exceeds women's, despite an increase in women's alcohol consumption in recent decades. New UK alcohol guidelines introduce gender-neutral low-risk alcohol consumption guidance. This study explores how UK newspaper and online news represent women's and men's 'binge' drinking to identify opportunities to better align reporting of harmful drinking with evidence.

DESIGN

Quantitative and qualitative content analysis of 308 articles published in 7 UK national newspapers and the BBC News website between 1 January 2012 and 31 December 2013.

RESULTS

Articles associated women with 'binge' drinking more frequently than men, and presented women's drinking as more problematic. Men were more frequently characterised as violent or disorderly, while women were characterised as out of control, putting themselves in danger, harming their physical appearance and burdening men. Descriptions of female 'binge' drinkers' clothing and appearance were typically moralistic.

CONCLUSIONS

The UK news media's disproportionate focus on women's 'binge' drinking is at odds with epidemiological evidence, may reproduce harmful gender stereotypes and may obstruct public understandings of the gender-neutral weekly consumption limits in newly proposed alcohol guidelines. In order to better align reporting of harmful drinking with current evidence, public health advocates may engage with the media with a view to shifting media framing of 'binge' drinking away from specific groups (young people; women) and contexts (public drinking) and towards the health risks of specific drinking behaviours, which affect all groups regardless of context.

Young adults' experiences of seeking online information about diabetes and mental health in the age of social media

BACKGROUND

The Internet is a primary source of health information for many. Since the widespread adoption of social media, user-generated health-related content has proliferated, particularly around long-term health issues such as diabetes and common mental health disorders (CMHDs).

OBJECTIVE

To explore perceptions and experiences of engaging with health information online in a sample of young adults familiar with social media environments and variously engaged in consuming user-generated content.

METHODS

Forty semi-structured interviews were conducted with young adults, aged 18-30, with experience of diabetes or CMHDs. Data were analysed following a thematic networks approach to explore key themes around online information-seeking and content consumption practices.

RESULTS

Although participants primarily discussed well-rehearsed approaches to health information-seeking online, particularly reliance on search engines, their accounts also reflected active engagement with health-related content on social media sites. Navigating between professionally produced websites and user-generated content, many of the young adults seemed to appreciate different forms of health knowledge emanating from varied sources. Participants described negotiating health content based on social media practices and features and assessing content heuristically. Some also discussed habitual consumption of content related to their condition as integrated into their everyday social media use.

CONCLUSION

Technologies such as Facebook, Twitter and YouTube offer opportunities to consume and assess content which users deem relevant and useful. As users and organizations continue to colonize social media platforms, opportunities are increasing for health communication and intervention. However, how such innovations are adopted is dependent on their alignment with users' expectations and consumption practices.

Social media as a space for support: Young adults' perspectives on producing and consuming user-generated content about diabetes and mental health

Social media offer opportunities to both produce and consume content related to health experiences. However, people's social media practices are likely to be influenced by a range of individual, social and environmental factors. The aim of this qualitative study was to explore how engagement with user-generated content can support people with long-term health conditions, and what limits users' adoption of these technologies in the everyday experience of their health condition. Forty semi-structured interviews were conducted with young adults, aged between 18 and 30 years, with experience of diabetes or a common mental health disorder (CMHD). We found that the online activities of these young adults were diverse; they ranged from regular production and consumption ('prosumption') of health-related user-generated content to no engagement with such content. Our analysis suggested three main types of users: 'prosumers'; 'tacit consumers' and 'non-engagers'. A key determinant of participants' engagement with resources related to diabetes and CMHDs in the online environment was their offline experiences of support. Barriers to young adults' participation in online interaction, and sharing of content related to their health experiences, included concerns about compromising their presentation of identity and adherence to conventions about what content is most appropriate for specific social media spaces. Based on our analysis, we suggest that social media do not provide an unproblematic environment for engagement with health content and the generation of supportive networks. Rather, producing and consuming user-generated content is an activity embedded within individuals' specific health experiences and is impacted by offline contexts, as well as their daily engagement with, and expectations, of different social media platforms.

Avoiding Pitfalls and Realising Opportunities: Reflecting on Issues of Sampling and Recruitment for Online Focus Groups

The increasing prominence of the Internet in everyday life has prompted methodological innovations in qualitative research, particularly the adaptation of established methods of data collection for use online. The alternative online context brings with it both opportunities and challenges. To date the literature on online focus groups has focused mainly on the suitability of the method for qualitative data collection, and the development of approaches to facilitation that maximise interaction. By reflecting on our experiences of designing and attempting to recruit participants to online focus groups for two exploratory research projects, we aim to contribute some novel reflections around the less articulated issues of sampling and recruitment for online focus groups. In particular, we highlight potentially problematic issues around offline recruitment for an online method of data collection; the potential of using social media for recruitment; and the uncertainties around offering incentives in online recruitment, issues which have received little attention in the growing literature around online focus groups. More broadly, we recommend continued examination of online social practices and the social media environment to develop appropriate and timely online recruitment strategies and suggest further areas for future research and innovation.

What young people want from health-related online resources: a focus group study

The growth of the Internet as an information source about health, particularly amongst young people, is well established. The aim of this study was to explore young people's perceptions and experiences of engaging with health-related online content, particularly through social media websites. Between February and July 2011 nine focus groups were facilitated across Scotland with young people aged between 14 and 18 years. Health-related user-generated content seems to be appreciated by young people as a useful, if not always trustworthy, source of accounts of other people's experiences. The reliability and quality of both user-generated content and official factual content about health appear to be concerns for young people, and they employ specialised strategies for negotiating both areas of the online environment. Young people's engagement with health online is a dynamic area for research. Their perceptions and experiences of health-related content seem based on their wider familiarity with the online environment and, as the online environment develops, so too do young people's strategies and conventions for accessing it.