This research explores the relationship between risk factors associated with cannabis use in young people. This thesis addresses the assessment of cannabis use and its association with risk factors and implicit associations, and the suitability of these for targeting at-risk cannabis users, and how theories of drug instrumentalization and normalization frame cannabis use behaviour in young people in contact with drug services using a mixed-methods approach. Additionally, this research addresses the implications for indicated prevention and the targeting of young people considered at risk for developing problematic cannabis use behaviours. This PhD reviews the scientific literature on cannabis use, with an emphasis on prevalence and use behaviours alongside associated risk and protective factors. Cannabis markets and potency, along with policy implications, are also explored. Furthermore, this PhD aims to understand how cannabis use behaviour assessment impacts on the identification of risk, and the subsequent implications for identifying those who might benefit from further support. Frequent, habitual cannabis users and their relationship with risk factors, including implicit cognitions, and use behaviour assessment are explored. Additionally, cannabis users in touch with drug services and their use behaviour are explored through frameworks of drug use instrumentalization and normalization. Lastly, the main findings of this dissertation are surmised and future research and policy implications are discussed. This PhD illustrates the importance of cannabis use behaviour assessment in identifying young people at-risk for developing problematic use behaviours. This thesis provides evidence that suggests that psychopathology, and the over-instrumentalization of use as a self-medication, coping mechanism may be associated with the development of problematic use outcomes. These findings are contextualised within the current cultural and political environments in the United Kingdom and discussed in regards to their suitability for indicated prevention.

Smoking in childhood is a predictive risk factor for smoking in later life and increases the likelihood of early mortality from smoking-related morbidities. Preventing the uptake of smoking in childhood is an important public health priority (Public Health England, 2014a). Evidence suggests physical activity participation may be protective against smoking uptake in children and thus physical activity is recommended as an active component for future smoking prevention efforts (Audrian-McGovern et al., 2013). Therefore SmokeFree Sports (SFS) was designed to explore whether physical activity could be used as a vehicle to prevent children within deprived neighbourhoods from starting to smoke. The research within this thesis forms part of a wider programme of research and evaluation of SFS. The aims of the research conducted within this thesis were to (1) explore the influence of social factors (mother, father, sibling and friend smoking) on preadolescent (aged 9-10) boys and girls cognitive vulnerability (e.g. smoking-related intentions, attitudes and refusal self-efficacy) towards smoking, (2) explore the feasibility and acceptability of SFS with primary school settings from the perspectives of children, teachers and coaches, and (3) examine the impact of SFS on preadolescents cognitive vulnerability towards smoking and explore perceived intervention impact from the perspectives of children, teachers and coaches. To address and answer the research questions within this thesis a mixed-methodological approach was undertaken. In 2012, a cross-sectional study involving 43 primary schools in Merseyside, England was conducted to explore the influence of social factors on preadolescent boys and girls cognitive vulnerability towards smoking (n =1143; 50.7% girls; 85.6% White British). Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data were analysed using multilevel linear and logistic regression models, adjusting for individual cognitions, school and deprivation level. Findings showed that social factors were associated with children’s cognitive vulnerability towards smoking, with the smoking behaviour of siblings and friends being identified as important influences. Further, whilst the majority of 9-10 year old children living in deprived communities had high non-smoking intentions and refusal self-efficacy, a substantial proportion displayed pro-smoking attitudes that could be addressed through smoking prevention efforts. Research suggests that physical activity participation is protective against youth smoking initiation (Audrian-McGovern et al., 2013) and increased smoking (Horn et al., 2013). Therefore, SFS, a UK multi-component initiative that aimed to deliver smoking prevention education to primary school children (aged 9-10 years) through the medium of sport and physical activity was developed and piloted in among 9-10 year old children in primary schools across Merseyside, England. In the preliminary phase to piloting the city-wide SFS intervention, a formative study was employed in three primary schools situated in Liverpool City and North. Children received six weeks of coaching activities (football and dance) for two hours each week. Key messages surrounding the effects of smoking on health and sporting performance were incorporated into activity sessions. Children also received SFS branded materials, attended a SFS launch and celebration event, and were encouraged to sign a pledge to be smoke free. In total, forty-five children (51% boys; 93% White British) participated in focus groups (n= 6 single sex and n= 3 mixed sex groups), and Year 5 teachers (n=3; 3 male) and SFS coaches (n=5; 3 male) participated in semi-structured interviews. Findings from this formative study revealed schools were a suitable setting to deliver SFS. Further, the use of physical activity as a mechanism to deliver smoking prevention education was considered acceptable by children, teachers and coaches but further modifications were made to ensure its acceptability and aid effectiveness for a larger SFS pilot study. This formative study was therefore integral to the development of SFS pilot intervention which included compulsory and optional components delivered by multiple implementers, including SFS coaches and primary school teachers. In 2013, a non-randomised SFS controlled-trial was conducted among Year 5 children (n=972; 50.7% Female) in primary schools across Merseyside, England. Schools were clustered into intervention (n=32) and comparison groups (n=11). Outcome measures that were employed in the cross-sectional study (Study 1) were assessed again at post-intervention (2-weeks from intervention end) and again at follow-up (approx. 12 months post intervention). Quantitative findings indicated that the SFS intervention did not impact on children’s non-smoking intentions, which remained high across both groups. However, qualitative data revealed that SFS reinforced children’s opinions about smoking and made them more determined not to smoke. Further, children in the intervention schools displayed significantly more negative attitudes towards smoking at post-intervention and at follow-up than those in the comparison group. Whilst no significant intervention effects were found for refusal self-efficacy at post-intervention, positive intervention effects were observed at follow-up. These findings may lend support for physical activity as one strategy for smoking prevention efforts targeted at preadolescent children residing in deprived neighbourhoods. In summary, the research within this thesis examined the influence of social factors on preadolescent’s cognitive vulnerability towards smoking, and explored the feasibility and acceptability of a novel smoking prevention intervention that used physical activity to deliver smoking education to UK primary school children, and examined its impact on preadolescent’s smoking-related cognitions. Utilising physical activity to deliver smoking prevention education appears to work at least as well as smoking prevention delivered through class-based learning. Importantly, teachers and coaches viewed physical activity as an acceptable method to engage children in smoking prevention. Nevertheless, strategies to increase the sustainability of SFS and embed intervention components into the school curriculum require further investigation.

Background: With almost 80,000 Europeans estimated to die annually from the consequences of exposure to second-hand smoke (SHS) and over a quarter of all Europeans being exposed to the toxins of cigarette smoke at work on a daily basis, SHS is a major European public health problem. Smoke-free policies, i.e. policies which ban smoking in public places and workplaces, are an effective way to reduce exposure. Policy options to reduce public exposure to SHS were negotiated by European Union (EU) decision makers between 2006 and 2009, resulting in the European Council Recommendation on smoke-free environments. A variety of stakeholders communicated their interests prior to the adoption of the policy. This thesis aims to analyse the engagement and collaboration of organisational stakeholders in the development of the Council Recommendation on smoke-free environments. Methods: The case study employs a mixed method approach to analyse data from policy documents, consultation submissions and qualitative interviews. Data from 176 consultation submissions serve as a basis to analyse the structure of the policy network using quantitative network analysis. In addition, data from these submissions, selected documents of relevance to the policy process and 35 in-depth interviews with European decision makers and stakeholders are thematically analysed to explore the content of the network and the engagement of and interaction between political actors. Results: The analysis identified a sharply polarised network which was largely divided into two adversarial advocacy coalitions. The two coalitions took clearly opposing positions on the policy initiative, with one coalition supporting and the other opposing comprehensive European smoke-free policy. The Supporters’ Alliance, although consisting of diverse stakeholders, including public health advocacy organisations, professional organisations, scientific institutions and pharmaceutical companies, was largely united by its members’ desire to protect Europeans from the harms caused by SHS and campaign for comprehensive European tobacco control policy. Seemingly coordinated and guided by an informal group of key individuals, alliance members made strategic decisions to collaborate and build a strong, cohesive force against the tobacco industry. The Opponents’ Alliance consisted almost exclusively of tobacco manufacturers’ organisations which employed a strategy of damage limitation and other tactics, including challenging the scientific evidence, critiquing the policy process and advancing discussions on harm reduction, to counter the development of effective tobacco control measures. The data show that the extent of tobacco company engagement was narrowed by the limited importance that industry representatives attached to opposing non-binding EU policy and by the companies’ struggle to overcome low credibility and isolation. Discussion: This study is the first that applies social network analysis to the investigation of EU public health policy and systematically analyses and graphically depicts a policy network in European tobacco control. The analysis corroborates literature which highlights the polarised nature of tobacco control policy and draws attention to the complex processes of information exchange, consensus-seeking and decision making which are integral to the development of European public health policy. The study identifies the European Union’s limited competence as a key factor shaping stakeholder engagement at the European level and presents the Council Recommendation on smoke-free environments as an example of the European Commission’s successful management of the policy process. An increased understanding of the policy network and the factors influencing the successful development of comprehensive European smoke-free policy can help to guide policymaking and public health advocacy in current European tobacco control debates and other areas of public health.

This thesis aims to shed light on the role of religious, spiritual and secular beliefs in individuals’ recovery from problematic substance use in Scotland. The findings are based on semi-structured interviews with twenty individuals, living in Scotland, who had past experience of problematic substance use. The methodology was influenced by narrative theory and the analysis drew on a thematic narrative approach. It is suggested that individuals in recovery construct personal belief systems by drawing chiefly on established cultural belief systems. Personal belief systems are learned and reinforced through practice, notably, engaging with belief-orientated communities and practising personal rituals. Participants use their personal belief systems as frameworks to interpret and give meaning to fundamental experiences that were part of their recovery. Personal belief systems are also integral to the construction of identity in recovery, helping individuals to establish a new self or reclaim an idealised past self. While personal belief systems did not often fit within neat religious, spiritual or secular categories, those with religious and/or spiritual beliefs often stressed the importance of their beliefs and associated practices to their recovery. Secular existential beliefs were also important to some people. The implications of these findings are discussed in terms of research, policy and practice.

This thesis investigates what it means to view disruptive innovation as a political problem. I take my point of departure in the tendency for controversial disruptions in heavily regulated sectors, such as electronic cigarettes or hydraulic fracturing, to open regulatory spaces by challenging established expectations about how they ought to be governed. In the wake of such disruption, policy actors with a stake in the matter engage in sensemaking and discursive contests to control the meaning of the innovations in order to close the regulatory spaces by aligning them with one set of laws instead of another. I study these contests in two recent legislative initiatives of the European Union to address the disruptive potential of e-cigarettes and fracking: the 2014 revision of the Tobacco Products Directive and the 2014 Commission recommendations on unconventional fossil fuels. The research draws on 51 interviews carried out with key policy actors during and after the policy debates. I bolster this with an analysis of policy documents, press releases and scientific studies, as well as a content and network analysis of position statements in newspaper articles. I find that the strategic use of rhetoric and framing plays an important part in creating, maintaining, and entrenching opposed coalitions in both policy debates. In both case studies, the policy solution is accompanied by deteriorating levels of trust among participants, leading coalitions to engage in strategies of venue-shopping to circumvent their opponents. This underscores the significant challenges there are for policymakers to address disruptions while maintaining legitimacy. The original contribution of the thesis lies in its novel conceptualization of disruptive innovation as a political problem, its application of micro-sociological approaches to the politics of expertise and European public policy, and its practical and theoretical suggestions for how to better study periods of disruption and govern through them.

Violence is often treated as an organisational compliment to illicit drug production and exchange in sub-Saharan Africa. The thesis challenges this view in light of the “chain work” undertaken by cannabis cultivators in Sierra Leone, and examines its complex web of labour, exchange, and extra-legal relations. Research reveals that an apprenticeship system during the early 1800s slavery abolition period continued to organise labour in Western Area’s small-scale agriculture. Meanwhile, the migration of cultivators from Jamaica during the economic crises and War on Drugs of the late-1980s coincided with the spread of Rastafari culture and a post-war Neo-Evangelist discourse that established apprenticeship as a legitimate means for learning how to cultivate under the guidance of those known as “shareholders”. These shareholders were gatekeepers in accessing land, exchange partners and extra-legal relations. They secured greater returns without organised violence. This is explained by examining the shortcomings of current conceptual approaches and turning to Pierre Bourdieu’s relational sociology. It employs a mixed methodology of objectivist and subjectivist modes of analysis. The analysis relates the qualitative experience of cultivators and dealers to the particular position they occupied within the economic field of cultivation and exchange and the juridical field of law enforcement. Despite being motivated by strong economic incentives, apprentices and journeymen were subject to the uncertainties of limited contracting arrangements and illegality, which exposed them to exploitation. However, by adopting particular ways of acting, reasoning and valuing that qualified their status as “youth men”, they continued to invest in and reproduce this institution. I examine how emic practices of “sababu”, “grade” and “haju” acted as covert principles that limited the possibility for newcomers to secure higher value exchange partners, greater returns and police inaction. The thesis concludes that apprenticeship was the site at which structural advantages favouring the established shareholders were reproduced.

The idea of evidence-based policy has gained increasing prominence. Much research exists on the subject, particularly tackling the evidence-based policy turn and, subsequently, its critique. A plethora of studies have identified the shortcomings of the evidence-based policy ideal and challenged its supposed linearity. This project aims to provide an understanding of the way in which evidence is utilized in policy, and contribute to this debate by enacting an innovative research design. I am proposing a 2x2 comparative approach, which looks at the use of evidence across two domains, drug and prostitution policy, across two countries, Australia and the UK. A case-based qualitative comparative approach has the potential to offer a certain depth while at the same time providing the opportunity for analytic generalisation. I argue that evidence can be a prime focus for analysis of the policy process, and that through its lenses one can appraise deeper theoretical and epistemological questions about the state in late modern capitalism, the relationship between knowledge and ideology, science and politics, science and values, reason and emotion. The labelling of prostitution and drug policy as morality policies exposes the nature of these domains as morally and politically antagonistic, whilst providing opportunity to reflect on the role of morality in filtering understandings of evidence and shaping policy positions.

The discourses of medicinal cannabis users are the topic of this thesis, examined by way of qualitative in-depth interviews with thirty-two medicinal cannabis users. The thesis focuses on four main aims: how medicinal users talk about their use of cannabis (including looking at what discursive resources and rhetorical devices they use); the prevalence and significance of talking about 'nature' and the 'natural' within these discourses; the differences between the accounts of different participants; and the potential of different 'types' of discourse in relation to contestation around the use of this substance for medicinal benefit. A discourse analysis approach is used that draws mainly on the work of Wetherell and Potter (1992) and Fairclough (1995; 2001). A Bourdieusian theoretical framework is employed that draws on the key concepts of field, habitus, linguistic habitus, cultural and linguistic capital and trajectory (1979; 1992). The main findings are that whilst participants discuss a range of issues and use a range of rhetorical strategies and discursive resources in doing so, the majority of participants discursively construct cannabis in relation to ideas about nature, with cannabis frequently being articulated as 'natural' and therefore preferable to prescribed medicines, alcohol, other illicit drugs and 'chemical' / 'man-made' substances in ways that are strongly related to various notions of 'risk' (Beck, 1992). However, there is a great deal of difference between participants' discourses and these differences are underpinned by different educational and vocational trajectories, the unequal distribution of linguistic capital and differential dispositions when using language and engaging with knowledge, and are mediated by participants' different engagement with the issue of medicinal cannabis use. This emphasises the importance of an awareness of how social structuration continues to affect how individuals are capacitated and disposed to talk about and understand issues and to engage in contestation in contemporary society.

This thesis examines the development of state-narco networks in post-transition Bolivia. Mainstream discourses of drugs tend to undertheorise such relationships, holding illicit economies, weak states and violence as synergistic phenomena. Such assumptions fail to capture the nuanced relations that emerge between the state and the drug trade in different contexts, their underlying logics and diverse effects. As an understudied case, Bolivia offers novel insights into these dynamics. Bolivian military authoritarian governments (1964-1982), for example, integrated drug rents into clientelistic systems of governance, helping to establish factional coalitions and reinforce regime authority. Following democratic transition in 1982 and the escalation of US counterdrug efforts, these stable modes of exchange between the state and the coca-cocaine economy fragmented. Bolivia, though, continued to experience lower levels of drug-related violence than its Andean neighbours, and sustained democratisation despite being a major drug producer. Focusing on the introduction of the Andean Initiative (1989-1993), I explore state-narco interactions during this period of flux: from authoritarianism to (formal) democracy, and from Cold War to Drug War. As such, the thesis transcends the conventional analyses of the drugs literature and orthodox readings of Latin American narco-violence, providing insights into the relationship between illicit economies and democratic transition, the regional role of the US, and the (unintended) consequences of drug policy interventions. I utilise a mixed methods approach to offer discrete perspectives on the object of study. Drawing on documentary and secondary sources, I argue that state-narco networks were interwoven with Bolivia’s post-transition political settlement. Uneven democratisation ensured pockets of informalism, as clientelistic and authoritarian practices continued. This included police and military autonomy, and tolerance of drug corruption within both institutions. Non-enforcement of democratic norms of accountability and transparency was linked to the maintenance of fragile political equilibrium. Interviews with key US and Bolivian elite actors also revealed differing interpretations of state-narco interactions. These exposed competing agendas, and were folded into alternative paradigms and narratives of the ‘war on drugs’. The extension of US Drug War goals and the targeting of ‘corrupt’ local power structures, clashed with local ambivalence towards the drug trade, opposition to destabilising, ‘Colombianised’ policies and the claimed ‘democratising mission’ of the Bolivian government. In contrasting these US and Bolivian accounts, the thesis shows how real and perceived state-narco webs were understood and navigated by different actors in distinct ways. ‘Drug corruption’ held significance beyond simple economic transaction or institutional failure. Contestation around state-narco interactions was enmeshed in US-Bolivian relations of power and control.

There is a lack of narrative research in the United Kingdom (UK) that captures the stories of young people who are, or have previously been, dealing with issues surrounding their use of drugs and/or alcohol. This study, through the utilisation of a narrative approach, aims to provide a rich and detailed description of young people’s experiences, and the difficulties they’ve faced, with their use of drugs and/or alcohol. In this study I have presented the stories of three males aged seventeen to eighteen in rough verse form and then individually analysed the narratives using Engels’ narrative analysis approach. The young males have recently been discharged from a specialist support service for their use of drugs and/or alcohol which has caused concern. The specialist support service supports adolescents (aged fourteen – eighteen) with their drug and/or alcohol use. Each young male was interviewed twice, the first interview allowed the young person to tell their story in its entirety. During the second interview, each young person’s narrative was presented back to them in rough verse form and they were asked to reflect upon reading their story as well as check the anonymity of their identity in their narrative. It is hoped that the findings will help inform Educational Psychologists of some of the challenges faced by young adults who have experienced difficulties as a result of their substance use. In turn it is hoped that this may lead to better informed hypothesis generation when encountering young people who have problematic relationships with drugs and/or alcohol.