Smoking is the leading avoidable cause of mortality and serious disability worldwide. The prevalence of smoking varies greatly between the 27 European Union (EU) Member States as does the implementation of tobacco control policies. The main aims of this thesis were to investigate the extent of the variation between and the reliability of measures of smoking prevalence, the relation between prevalence and tobacco control policy implementation, the country characteristics associated with policy implementation, and a detailed analysis of the association between cigarette prices and smoking prevalence.

This thesis examines representations of Roman female suicide in a variety of genres and periods from the history and poetry of the Augustan age (especially Livy, Ovid, Horace, Propertius and Vergil), through the drama and history of the early Principate (particularly Seneca and Tacitus), to some of the Church fathers (Tertullian, Jerome and Augustine) and martyr acts of Late Antiquity. The thesis explores how the highly ambiguous and provocative act of female suicide was developed, adapted and reformulated in historical, poetic, dramatic and political narratives. The writers of antiquity continually appropriated this controversial motif in order to comment on and evoke debates about issues relating to the moral, social and political concerns of their day: the ethics of a voluntary death, attitudes towards female sexuality, the uses and abuses of power, and traditionally expected female behaviour. In different literary contexts, and in different periods of Roman history, writers and thinkers engaged in this same intellectual exercise by utilising the suicidal female figure in their works.

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Background: Information communication technology (ICT) such as the Internet, mobile phones, computers and tablets, has become a central part of daily life. However a large number of older people do not use ICT, putting them at risk of exclusion from the digital society. Aims: To investigate level to which older people or are “e-included” (or engage with ICT) across various contexts, the factors which influence their e-inclusion and their access to ICT-based care, and the effects of ICT-use on their quality of life. Methods: Using a mixed method approach, I collected both secondary and primary data from numerous different sources including national datasets, the MonAMI project, the relevant literature, and interviews with older adults and technical experts. Analysis: Quantitative and qualitative analyses were performed according to the dimensions of the 6C framework for e-inclusion. The effects of ICT use was assessed against the domains of the ASCOT and WHOQOL models of quality of life. Results: Older people’s e-inclusion and access to ICT-based care were affected by a number of person-centred and environmental factors. There were marked variances in level of e-inclusion with the older population, which was partly attributed to a cohort effect. The evidence showed that access to ICT-based care was affected by local eligibility policies and care practitioner endorsement. Analyses revealed that ICT use positively affected older people’s quality of life in terms of maintaining independence and social networks, and improving psychological wellbeing. However, ICT-use had negative effects on older people’s sense of privacy. Moreover, ICT-based care services proved to be obtrusive and stigmatising for many older people. Conclusion: The findings highlighted a paucity in targeted policies which consider older people’s specific digital interests. There is also a need for a better understanding of the effects of ICT-based care on older people’s quality of life.

This study makes an argument for a constructionist understanding of crime in Antigua and Barbuda. Specifically, the study argues that the way in which members of the public and the news media talk about crime is important because understanding how crime is framed in terms of causes and remedies necessarily influences who we criminalise, what legislation we pass and how we allocate our tax dollars. As such, framing crime in ways that are tinged with hyperbole, or that run contrary to evidence is unlikely to result in effective policy responses. The way in which crime is currently framed in Antigua and Barbuda – as a relatively recent phenomenon that is spiralling out of control and is characterised by increasing violence, as a phenomenon that is perpetuated by predatory young people with individual pathologies, as a phenomenon that is increasing largely because police and politicians are corrupt and young people are being inculcated with foreign cultural values – has resulted in punitive policy and ‘tough on crime’ rhetoric that do not appear to have had a substantial effect on the country’s crime rate. However, this study finds that there might be room for more progressive crime policy – policy that is informed by an understanding of crime that does not have at its heart notions of law and order or getting ‘tough on crime’.

This thesis presents the results of a qualitative investigation of Unemployment Benefit II (UBII) recipients' experiences of skill training and job placement services under Germany's Hartz IV welfare reforms—arguably a (neo-) liberal intervention in the context of what has traditionally been described as a conservative-corporatist welfare regime. This thesis explores the experience of skills training and job placement services in terms of the degree to which these support mechanisms engage with UBII recipients’ needs and perceptions and how these necessarily reflect the purposes of the support and activation mechanisms (to provide support to and assist the long-term unemployed find work) and the underlying policy assumptions (that the long-term unemployed need to be made to demonstrate responsibility in finding work). The evidence presented suggests such services have not necessarily provided a route into regular employment. Instead the ‘support’ mechanisms tend to ‘busy’ the recipients; to be irrelevant to the recipients’ employment history and/or future interests; and not to match what recipients wish to, or are interested in, doing. Secondly, the policy rhetoric and design of the Hartz IV reforms implied, ostensibly, a shift with some cultural significance—from social solidarity to individual responsibility; from old (conservative) to new (neo-liberal) paternalism. The thesis examines UBII recipients’ perception of their ‘right’ to and ‘responsibility’ in finding work. The evidence suggests that popular discourse and understandings of the right to and responsibility in finding work in Germany are not so distinct or dissimilar from the Anglophone world. Finally, this thesis identifies a potential contradiction within the German government’s political objective of providing support (Fördern) to recipients in return for UBII recipients demonstrating responsibility (Fordern) in finding work. The findings suggest there is little need to make unemployed Germans feel ‘responsible’ for finding work. The demands placed on recipients to demonstrate to case managers that they are taking responsibility for finding work may undermine the recipient’s ability responsibly to look for work. And UBII recipients may ‘trick’ the system to meet these demands, ostensibly wasting the time and resources of Jobcenter staff and UBII recipients. This thesis concludes by arguing that Fördern and Fordern are ultimately not compatible within a policy framework. Where Fordern (demand/require) exists in conjunction with the threat of sanctions for non-compliance, there is too much of a chance that Fördern (support), in the form of job placement and skill training services, will be used to regulate the conduct of and discipline UBII recipients rather than provide legitimate support. Thus, any support provided starts to break down as soon as Fordern is inserted into the policy framework.

New health technologies offer both challenges and opportunities. Regulation is one mechanism to help balance the benefits and risks of new health technologies. This thesis examines the extent to which ‘good’ health technology regulation is achieved and the effectiveness of the policy measures regulators (and others) employ to meet such aims. To accomplish these objectives, a conceptual framework of ‘good regulation’ based on the academic and practitioner literatures was developed and its various dimensions considered and explored across eight different studies. Taken together, the studies provide an analysis of the roles, processes, policies, and performance of the regulators responsible for the market authorisation and coverage and reimbursement of pharmaceuticals and medical devices in Europe and the US; the role and use of technology assessment in health technology regulation and its impact on attaining good regulation; and, the factors that impact regulatory performance. The thesis demonstrates that attaining good health technology regulation is complex and challenging, because of the inherent uncertainty regarding the benefits and risks of new technologies, their growing diversity and complexity, the limitations of existing study designs and assessment methods, the increased demands placed on regulators to meet sometimes conflicting objectives, and the underlying political nature of making decisions about public access to and financing of new health technologies. Regulators have made progress on addressing these challenges. However, additional improvements are needed to improve health technology regulatory performance. Like much of health care policy, movement toward achieving the various criteria of good regulation will be incremental, especially considering the often step-wise nature of technological innovation.

Background: According to the guidance to the Children Act (1989 and 2004), ‘Working Together to Safeguard Children’ (2010; 2013), all organisations that work with children have a responsibility to protect children from maltreatment. However, previous research on child contact centres raises questions about how well this service is meeting the responsibility. This study seeks to explore in more detail how well contact centres manage their responsibility to protect children and what factors may influence them in this task. Research in the area of safety management has shown the limits of top-down guidance in achieving the desired level of practice. It provides a systems framework for studying how guidance is being implemented on the ground, including how it is interpreted by different actors in the system, and how they interact to produce the observed level of practice. Methods: Mixed methods were used to undertake a systems approach to studying the management of child protection responsibilities in contact centres. This approach aims to provide an in-depth understanding of what is happening in child contact centres, in terms of child protection, and why. Findings: Despite the introduction of reforms which aimed to improve safety in child contact centres, problematic child protection practice has persisted. It is argued that this is because common weaknesses in voluntary sector provision of human services have not been fully addressed. These weaknesses are insufficient funding, inadequate professionalization and narrow organisational focus. The findings suggest that these issues informed how actors in the system experienced and understood the practice of protecting children. The findings suggest that the safety of children in contact centres is also affected by the persistence of problematic inter-professional working. It is argued that the tools which have been introduced to address this have not been effective because they do not in themselves address the difficulties actors face in working together. There remains a lack of capacity amongst some centres and referrers who do not necessarily have the skills required to safely make and accept referrals. In addition, actors in the system experience role ambiguity. Finally, the thesis suggests that although organisations that work with children are encouraged to take account of children’s wishes and feelings in order to protect them, workers in child contact centres engaged with children in diverse ways. A typology of engagement, which was developed from the data, suggests that engagement can be conceptualised as ranging from ‘coercive’ to ‘limited’ to ‘meaningful’. The findings suggest that workers’ engagement with children was influenced not just by factors within contact centres but by individuals’ personal values and the wider family justice system, which contact centres operate in. Implications: This research suggests that in the empirical context of child contact centres, the ‘Working Together’ guidance to organisations working with children does not in itself produce predictable effects which will fulfil the guidance aims. Rather, when the guidance combines with local factors it produces unexpected effects. The meaning that actors attributed to their actions was not static. Instead, socially constructed, local rationalities influenced how actors understood and experienced the process of protecting children. The findings contribute to the growing body of research which argues that policy makers need to focus, not simply on telling organisations what do, but on enabling them to do it. In addition, the findings contribute to the systems approach literature, which suggests that safety needs to be understood within the socio-technical system that actors inhabit.

Cultural transmission theory and methods focus on the qualities of cultural artefacts (e.g. religious beliefs, supernatural ideas, folk stories) to understand how and why some spread and last better than others. This epidemiological approach is part of a broader project, cognition and culture, which seeks to understand links between mind and culture. Cognition and culture is concerned with universal, recurrent cultural phenomena, whose developmental acquisition and patterns of distribution and variation may be linked to innate mental competencies. Anthropologists, ethno- and cognitive linguists, and cognitive and developmental psychologists have established that metaphor exhibits exactly these characteristics—universality, cultural variation, and developmental acquisition patterns. Yet, the cultural transmission of metaphor has not been addressed in the cognition and culture literature. This thesis proposes a novel application of an epidemiological account of cultural transmission to small-scale, linguistic, cultural artefacts—everyday, sensorimotor metaphorical talk about knowledge, learning, and understanding. Serial reproduction tasks, experiments, interviews, and metaphor analysis were used in a mixed-methods approach to investigate the use and transmission of metaphorical language. Three initial experimental studies, which aimed to investigate transmission advantages of metaphor, showed no statistically significant effects of metaphor on transmission fidelity of short stories across serial reproduction chains. Four further studies were conducted to follow up on these findings. Results of the first follow-up experiment, more sensitive to the agency of speakers in communicative exchange, indicated that metaphorical prompts to invent stories yielded more metaphors in the story endings and descriptions. Findings from experimental and conversation-based judgement tasks suggested that metaphorical language provided more inferential potential than non-metaphorical language to support assessments of the verbal material and inferences about the speaker. The final qualitative study revealed ways that metaphor is used to support social interaction and co-operation in more naturalistic conversation contexts. Overall, it was found that social and pragmatic aspects of communication, undetectable in traditional serial reproduction experiments, contribute significantly to the wide distribution, or cultural success, of metaphor. An account of the cultural success of metaphor based in inferential processes that support social interaction is proposed. Reflections are offered on its theoretical and methodological implications for the epidemiological view of cultural transmission and its generalisability to different types of cultural artefacts.

This research investigates whether the introduction of Payment By Results (PbR) into the National Health Service aligned clinical and managerial incentives and improved output, quality, quantity and productivity. The methodology applies three data collection techniques; in-depth interviews; documentary data; and numerical data for each of four foundation trust (FT) case studies. The results indicate that the case studies had not produced consistent and sustained improvements in productivity and did not appear particularly engaged with productivity improvement, or cost control or in the relationship between these factors and tariff under PbR. Boards of directors did not appear to focus on productivity; and the use of service line reporting, to allow clinicians and managers of hospitals to drive productivity improvement, was not widely available at board or clinical level. The results also demonstrated the dominance of Monitor, the FT regulator, in influencing the agenda of FT boards. It suggests that, without central direction and/or external pressure, FTs will not focus on productivity and quality issues. The policy significance of these results are that (a) with the lack of alignment of clinical and managerial incentives, it is unlikely that FTs will be able to produce a sophisticated and targeted review of clinical care pathways to target productivity improvement at areas where there is real opportunity for efficiency improvement; and (b) if, as the research results suggest, NHS management, and the organisations they lead, respond more effectively to central direction and control then, as the NHS enters one of the most financially challenged periods of its history, alternative policy options to the development of quasi markets need to be considered. The research explores several of these options, including: the roll-back of the FT movement, management franchising, creating conditions for increased pressure on hospital performance, a more radical introduction of competition, and options for the use of social enterprises.