In Australia, fetal alcohol spectrum disorder (FASD) is a largely hidden disability that is currently under-recognized, under-resourced, and under- or misdiagnosed. Unsurprisingly, efforts to prevent FASD in urban Aboriginal and Torres Strait Islander communities are lacking. Further, mainstream approaches are not compatible with diverse and distinct Aboriginal and Torres Strait Islander ways of approaching family, pregnancy, and parenting life. To support the creation of culturally appropriate urban Aboriginal and Torres Strait Islander FASD prevention strategies, we sought to understand local perspectives, experiences, and priorities for supporting healthy and alcohol-free pregnancies. Using a narrative methodology, we undertook research yarns with eight female and two male community participants. Data were analyzed using a narrative, thematic analysis and guided by an Indigenist research practice of reflexive listening. Participant yarns provided important insights into local urban Aboriginal and Torres Strait Islander cultural, social, and structural determinants that support family and child health, alcohol-free pregnancies, and the prevention of FASD. The results provide critical guidance for Indigenizing and decolonizing FASD prevention strategies to support culturally safe, relevant, and strengths-based services. This approach has critical implications for all health and social professionals and can contribute to Aboriginal and Torres Strait Islander peoples’ justice, recovery, and healing from colonization.  Aboriginal and Torres Strait Islander communities, regardless of geographical location, practice family life outside of normative Euro-Australian approaches . While rIndigenous cultural practices continue in various capacities despite experiencing significant disruptions to intergenerational transmission from historical and contemporary colonization, for example, through the dispossession of culture and land, widespread massacres, the forced removal of children during the Stolen Generations period, and enduring impacts of institutionalized racism, which entrench socioeconomic disadvantage and inform State child removal policies ,4,5. In FASD is a complex neurodevelopmental disorder that arises from prenatal alcohol exposure and is a leading cause of non-genetic disability in Western countries . FASD prCentering urban Indigenous healthcare priorities is pivotal in the development of urban Indigenous FASD prevention services. In South-East Queensland, where this study took place, an overarching healthcare priority is the delivery of strengths-based, culturally safe services ,15,16. STo support the creation of culturally appropriate and relevant urban Indigenous FASD prevention strategies, we sought to understand local Indigenous perspectives, experiences, and priorities for supporting healthy and alcohol-free pregnancies.This qualitative study took place in Yuggara Country, with the Indigenous community of Inala, a south-western suburb of Brisbane. The Inala Community Jury for Aboriginal and Torres Strait Islander Health Research  identifiTo support a culturally appropriate approach to our investigation, we used a narrative research methodology ,21. ThisPrior to commencement, we sought feedback and consent for the project from the Inala Community Jury . EthicalThe project’s viability was due to the established community relationships and trust that the research team had fostered over years of working in Inala. Aboriginal Research Officer S.E. has worked within her community over the past decade and had established relationships with all study participants. S.E. guided all aspects of the project to ensure its safety and appropriateness for the community. Researchers D.A. and V.L. are both non-Indigenous and therefore do not have a lived understanding of Indigenous family life, culture, and experiences of systematic historical and contemporary racism and discrimination that is part of Indigenous life in Australia. Therefore, they relied upon S.E.’s cultural guidance and oversight in all aspects of the research. D.A. is the former COE Research Director (2010 to 2020) and was already known to most of the participants and Jury members. V.L. is a former COE Research Officer (2016–2018), where she worked closely with COE Indigenous staff, as well as the Jury and community members on several projects. We used a critical sampling strategy  to enablResearch yarns occurred between late 2019 and early 2020. Recruitment ceased with the onset of COVID-19 lockdowns and redeployment of research staff and did not recommence as analysis revealed sufficient depth and diversity of themes . Yarns rData were analyzed using narrative, thematic analysis ,33, wherTo identify themes, V.L. immersed herself in the data by listening to the audio recordings and reading and re-reading the transcripts. Using NVivo 12  for dataEight female and two male members of the Inala Indigenous community participated in this research. Participants ranged in age from their mid-20s to 70s. They held multiple social and familial roles in the community as mothers, grandmothers, aunties, fathers, and grandfathers, with the majority having worked in social and health service and volunteer roles. Participants’ narratives tell of distinct urban Indigenous ways of knowing and being across key life stages that lift-up cultural approaches to pregnancy and parenting, and support maternal and child health and wellbeing. Woven throughout yarns were participants’ knowledge, experiences, and cautionary views around navigating alcohol use in social and family life, including during pregnancy and parenting. Four main story themes were identified: community life, parenting and family life, pregnancy time, and reflections on the role of health services in supporting healthy and alcohol-free pregnancies. Participants described their community as proud, strong, and connected, representing a diversity of Indigenous Nations. Particularly, the visibility of the Indigenous community was described as affirming place, belonging, and cultural safety for those who live and visit the area. “So I think for a lot of black people and a lot of people of other cultures, they feel safe because they are in a place where they can see themselves and they can see you know that—yeah, they can see themselves and see their culture represented throughout the community…”(p. 2)Contributing to this visibility, several local Indigenous organizations were identified as valued community pillars, connecting families and increasing the community’s access to culturally relevant services. Yet, at the heart of participants’ stories were the valued community relationships that shaped their family lives. Here, Indigenous yarning was highlighted as an important facilitator of community connectedness, caring, and support. “Like, I just came to here [to Inala] … I didn’t have [support]—yeah, somebody would tell you something… it’s just all that community yarning. Yeah, it’s so powerful… because that’s one thing I really get out of Inala… there is always someone there that can maybe give you some information that you can go and do… but Inala itself has that, because people do… they want to help you…”(p. 4)Participants affirmed an Indigenous approach to family that includes biological and non-biological members. The proximity of family members and regularity of family gatherings were valued, as was a sense of shared responsibility for caring for one another. “And everyone is like one big family and we all look after each other’s kids through good and bad times… and we know that we have that here.”(p. 1)When participants considered the role of alcohol in family and community life, togetherness was the foremost driver of gatherings. Similar to broader Australian society, for many participants, alcohol was a normal part of social life. However, some reflected on times past when heavy alcohol use was prevalent in the community, along with life chapters characterized by trauma, stressful relationships, and circumstances. “And there would be those that just drink to get drunk; they’re either stressed out, or just need to let it go, leave the week behind or whatever… I think it’s just a temporary Band-Aid. It’s just that quick little buzz. And I think they’re trying to cope… They’re just getting that quick little—probably that time where they’re not thinking about that stress, and being weighed down with whatever’s going on in their lives.”(p. 8)When identifying underlying factors influencing heavy alcohol and other substance use, participants highlighted intergenerational stressors due to structural disadvantage and discrimination that the community continues to experience. “Inala’s good. I like living here. I’m proud of Inala. It’s just that we’ve had our fair share of problems: drug use, unemployment, police harassment and discrimination. And a lot of that is still happening today. Nothing much really changed… I’ve experienced it [police harassment] personally over the years—and my family and other members in the community that we know…”(p. 3)Several participants described the care and assistance received from biological and non-biological family members in the community as foundational to their child raising. Connected to this, learning about parenting was emphasized as commencing in younger years through being included in the care of younger siblings and cousins. “… my mum would have maybe four of her siblings living with us and they all had babies and we were all older, so we had to help with those babies and that’s where we were taught all our little things [about child raising] that she was taught—so they all teach us, all our aunties as well. Not just our mother, they were all taught the same but yeah, our aunties as well would teach us.”(p. 7)Indigenous ways of caring for one another, and particularly children in the community, were an important feature of the community service roles that many participants held. Participants shared how their community relatedness and connections helped them be aware of the unique needs and challenges that young ones may be facing. Understanding family dynamics and if alcohol and other substances were used during pregnancy also helped community workers draw connections with some children’s behavioral challenges and tailor care accordingly. “… I was working as the administrator and a court support liaison person. And the people [parents of clients] that I went to school with, that I know, were, and still are, alcohol drinkers. And they drank through pregnancies, they drank through sadness, they drank through happiness, they did. [I knew these clients struggled with understanding bail conditions] It was sort of—it was in the body language, it was in the fact that there were things that I would say that I know myself, I would question… So I knew I had to try and explain a little bit more… Yeah, I don’t know why. I put it down to the fetal alcohol syndrome…”(p. 5)When yarning about ways of de-centering alcohol use norms in the community, older participants described their own reconciliation with alcohol use across their lives—stories that were spoken with a sense of empowerment. To help teach younger ones about their choices around alcohol, one participant made a point of role modeling alcohol abstinence or low-level consumption at gatherings where drinking was expected. “But I make sure that when we do have twenty-first [birthdays] and family functions… I always try to tell my nieces and nephews that are drinking, I’m still having fun, I’m the first one up on the dance floor, I’m the last one up on the dance floor. I can still have fun. And they’re always like, “Aunty, are you drinking?” I’m like, “No, I don’t have to. I’m good. I’m going to be fine tomorrow; you guys are going to be hungover,” and stuff like that.”(p. 8)Finally, participants shared family approaches to protecting children from alcohol use exposure. For some, alcohol was excluded from children’s gatherings and moderated at family and social gatherings when children were present. Related to this, the role of grandparents in families was highlighted by one participant (p. 3). She described how she and other grandparents in the community worked to protect their grandchildren if parents were using alcohol and other substances to cope with stressors. While not without personal challenges, pride in protecting children, not only from domestic harm, but also from state intervention, was palpable. www.wikiwand.com] community, I would say.”“Due to drugs and alcohol. Whereas the parents aren’t able to focus or function, so in order not to see our grannies [grandchildren], our kids, go into foster home or—we step in and we take them, look after them. None of us care much for Child Safety… Our main concern is our children. Get them out of harm’s way… That just goes way, way back… It’s just something we all do. It must happen in the white community as well sometimes, but not very often. Not as much as within our Murri . For any of those nurses or anything—we feed our kids like this and we bath our kids like this and that’s from our mothers. Our mothers have handed that to us. Her mother has handed that to her. So, that’s the cycle again…we believe what our mother says, how to look after ourselves. We’ve always believed in what we were supposed to do when we were pregnant.”(p. 7)Some participants stressed barriers to learning about and supporting women’s and child health and alcohol-free pregnancies when misinformation is passed through Indigenous learning channels. “It comes from what’s been passed down to you as well, so there are people that may not get that message that drinking during pregnancy is not good for the baby. So they might not then be able to make a decision that’s best for the baby because they don’t have anybody guiding them with that and particularly if you don’t get that from your family, and if your partner doesn’t understand that as well, then you are not going to be able to get that support from the partner.”(p. 2)Different ideas about the risks of alcohol use during pregnancy are unsurprising when considering the changing pregnancy health guidelines across different generations—a point several participants touched upon. “Cause when I was growing up, it was normal to see pregnant women drink and smoke. Because it wasn’t out there like the effects that alcohol, drugs, and smoking does to a child. It was like having—like, with seatbelts, you didn’t have seatbelts back in them days… they didn’t have that—the information out there and the research… it just wasn’t there.”(p. 7)One participant (p. 2) also pointed to the impact of the Stolen Generations in disrupting the intergenerational transmission of pregnancy and parenting knowledge and traditions. When reflecting on current alcohol use norms in the community today, several participants considered that only a minority of women might use alcohol after pregnancy recognition, usually in response to life stressors, to help “calm themselves down” (p. 10). Furthermore, there were conflicting views among older participants that there exists greater awareness these days about prenatal alcohol use risks. However, there was shared agreement that a lack of awareness and understandings about FASD was common. “And I never drank through my pregnancies because it’s not right and then to this day I don’t see a lot of people pregnant drinking [in my social circles] but I do see a lot of younger ones pregnant drinking on a regular basis, getting drunk, being pregnant. And they don’t like people telling them that they can’t drink. Or Facebook status is about them, people whinging to them about you shouldn’t drink while you’re pregnant. Why, what’s it going to do? They don’t know the effects of it.”(p. 1)Several participants made special mention of partners and their role in supporting women’s alcohol reduction or abstinence during pregnancy, although significant barriers were noted for mothers that were solo parenting. “So, [the father] would just be that support system. A quiet support system. Yeah. You know, my mother knows best. That’s the way we do it… and I just think that support [from the father]—and that’s even, like, washing, feeding, all that, like, washing the clothes, the babies, newborn clothes before they come home.”(p. 7)Having a supportive partner that refrained from excessive alcohol use during pregnancy and parenting was stressed by participant (p. 4) as vital for supporting women’s health, capacity, and wellbeing.“It’s so massive. Like, they have got a massive responsibility to support the women. And go and be there, through that whole journey with them. Because having two children to two different men, the difference in having the supportive man, that goes to your appointments, and goes with you, is massive. But then if you’ve got one that’s out partying, yeah, you’re on your own.”(p. 4)All participants reflected upon the role of health services in supporting healthy and alcohol-free pregnancies and FASD awareness. Acknowledging Indigenous approaches to family and pregnancy, participants agreed on the need for health and social programs that target the whole-of-community and not just mothers. “Because the more knowledge, and more support that you have around you, that’s not going to harm, it’s going to empower people.”(p. 4)Supporting an inclusive approach, one participant acknowledged the lack of opportunity that older community members have had to learn about risks associated with alcohol use during pregnancy and FASD. “Yeah, that’s right because if we don’t like educate our Elders. They didn’t have that opportunity to be educated and they can set that through their families… So I think just promoting it at all age levels, especially our Elders.”(p. 7)Several participants stressed the importance of services developing culturally appropriate and safe messages. To facilitate this, the quality of relationships that healthcare practitioners can establish with community members was considered essential for effective message delivery. “And, depending on your relationship with your doctor and your health service as well, it’s how that message [about alcohol use risks during pregnancy] is then given to that woman to then be able to make a decision around their behaviors and how they actually care for that pregnancy.”(p. 2)Participants urged healthcare professionals to avoid using authoritative messages and tones with clients and stressed the negative impact “preaching” to Indigenous people about alcohol use risks. Rather, to support culturally safe learning, the importance of Indigenous health workers delivering messages was emphasized, along with incorporating Indigenous perspectives in messaging resources. “It’s the worst thing to do to a black person or anyone, I think, is preach. Making people aware is a bit different. Maybe posters advertising it but coming from an Aboriginal view it might be a bit different than coming from a white man view… from the beginning it’s how do you ask someone these questions without offending someone so that would be interesting with this project.”(p. 1)Connected to this, one participant cautioned against health practitioners’ use of simple abstinence-only messages with women and their supporters (p. 8). Rather, they stressed that families want to be properly informed so that they understand the reasons behind alcohol-related advice. Finally, younger parents were described as being particularly resistant to pregnancy health and alcohol abstinence messages from white healthcare professionals. Rather, one participant noted the increasing role of social media in young Indigenous women’s pregnancy self-care learning. “So I think some of our young mums would see some of these ones on social media influencers and that, and probably, maybe, inspiring or striving to be similar…”(p. 8)Participants’ stories provide important insights into distinct local urban Indigenous cultural, social, and structural determinants that can support family and child health, alcohol-free pregnancies, and prevent FASD. The results highlight the centrality of place, community, culture, and family for supporting women’s health during pregnancy, along with some of the stressors that can be present for Indigenous families. Across participants’ stories, the place and impact of prenatal alcohol use varied considerably, depending on life stage, exposure to changing alcohol use norms over time, and the presence or absence of social and structural supports and stressors. While participants’ stories are embedded in distinct geographical, historical, and cultural contexts, their messages are resounded in broader Indigenous affirmations of the holistic factors that support community health and wellbeing, as well as key barriers to these ,6. The bIn the restructuring of FASD prevention efforts for urban Indigenous communities, the importance of culturally centered, Indigenous-led, community-based, and contextualized approaches cannot be understated ,37,38,39Working outside of the deficit paradigm, an Indigenous health determinants approach to FASD prevention addresses the contexts and complexities of Indigenous women’s lives in compassionate, positive, and non-stigmatizing ways ,40. IndiAn Indigenous health determinants lens also recognizes the relationship between intergenerational trauma, violence, and Indigenous women’s health behaviors ,45. ThisIn Canada, the causal relationship of colonization, specifically the impact of the residential school system, with the prevalence of FASD in Indigenous communities has been recognized as being of critical importance and was included in the nation’s Truth and Reconciliation Commission action plan . This laIn Australia, FASD and its prevention, although gaining recognition, continues to be poorly understood and underserviced in mainstream health services ,49. PartIn response, we encourage the centering of Indigenous leadership and knowledge, and collaboration with communities to ground FASD prevention efforts in local culture. By doing so, health and community services and non-Indigenous practitioners can be better informed to support local priorities and cultures. Practitioners will also be better positioned to foster culturally safe, relevant, and strengths-based FASD prevention approaches. Participants in this study urged practitioners to avoid preaching and authoritative messaging and tones in their prevention work, approaches that are symptomatic of a deficit lens towards Indigenous people. Rather, we urge services and practitioners to commit to self-reflexive practices to challenge conscious or unconscious biases and narratives towards Indigenous people. Also, to be cognizant of the limitations and potential negative impact of Western concepts of health and wellbeing that invariably shape practitioners’ provision of care ,53,54. The study contributes to an emerging body of qualitative literature that prioritizes learning from local Indigenous communities to inform the cultural and contextual tailoring of FASD prevention services. We see this approach as vital. First, centering community voices supports the creation of strategies that are highly relevant to local Indigenous family life, culture, needs, preferences, and priorities. Second, a localized study focus enabled us to avoid homogenizing the many distinct urban Indigenous communities across Australia. As such, the nature of the findings precludes the generalization of participants’ stories to other urban communities. The findings do, however, share important insights for healthcare services and professionals who seek to progress urban Indigenous FASD prevention strategies that are culturally centered, Indigenous-led, and community-based. We attribute the depth of insights gained in this study to the quality of pre-existing researcher-participant relationships that we believe enabled the yarning process and better positioned the researchers to understand the nuances of participant’s stories. While the findings provide an important orientation to tailoring FASD prevention to local community cultures and priorities, this research does not replace the need for ongoing community collaboration and developmental evaluation to ensure the appropriateness and cultural safety of future FASD prevention services. To support the creation of culturally appropriate and relevant FASD prevention services for urban Indigenous people, we sought to understand local Indigenous perspectives, experiences, and priorities for supporting healthy and alcohol-free pregnancies. Participant yarns highlighted the importance of place, community, culture, and family, and some of the structural factors influencing women’s health behaviors during preconception, pregnancy, and parenting years. Insights from the yarns align with an Indigenous health determinants perspective and emerging Indigenous approaches to FASD prevention. Together, they call for health interventions that are Indigenous-led, culturally centered, holistic, relational, and strengths-based. The findings offer a critical road map for reorientating mainstream FASD prevention work beyond the narrow confines of individualized behavioral change approaches that are prevalent in public health and medical models. Rather, Indigenous approaches to FASD prevention support harm-reduction strategies that are tailored to the lived realities and priorities of urban Indigenous women and their families. This reorientation has important implications for all professionals who work in this space and contributes to the broader movement toward Indigenous justice, recovery, and healing from colonization.


Though the lack of Yayoi skeletal material available for DNA analysis greatly inhibits direct study of how the pre-agricultural Jōmon peoples interacted with rice agriculturalists, our review of Jōmon genetics sets the stage for further research into their relationships. Modern linguistic research plays an unexpected role in bringing Izumo (Shimane Prefecture) and the Japan Sea coast into consideration in the populating of northeastern Honshu by agriculturalists beyond the Kantō region.Formally, the Farming/Language Dispersal hypothesis as applied to Japan relates to the introduction of agriculture and spread of the Japanese language (between ca. 500 BC–AD 800). We review current data from genetics, archaeology, and linguistics in relation to this hypothesis. However, evidence bases for these disciplines are drawn from different periods. Genetic data have primarily been sampled from present-day Japanese and prehistoric Jōmon peoples , preceding the introduction of rice agriculture. The best archaeological evidence for agriculture comes from western Japan during the Yayoi period (ca. 900 BC–AD 250), but little is known about northeastern Japan, which is a focal point here. And despite considerable hypothesizing about  Media summary: How Jōmon genetics, Mumun migrations, and Japanese dialect differences inform farming/language spread hypothesis in Japannot Yayoi, they were Mumun.The Jōmon period see  is one oThe term Yayoi has four uses, which can create much confusion. First, it is the designation of the period beginning with the introduction of rice agriculture around 1000 BC until the advent of the Mounded Tomb Culture in the third century AD. Yayoi is a period designation exclusive to Japan; it includes both farmers and hunter–gatherers and entails the agricultural transition in a time-transgressive and regionally disparate process. Second, ‘Yayoi people’ may refer to anyone living in the Japanese Islands in the Yayoi period, or third, Yayoi may refer specifically to admixed people (Mumun + Jōmon in varying in proportions and across great distances). Fourth, Yayoi may indicate acculturation: the adoption of (rice) agriculture  by Jōmon-lineage people in the Yayoi period. All of these conflicting aspects of Yayoi must be kept in mind and clearly defined in any discussion.Upon the Mumun migrants’ arrival, it is assumed from artefactual, skeletal morphological, and genetic evidence that many took partners from the resident Jōmon population, leading to mixed descendants – and to cultural transformation. These generational ‘admixed’ farmers then spread out from North Kyushu into the rest of the Japanese Islands, meeting more local Jōmon-lineage peoples with further admixing taking place. It is common in the literature to label the admixed farmers as ‘Yayoi’ because they carried the new culture based on rice, while increasingly recognizing that Jōmon-lineage peoples  survived well into historical times without substantial admixture. The mixing of these two populations is recognized as the Dual Structure Hypothesis of the modern mainland Japanese population  rice and millet cultivation that may be earlier  Proto-Japanese split into several dialects, and then Ryūkyūan split off from the Kyūshū dialect. Evidence for the latter scenario has been growing in recent years. , which exists outside the nucleus, and the non-recombining portion of the Y-chromosome. The primary units considered when studying these markers are haplogroups, which are variants of a DNA segment that derives from the same common ancestor, and they can provide information on a population's genetic history.Since uniparental transfer results in no recombination, it is straightforward to reconstruct phylogenetic trees and assign a haplogroup to the mtDNA or Y-chromosome region  can be interpreted as study of small portions of thousands of different individuals, resulting in high statistical power for inferring the history of the population(s) represented by those individuals. Thus, sampling genome-wide is imperative for assessing the accuracy of the demographic relationships inferred from uniparental markers.The ability to extract and sequence ancient DNA (aDNA) has revolutionized the study of human prehistory, allowing direct sampling of past populations and revealing genetic variation no longer observed today. Post-mortem degradation of DNA makes it very difficult to sequence aDNA, so the greater numbers of mtDNA makes it much easier to extract and sequence. The earliest ancient DNA studies in humans were for mtDNA  in interpreting the genetics of the Yayoi in future studies.Analyses of both uniparental (Y and mtDNA) and nuclear DNA of present-day populations have highlighted that ancestry persists in Japan that is deeply diverged from ancestry found in mainland East Asian populations. The distribution of haplogroup frequencies across multiple populations is often used to determine where haplogroups originated. For example, those that occur in high frequency in present-day populations from Japan but low frequency elsewhere  were proposed as candidate haplogroups of Jōmon origin  is ca. 22,000 years ago, which is older than the tMRCA for several other haplogroups found in East Asians ; and f4 < 0 corresponds to the lowest tree for each figure. The presence of gene flow in the model is indicated by the red arrow. A significantly positive value highlights gene flow between the outgroup (P1) and ‘X’ East Asians (P3). A significantly negative value highlights gene flow between the outgroup (P1) and the other population in the tree (P2). Two standard errors are indicated by the thin grey bar, while one standard error is indicated by the thick grey bar. Points are coloured (colour online) by region of origin, with darker colours for ancient populations and lighter colours for present-day populations. East Asians for whom all or part of their population live near coastal East Asia are shaded grey. *Ancient islanders were sampled from Southeast Asian and Southwest Pacific islands, but were previously shown to share a close relationship to present-day Austronesians , which is not observed. In all cases, the Ikawazu Jōmon shows no connection to Hòabìnhians (f4 ≈ 0).4 > 0) indicates that the Ikawazu Jōmon shares connections with that East Asian (X) that the ancient inland East Asian Chokhopani or Shamanka_EN do not possess. No connections are observed between the Ikawazu Jōmon and ancient inland East Asians, which would be indicated by a significantly negative statistic (f4 < 0). A symmetric relationship to Ikawazu is observed when comparing with other non-coastal ancient and present-day East Asians (f4 ≈ 0). Coastal East Asians from northern and southern East Asia tend to show significantly positive results (f4 > 0), indicating a connection to the Ikawazu Jōmon that ancient inland East Asians do not share.In In fact, the Jōmon sampled thus far probably separated earlier than the split time of East Asians and the early Asian population that contributed to Native Americans  shows that the East Asians and Jōmon ancestry are equidistant from Hòabìnhian ancestry , indicatConnections do exist between the Jōmon and East Asians who live along the coast of East Asia. The first Jōmon mtDNA sequenced in 1989, from the Early Jōmon Urawa-I site in the Kantō region , shared Siberian connections, particularly in Hokkaido, have also been a recurring theme of Jōmon-related genetic studies. Several of the mtDNA haplogroups prevalent in the Japanese and Jōmon but rare in mainland East Asians, especially G1b, can be found in southeastern Siberians, highlighting potential contacts along the coast in northern East Asia as well  how archaeological shifts indicate a complex role for migration and admixture that was probably region-specific and (2) how similarities in dialect types hint at prehistoric migration of admixed Yayoi populations along the Japan Sea coast, which only stresses the need for more data on ancient Yayoi DNA.The coastal genetic connections proposed are not directly tied to the farmer/language spread hypothesis because they are found in the Jōmon and thus would be prior to the spread of farming. Instead, they are a cautionary point – to understand farmer/language spread, we need to understand who were the pre-existing populations (the Jōmon). If their ancestry is not as genetically isolated as has been argued, then future studies need to account for that.Echinochloa utilis) among others – were not suitable for intensive cultivation as carbohydrate sources to become staples  and millets  in Early Yayoi, with barley and wheat added in later Yayoi.In dealing with this problem, first we must define ‘agriculture’. This is not as easy as it appears, since the Jōmon were experienced at plant management, leading to several local domesticated species. Thus, they can be called hunter–gatherer–fisher–horticulturalists. However, the plants that they domesticated or at least managed – soybeans, adzuki, Perilla, sweet chestnuts and Japanese millet  nor Japanese speakers. Rice agriculture was established in Hokuriku and Tōhoku from 380 BC. However, settlements at the northern tip of Honshu failed by 100 BC, with occupants reverting to a hunting and gathering lifestyle. Thus, North Tōhoku is included with Hokkaido in the Epi-Jōmon period, which lasted to 700 AD, but we will refer to Jōmon-lineage people in other parts of Tōhoku also as Epi-Jōmon.Beyond the Waist of Honshu, the uptake of farming was far more diverse. Current research identifies phases of Jōmon pottery usage during the advent of agriculture in the Kinai, Chūbu central mountains, and Kantō regions where cultivation of dry-field crops also preceded irrigated rice agriculture  period Barnes,  witnesseemishi in court documents. The Nara state actively pursued military activities to bring this region under court control, although they ultimately failed and the region remained under the rule of prominent emishi.The Nara period began when a national capital, Heijō , was buiEmishi’ in the Nara period is understood to have been a word that designated people who lived in the north beyond the reach of the state. It was neither an ethnonym nor referred to a way of life but was an administrative term – and so encompassed everyone living beyond state jurisdiction regardless of subsistence, language, or genetic background. We assume that those emishi who practised rice agriculture spoke Japanese, but Ainu place names surviving from Niigata and Fukushima northwards clearly indicate that the Ainu language was being spoken by some emishi  , this has resulted in mergers between vowels . This gei/ and /u/ is present, and the fact that the tonal distinctions have disappeared is most likely the result of a mixture of West Kantō (Chūrin) and Tōhoku (Gairin) influences. From other areas in Japan it is known that confusion between adjacent tone systems with different merger patterns of the tone classes can lead to collapse of the system. The northeastern toneless zone includes not only the East Kantō dialect, but also the Pacific side of southern Tōhoku  takes a somewhat intermediate position between the West Kantō dialect and the Tōhoku dialect. Some centralization of /n Tōhoku . On the What does the opposition between the West Kantō tone and vowel system and the northern Tōhoku tone and vowel system and the intermediate zone between them mean for the way in which the northeast was settled by Japanese-speaking farmers? There are a number of things to consider. Vocabulary can be easily borrowed long distance from other dialects, as long as there is contact . Phonology, or the sound structure of a language, on the other hand, usually spreads to adjacent areas, with which there is sustained contact. If it spreads to distant areas, migration is the most likely cause, although it is possible for similarities in phonology between far-flung regions to be the result of parallel independent development, if the innovations are easily repeatable and cross-linguistically common.The similarities between Izumo and Tōhoku (and to a lesser extent the Noto Peninsula) come in shared sets  is nowadays relatively poor and sparsely populated, this was not always the case. Izumo was one of the most powerful confederacies of the Mid and Late Yayoi periods. It was the great rival of Yamato and the focal point of a wide maritime trade network that included the Japan Sea coast, the Ryūkyūs, Kyushu, Korea and China  and Toyama, as Izumo-style mound burials have not been found in Niigata. If there was already some Izumo influence on the dialect of Niigata at the time when rice farmers moved inland to Gunma, it would have been on the vowel system only. The tonal innovations in the Izumo dialect had not yet occurred, judging from the fact that these are not present in the dialects of Ishikawa and Toyama. What applies to the dialect of Niigata also applies to Nagano (Chūbu) and Gunma (West Kantō), which was settled from Niigata, and to Tochigi and Ibaraki (East Kantō), which were all settled overland. If the Tōhoku region was entirely settled overland from these areas, the similarities with the Izumo dialect remain unexplained.Can migration of Izumo dialect speakers into Tōhoku in later periods explain the similarities between the dialects? Piggott  examinedUnder the circumstances it is possible that groups from Izumo, avoiding Yamato pressure, would migrate northward along the Japan Sea coast. Diffusion into Tōhoku through mountain basins and over passes could have taken place, but were the numbers enough for linguistic change throughout Tōhoku? The mixed nature (and collapse) of the tone systems in south and central Tōhoku suggest that there was some influence but not enough to determine the dialect. The linguistic influence in northern Tōhoku, however, was much stronger.emishi who, from the evidence of place-names, must have spoken an Ainu-related language, moved away from northern Honshū into Hokkaidō in that period. According to Matsumoto (Hudson  mentionsatsumoto , p. 158,atsumoto , p. 159.If the people arriving in the late sixth century were from Izumo, then northern Tōhoku would have been sparsely populated at that time, as the Epi-Jōmon population had for a large part moved away. That means that the new population could rapidly spread out over the entire area, which would explain why the Izumo-style tone system was preserved well there, in contrast to the situation in south and central Tōhoku. In south and central Tōhoku there was interference not only from other dialects but most likely also from languages of the local Epi-Jomon population, who were no longer hunter–gatherers but settled farmers by then. The relatively low internal diversity of the Tōhoku dialects may be attributed to the overall later spread of Japanese to the northeast compared with other areas of mainland Japan Inoue, .Migration of people from Izumo to the northeast may even have left a genetic trace. Saitō , p. 127 Saitō concludes that, in contrast to Ryūkyūans, the Tōhoku population has very low traces of Ainu-related ancestry, which was used as a proxy for Jōmon-related ancestry. He also includes a PCA showing the position of Izumo individuals relative to Okinawan and Kantō individuals Saitō, , p. 155,It is better to be cautious in drawing conclusions until more detailed comparisons from different areas of Japan are available, but the initial results are definitely interesting in light of the dialectal similarities between Izumo and the Tōhoku region.Confronted with the Yayoi farmers and their new mode of subsistence, the different ethnic groups that were already present in Japan could react in different ways: assimilation and adoption of the new techniques, specialization in products with which to trade with the new farming populations, resistance or withdrawal. The available options differed per region and per period, influencing the way in which the Japanese language spread.emishi population were speakers of an Izumo-type dialect. There certainly will have been Epi-Jomon people speaking an Ainu-related language among the emishi ranks, but what seems clear is that the Izumo-type dialect of Tōhoku must have already had a strong foothold in the northeast before the period of the Emishi Wars of the late eighth century. That dialect is proposed to have spread either with the introduction of rice agriculture by admixed Yayoi peoples in Mid to Late Yayoi, or in the expansion of the mounded tomb culture in the Kofun period.The present-day dialect distribution in northern Honshū suggests that a considerable part of the early historic This study has highlighted a strong need to bring Japanese scholarship on the history and archaeology of Tōhoku into consideration with the farming/language dispersal hypothesis. The complexity of population movements in this area is illustrated by Hakomori . Also ne


Among Japanese pharmacists, there is a gap in their commitment to self-improvement and a possible gap in their ability to identify and solve problems. However, the factors causing this situation have not yet been clarified. This study was conducted to identify factors that influence the abilities of Japanese pharmacists to identify and solve problems, which are skills considered essential for this profession. A prior history of presenting at academic conferences was set as a surrogate outcome to clarify whether having this experience affects the factors.A nationwide internet-based survey was conducted among 300 participating hospitals and 300 community pharmacists. The survey was discontinued when the sample size of each group reached 300. The respondents were categorized into two groups on the basis of their experience of presenting at academic conferences in the survey item “status of self-improvement after employment.” Their association with other survey items was determined using univariate and multivariate logistic regression analyses.The multivariate analysis revealed that 152 (50.7%) hospital pharmacists and 41 (13.7%) community pharmacists had presented at academic conferences. Among the hospital pharmacists, the experience of presenting at academic conferences was significantly associated with the “age 30 s (*references 20 s),” “presence of pharmacists to consult,” “experience supervising interns,” and “number of types of self-improvement” factors. For the community pharmacists, prior conference presentation experience was significantly associated with “age over 70 s,” “highest educational background ,” and “number of types of self-improvement.”This pioneering study suggests that having prior experience of presenting at academic conferences as a surrogate outcome of pharmacists' problem-finding and problem-solving skills may be related to the support provided by human environmental factors at the facility, the status of self-improvement, and the highest educational background. In recent years, the requirements of the Japanese society for pharmacists have changed significantly. In October 2015, the Ministry of Health, Labour and Welfare formulated the “Pharmacy Vision for Patients,” which requires community pharmacists to work with related institutions to provide support for anticancer drugs (advanced pharmacy management function), centralized and continuous access to medication guidance information, 24-h support, and home support [To be a pharmacist who can respond to these changing needs, it is essential for pharmacists to possess the skills to identify patients' medication-related problems and problem-solving skills. Those skills must be developed and demonstrated by pharmacists throughout their careers, and therefore, it is important to continue self-improvement even after employment.Although there are various self-improvement methods, participation in workshops and e-learning is currently mainstream. However, as of December 2021, approximately 40% of pharmacists in all prefectures in Japan have received certification from the Japan Pharmacists Education Center for continuous self-improvement . WritingHence, post employment experience in presenting at academic conferences indicates proficiency in identifying, solving, and summarizing problems through research activities, In this study, experience of presenting at academic conferences, one of the self-improvement activities for pharmacists, was set as a surrogate outcome of ability to identify and solve problems, and the purpose of the study was to clarify the differences in factors depending on whether the pharmacists had this experience or not.The survey covered hospital pharmacists and community pharmacists nationwide. Considering that the number of survey targets for this study in 2018  was apprSurveys targeting specific groups of people , in a specific region, whose educational and environments, motivation, etc. were similar, were at risk of response bias. Therefore, to improve external validity, a nationwide Internet survey was conducted using Loom Inc. Ltd., a company commissioned to randomly select survey targets from among registered pharmacists nationwide, distribute the survey questionnaire, obtain consent from survey participants, and collect responses to the questionnaire until the number of targets was reached.The survey period was from February 7, 2022, to March 7, 2022.The survey items were set to clarify the factors related to hospital and community pharmacists’ “ability to identify and solve problems.” Details, including the abbreviations of survey items, are presented in Table P < 0.2.Experience in presenting at academic conferences on the status of self-improvement activities after pharmacy school graduation was set as a surrogate outcome of “problem identification and solution ability” among the survey items. The survey items were categorized into two groups: those who responded that they had presented at academic conferences (group with experience presenting at academic conferences) and those who responded that they had not presented at academic conferences (group without experience presenting at academic conferences). The χ2 test for nominal data comparisons such as gender and region of residence, and the Mann–Whitney U test for numerical data comparisons such as the number of self-improvement experiences and number of life events experienced by hospital pharmacists and community pharmacists, respectively, and each survey item. Multivariate logistic regression analysis was conducted after considering multicollinearity for items with To examine the influence of facility affiliation, a stratified analysis was conducted by categorizing hospital pharmacists into hospitals with specific functions and community health care support  and hospitals other than those with specific functions and community health care support ; community pharmacists were categorized into community pharmacy chains and drugstores (hereafter referred to as “pharmacy chains and DS”) and individual and small community pharmacies .Additionally, multivariate logistic regression analysis was conducted with the item and the number of life events experienced in place of the item of sex as a sensitivity analysis. IBM SPSS Statistics Version 27  was used for analysis.This study has been approved by the Ethical Review Board, Faculty of Pharmacy, Meijo University .The backgrounds of the hospital and community pharmacists respondents are shown in Table P < 0.001) etc.The “group with experience presenting at academic conferences” consisted of 152 hospital pharmacists (50.7%) and the “group without experience presenting at academic conferences” consisted of 148 hospital pharmacists (49.3%). The survey items that showed differences in respondents’ backgrounds between the “group with experience presenting at academic conferences” and the “group without experience presenting at academic conferences” were sex (P < 0.001).Next, the “group with experience presenting at academic conferences” consisted of 41 community pharmacists (13.7%) and the “group without experience presenting at academic conferences” consisted of 259 community pharmacists (86.3%). The only difference in the backgrounds between these two groups was in their highest educational background ” and “age 50 s” of the respondent background. For community pharmacists, the sensitivity analysis revealed that no new survey item showed a significant positive association with the “group with experience presenting at academic conferences,” but the highest educational background , which had previously been considered associated, was no longer considered so.There was no significant bias in respondents' backgrounds in terms of age, undergraduate course, or region of residence. However, differences were found in terms of sex and highest educational background.The results of multivariate logistic regression analysis of hospital pharmacists revealed significant associations between “experience presenting at academic conferences” and “age 30 s,” “presence of pharmacists to consult,” “experience in supervising interns,” and “number of types of self-improvement.”In a report on clinical research by hospital pharmacists, 94.6% of the participants indicated that they were anxious when planning and conducting clinical research. They cited “statistical analysis,” “preparation of research protocol,” and “how to formulate clinical questions” as points of anxiety (or uncertainty) . Muroi rHowever, the items that showed significant associations with the results for community pharmacists were “over 70 s,” “highest educational background ,” and “number of types of self-improvement.” No significant associations were found between physical or human environmental factors in the facility to which they belonged. Thus, among community pharmacists, physical and human environmental factors did not differ significantly among pharmacies, suggesting that individual motivation influenced their commitment to present at academic conferences. In a survey of Canadian pharmacists working in emergency medicine, there was a relationship between current research and the experience of obtaining a master's or doctoral degree , and it Regarding the results of the stratified analysis, significant associations were found for “sex ” and the “number of types of self-improvement” among pharmacists affiliated with large hospitals. Ueki et al. reported that the greater the number of hospital beds, the lower the levels of job satisfaction . Women aA survey on clinical research support efforts reported that the number of oral presentations at academic conferences and the number of papers written by hospital pharmacists improved when universities and civil hospitals collaborated and university faculties provided research guidance to hospital pharmacists . Since sAccordingly, pharmacists in small- and medium-sized hospitals may be constrained from taking part in conference presentation efforts because of a lack of a specific number of years of experience or a sufficient number of pharmacists. It is possible that those in their 20 s may not have had many opportunities to experience academic conference presentations, as the focus of their work is on daily duties. However, the “presence of a pharmacist to consult” and “meeting a role model” may have positive impacts.It was interesting that “meeting a role model” was related to the experience of presenting at academic conferences in an environment with insufficient physical and human resources at one's facility.In the stratified analysis of community pharmacists, only the highest educational background  was significantly associated with pharmacists affiliated with a pharmacy chains or DS. Regarding motivation for self-improvement, it is possible that pharmacists affiliated with pharmacy chains and DS have a better environment for self-improvement, such as training, than small- and medium-sized community pharmacies, and that no difference was found. Therefore, it is conceivable that only past research experience may have led to their commitment to academic conference presentations. However, the small number of community pharmacists who had　presented at academic conferences may not have accurately captured these factors.A significant association was found between number of types of self-improvement among pharmacists belonging to small- and medium-sized community pharmacies. Therefore, it is possible that pharmacists belonging to small- and medium-sized community pharmacies have greater differences in motivation for self-improvement, which may affect their commitment to academic conference presentations.Additionally, a comparison of hospital pharmacists and community pharmacists showed a significant difference in the background of the respondents, with only 41 (13.7%) of the community pharmacists having “experience presenting at academic conferences” compared to 152 (50.7%) of the hospital pharmacists. Compared to the latter, the former are expected to face multiple physical environmental and human environmental factors at your facility when presenting at academic conferences. Hospital pharmacists can obtain detailed patient information, such as background, medical history, and laboratory values from medical records. However, community pharmacists will only be able to access limited information from prescriptions and medication records.Additionally, according to a survey  by the MSato et al. conducted a clinical study as a community pharmacists, in collaboration with hospital pharmacy departments and universities and reported the results , 15. In In the sensitivity analysis, there was no significant variation in items other than respondent attributes  for hospital and community pharmacists. Therefore, the results of this analysis were considered robust. The percentage of hospital pharmacists who had presented at academic conferences was similar to that in previous studies .Since this study was a nationwide, Internet-based survey, a limitation was the inclusion of only pharmacists registered as monitors with an Internet research firm and of those able to use a PC or other electronic devices. However, the use of electronic devices is currently mandatory in pharmacist practices. As there was no bias in respondent age, we were able to collect results that were close to the current situations of pharmacists. Based on the results of a survey of hospital pharmacists regarding the surrogate outcomes of this study , we consTherefore, in order to emphasize the feasibility of the study, we set the experience of presenting at academic conferences, which is considered the first step in evidence generation, as an outcome in this study, although it is a lower hurdle compared to writing a paper. Therefore, factors other than the experience of writing may exist.In addition, we did not confirm the affiliations and number of presentations for the surrogate outcome in this study, which was the presence or absence of experience presenting at academic conferences after employment. Therefore, it is possible that employment history influenced the results or that the presentation was a one-time event. Therefore, it is unclear whether the problem was continuously identified and resolved. And we did not investigate the quality of evidence for the content of past conference presentations.The number of pharmacists who had presented at academic conferences was extremely small among community pharmacists, and the sample size was not large enough to accommodate the number of factors in the multivariate analysis. This limitation reduced the reliability of the analysis.In this study, the experience of presenting at academic conferences after employment was examined as an indicator of problem-solving ability.The results revealed that factors influencing pharmacists’ experiences post-employment and presenting at academic conferences might include sex, the highest educational background, experience during pharmacy school, the human and physical environment of the institution, and the status of self-improvement. The factors differed by hospital, pharmacy, and the size of each institution. Among the factors newly identified in this study, “presence of a pharmacist to consult,” “experience in supervising interns,” and “meeting a role model” were associated with improved practical knowledge in each environment. To improve this situation, it is necessary to consider measures to motivate pharmacists for self-improvement as well as attempts to accumulate practical knowledge and share it among pharmacists in the future.


Survey respondents reported that they enjoyed their involvement in the campaign (92%), were more confident to talk with men about mental health and suicide (95%), and would recommend Buddy Up to others (95%). Qualitative interviews were thematically analyzed to develop three inductively derived themes: (a) Engaging men with relatable masculine content and design: “Buddy Up really spoke to them in their language,” highlighting the importance of understanding and working with gendered practices and motivations to legitimize and motivate involvement in suicide prevention; (b) Leveraging campaign participation to initiate conversations and promote mental health: “It gives men language and license to start asking questions,” revealing ways in which participants utilized Buddy Up to negotiate and norm checking-in to promote men’s mental health; and (c) Driving new masculine cultures: “We start every meeting with a mental health moment,” identifying how participants fostered healthy milieus for disclosing mental health challenges with teamwork and preventive action under the banner of Buddy Up. The study findings support the feasibility of Buddy Up and highlight the acceptability of peer-based approaches to mental health promotion. The findings can also empirically guide future efforts for systematically building men’s peer-based suicide prevention programs.Suicide is a major public health concern and leading cause of death among men in Canada. This study reports the feasibility and acceptability of Buddy Up, a peer-based suicide prevention campaign for men. A mixed-methods approach was used to analyze respondent survey questionnaires ( Suicide persists as a leading cause of death worldwide , with meSuicide prevention campaigns have demonstrated promising results in a variety of contexts  and as such are considered a cost-effective and effective approach for reducing the incidence of suicide and disability due to depression . SuicideThe current study explores participants’ experiences and perspectives of Buddy Up, a men’s suicide prevention campaign developed by the Center for Suicide Prevention in Calgary, Alberta, Canada. Buddy Up was developed through a co-production process involving a community advisory committee and focus groups with 60 men to design and disseminate targeted advertising, promotional materials, and educational resources. The campaign features nine characters  that depict men experiencing various mental illness symptoms .Buddy Up participant survey data were collected online by the Center for Suicide Prevention and the research team conducted a secondary analysis in deciding the qualitative questions to be asked of campaign users. Participants were invited via a campaign mailing list of approximately 650 registered users in June 2022. Specifically, individuals were invited to share their perspectives and experiences of the Buddy Up Campaign in a survey questionnaire requesting respondents’ characteristics, use of campaign features and materials, and overall satisfaction with the campaign. The survey took approximately 15 min to complete and included four-point Likert-type scales , with 4 indicating the most positive rating on each item, and open-ended response questions . Interviews were video and audio recorded, transcribed verbatim, and identifiable information was removed to ensure anonymity and confidentiality prior to analyses. Participants were sent a $20 e-gift card after the interview in recognition of their time and contribution to the study.An email invitation was sent via the campaign mailing list to invite potential participants to complete an individual interview regarding their experiences and perspectives of Buddy Up. Interested individuals contacted the project coordinator via email and were provided a link to complete an e-consent and demographics questionnaire. Once consent was obtained, participants completed a 45- to 60-min Zoom interview at a mutually convenient time. All interviews were conducted by a post-doctoral researcher with expertise in men’s mental health and experience in qualitative research. A semi-structured interview schedule was developed based on feasibility parameters including motivation for participating, acceptability of the campaign and content, and experiences with promoting men’s mental health and suicide prevention  by coauthors to allow for detailed discussion of the data, coding, and interpretation. Codes were inductively generated by identifying key features of participants’ experiences relevant to the study objectives (Quantitative data (online survey responses) were analyzed using IBM SPSS and data are reported as means and frequencies. Qualitative data were thematically analyzed to examine participants’ experiences and perspectives of Buddy Up . Transcrjectives . For exaSD = 12.71, range 21–69) years. Most respondents had previous experience with suicide prevention  and were women . Interview participants’ (n = 19) mean age was 47.89  years, and they were predominantly men , lived in Alberta, Canada , and were employed for wages . Approximately half of interview participants  were employed or volunteered for mental health related work within health care, government, or non-profit organizations. Most interview participants had experience promoting Buddy Up for at least two annual campaigns . Participant characteristics for interview participants are presented in A total of 48 respondents completed the survey questionnaire with a mean age of 42.29 , enjoyed their involvement , and would recommend Buddy Up to others . Open-ended survey responses identified “straightforward messaging,” “easy and accessible language,” and “relatable branding and graphic” as important campaign features. Survey participants reported engaging in an average of 5.8  campaign activities including telling others about the campaign via email, text, or word of mouth ; reading resources on the Buddy Up website ; putting up posters ; and using a Buddy Up sticker or air freshener . Participants reported initiating a range of conversations as a result of Buddy Up including “casual discussions with friends and family,” “one-on-one support with a friend,” and “talking to a colleague about their anxiety following a break-up.” A majority reported that they were more confident to talk with men about mental health  and suicide  after participating in the campaign and that the campaign had helped prepare them to talk with a man who was considering suicide . However, some survey respondents  indicated that they were not ready to have a conversation with someone about suicide. Recommendations to improve the campaign included “more guidance for how to initiate activities,” “tools on how to start the conversation with someone who is not close to you” and “information on how to respond to statements like ‘I’m not suicidal so this has nothing to do with me.’”The majority of survey respondents reported that they were satisfied with the campaign (Three overarching themes were identified that reflected participants’ experiences and perspectives of Buddy Up: (a) Engaging men with relatable masculine content and design: “Buddy Up really spoke to them in their language”; (b) Leveraging campaign participation to initiate conversations and promote mental health: “It gives men language and license to start asking questions”; and (c) Driving new masculine cultures: “We start every meeting with a mental health moment.” While connected, themes are presented separately to provide a detailed analysis of three inductive components underpinning the campaign’s feasibility.Men With Relatable Masculine Content and Design: “Buddy Up Really Spoke to Them in Their Language”.I thought that Buddy Up really spoke to them in their language. The characters that they used, the simplicity of the message, and the language they used, it was really attractive. We were out at a drilling rig on a platform, and one of the guys had a Buddy Up sticker on his helmet along with a whole bunch of other inappropriate stickers. But you know, it was kind of the defining moment for me. These guys know what it’s about. They’re not putting it on there because it’s just another sticker. I think it really served the purpose of breaking through some barriers.Interview participants highlighted how the design and messaging were appealing to men in a range of settings and contexts. James, a 52-year-old health service provider who promoted Buddy Up to men working in male-dominated, resource-based industries, explained:It started to show up on our internal webpage and I thought, “this is something that I should participate in.” I have a feeling that due to some things I’ve been through, that I have a duty to give back, and a duty to help. That’s easier said than done because I’m not sure what to do but this came up and it was very much mapped out. There’s material, there’s support, and I thought “Well what better thing to jump on than this.”James alluded to the challenges of engaging men in settings where traditional masculine values are often staunchly upheld. Highlighted was men’s covert but intentional support of the campaign and resources. That the Buddy Up materials were prominently displayed at the worksite suggested that the imagery and messaging were acceptable and resonated with many men. James also referred to the Buddy Up characters, which feature prominently on the campaign website and print posters, depicting men of diverse ages, backgrounds, and circumstances experiencing common mental health challenges. Herein, men are called to “step up and offer support” to other men in their lives who may be struggling. These relatable characters and calls to action might be understood as increasing awareness about distress in men as well as norming men’s provision and receipt of peer support for mental health challenges. In this way, men’s engagement with the campaign was leveraged according to masculine protector and provider identities. For many, including Rick, a 56-year-old project manager who promoted Buddy Up in his workplace, the desire to help others was key to their campaign involvement:My mental health is being challenged right now. Given the circumstances with the pandemic, my separation, and not knowing what is going to happen with the kids or our matrimonial home, which is likely getting sold. It was almost like just having it [Buddy Up] as a resource to keep me grounded in something that felt meaningful. Instead of sticking to my own personal challenges, at the time I felt like I wasn’t really getting out of those, something like the Buddy Up campaign could allow me to extend beyond myself and help other people. It felt like a connection to the world outside, the world beyond me and my own space. Getting that sense of greater purpose was a boost which increased my own mental wellness.Rick explained how Buddy Up provided him opportunities to share his vulnerabilities and the knowledge that he had gained from his personal experiences to help others who may be struggling. For many men, providing support and helping others was strength-based and asset-building, and participants found value and purpose in promoting the peer-support messages via the campaign. Several participants noted personal benefits from their involvement in Buddy Up that stemmed from contributing to a cause to help others and provide peer support. Indeed, Mark, a 35-year-old man currently looking for employment, discussed his involvement in Buddy Up:For Mark, the mental health challenges stemming from his disrupted relationships and interruption of paid work contributed to a loss of control which drove him to seek purpose through his campaign participation and reciprocal peer relationships. Mark spoke to the benefits of giving at a time when he was losing so much—as a distraction in part, but also as a force for grounding and solace in certainty. In recognizing one’s own challenges and norming those states, men can redirect their distress as energy to authentically prioritize and contribute to helping others who are struggling.Findings in this theme underscore the importance of understanding and working with masculine codes, values, and motivations. The importance and value of relatable masculine content and design was a prominent feature within the survey and interview data. Herein the design and messaging of the campaign were deemed appealing to men as they resonated with men’s protector and provider identities to legitimize and motivate involvement in suicide prevention. Buddy Up afforded an important vehicle for men’s involvement, offering a sense of purpose, belonging, and community.I think there are intentionally a number of different levels for participation which is highly appealing because of the flexibility. So it’s about encouraging discussions with men about mental health, posing questions with your son, with your classmate, with a co-worker, asking how they’re doing and engaging in conversations. Then there’s material that just gives basic information on the fact that it’s okay to ask and what you might say without feeling like you’re stepping into the role of a therapist.Interview participants promoted the campaign within workplaces, health care settings, community centers, and universities, where they engaged with friends, family, colleagues, clients, employees, students, and community members. Kathy, a 65-year-old university administrator, reflected on her experience promoting the campaign to staff and students at a large university:Similar to Kathy, many interview participants spoke of the need to encourage and initiate conversations about men’s mental health and suicide prevention. Herein, interview participants discussed leveraging their campaign participation in different ways by directly and indirectly discussing mental health with other men. Albert, a 63-year-old retired man, discussed how the campaign afforded him the confidence and clout to inquire and talk about mental health with other men:I’ve also used it on a personal level just in talking with other men. Informal sort of chit chat, but also, you know, being able to ask the question: “Are you doing okay?” And one of the things I like about the campaign is it gives men language and license. It gives them permission to start asking questions when they see something because oftentimes I think we have gut feelings that something’s not right, and it’s the license then to start asking questions.You check off all your activities and it’s encouraging. I sent that on to some other men I know to get involved. When I’ve been doing stuff with them, I show them the sheet, saying, “yeah, we’re out for a walk. I’m checking off something on my sheet because I’m here with you.”Similar to Albert, many interview participants used campaign activities and resources to initiate conversations with men and justify inquiring about their mental health. In this way, the campaign provided an excuse to inquire about mental health and could be used to explain discomforts that might arise during the conversation. Richard, a 70-year-old retired man, discussed how he utilized the Buddy Up Activity Card, a checklist of campaign activities , to engage other men in mental health promotion activities and initiate conversations about mental health:I think it depends on the group if I’ll mention if it’s with Buddy Up. I think if there is a little bit more resistance, I might be less likely to mention that it’s Buddy Up and approach it as more of just hanging out and exercising together, or whatever the activity is, as opposed to being like, “hey, this is a mental health campaign.”However, while positioning the campaign as a centerpiece in discussions helped some participants to engage in conversations, others were more reticent to directly discuss mental health or disclose their campaign participation. Tom, a 24-year-old university student, expressed his hesitation in disclosing his participation in a suicide prevention campaign to some men:The tenets of the campaign clearly resonated with Tom as he sought opportunities to actively engage in peer support and mental health promotion. Yet, he carefully considered his approach and was sensitive to the potential for the “mental health” label to deter some men. Instead, Tom provided an example of covert mental health promotion, demonstrating understanding of an approach to doing peer support without naming it. Tom’s approach may also support survey findings that suggest a need for more information on how to initiate difficult conversations with men.Findings in this theme revealed ways in which participants mechanistically utilized Buddy Up to engage men in suicide prevention. Highlighted were covert strategies that participants used to negotiate and norm peer support for men’s mental health promotion. Participants’ approaches were predicated on understanding men’s receptivity to health-promoting conversations and activities which they used to adapt their delivery.They have stickers with like a little thumb print logo, I actually cut it up and put the thumb print on my right above my outside door handle. My door is orange already, just by coincidence, and I just thought this is going to be a message to guests who come to the house, or anyone who drops off a package, or whatever. This will be just a little heads-up.Campaign participation was diverse and varied contextually for many participants. Interview participants revealed several creative and unique approaches to men’s mental health promotion and suicide prevention. For example, Mark  shared his creative use of the stickers to raise awareness for suicide prevention:We were doing some mental health stuff before, but. . ..it’s becoming more of a topic that people aren’t afraid to discuss as much . . . They want us to start every meeting with a safety moment. So someone will say, “Last night I was putting on my Christmas lights, and I had my extension ladder out, and I asked my wife to come out and hold the ladder because it was pretty wobbly” and everyone says, “oh, great safety moment!” So now we do a mental health moment. If someone said, “on the weekend, I had a buddy having some issues with his wife, and he was concerned that she may be leaving him, and he gave me a shout and asked if I could come out. So I pulled another guy up, and we drove out there and talked with him and reassured him, and got him in the right hands of, say, his dad. That would be like a mental health moment.For many participants like Mark, there were clear intentions to raise awareness and challenge masculine norms of self-reliance and stoicism. In this way, Buddy Up might be understood as a driver and catalyst for cultural change. Within workplaces, some interview participants suggested Buddy Up was a point-of-entry or pathway to their Employee and Family Assistance Program whereas others discussed procedural and policy changes. Steve, a 34-year-old man involved in his workplace Health and Safety Committee, discussed how Buddy Up encouraged procedural changes that promoted mental health:I had one situation where a guy came up to his foreman and said he’s not doing well. I intercepted him and chatted and we got talking about stuff. The police came in and did a welfare check on him, because we didn’t know at that point what was going to happen. It was a situation where he felt comfortable enough to ask me, “can I text you whenever I’m having any issues?” He’s back to work now . . . I text him every once in a while, and just say, “hey, how’s it going?” I ran into him on a site recently, and he gave me a big bear hug.Steve discussed the creative adoption and adaptation of Buddy Up with his workplace as a catalyst for change. Similar to Steve, many interview participants believed that they had helped to raise awareness for mental health promotion and suicide prevention and normalize peer discussions and help-seeking. Oliver, a 36-year-old construction manager, discussed how promoting Buddy Up had helped to shift workplace culture and potentially prevent crisis situations:It’s hard to say how much engagement we’re getting at times, because you can’t be there when people are coming to take resources . . . I forward that email out to my distribution list, encourage everybody to continue these pieces, but nobody actually gets back to me with a group picture that says, “all this was done,” right? That’s kind of the unmeasurable component.However, while many interviewees perceived their promotion of Buddy Up to be meaningful and important, they were universally challenged to identify the reach or impact that their work had on men. When distributing resources or sharing information on social media, participants discussed how difficult it was to measure the impact of their work. David, a 38-year-old man, frequently promoted Buddy Up to organizations through his health service work and discussed difficulties with assessing uptake in these settings:David identified the intangibility and challenges for evaluating cultural change, wherein participants’ efforts were focused on contextually and circumstantially doing “good work,” rather than the empirical evidence of rupturing and reformulating masculine cultures. Herein, the unit of measurement that could be used to meaningfully evaluate cultural impacts might vary greatly by context.In summary, this theme revealed participants’ buy-in to changing milieus by challenging masculine norms of self-reliance. Here, participants used Buddy Up to support cultural ideals for men’s comradery and peer support through teamwork and crisis prevention actions. Participants were careful to work within masculine and cultural bounds and Buddy Up offered them the legitimacy and cover to do that work.Findings from this research provide evidence for the feasibility and acceptability of Buddy Up and highlight important factors that may contribute to men’s engagement with suicide prevention campaigns more broadly. Campaign satisfaction was high and participants’ feedback was resoundingly positive. Strengths of the campaign included appealing messaging, straightforward calls-to-action, tangible resources and materials, and flexible delivery options. These findings support mental health promotion strategies identified by others , and proParticipants’ involvement with Buddy Up revealed complex and nuanced approaches to men’s mental health promotion and suicide prevention. Showcased were creative community-based strategies for engaging in peer support which offer insight into how some men foster and maintain healthy supportive relationships that enhance mental health. Participants demonstrated an awareness and understanding of masculine norms and cultures and the influence that restrictive ideals can have on men’s engagement with mental health promotion and suicide prevention. While some focused on interpersonal relationships, others sought to influence cultures more broadly. The complex interplay between masculinities and men’s mental health demands consideration of gender at multiple levels in campaign design and/or tailored intervention content. Many participants in the present study demonstrated a profound awareness and understanding of these complexities by actively working with and around masculine norms to promote men’s mental health. Particularly following the COVID-19 pandemic, the diversity and prevalence of mental health challenges among men suggests the need to carefully consider strategies for addressing gender norms, roles, and relations . FindingStrengths of the current study include the inductive approach used to synthesize the feasibility and acceptability parameters of Buddy Up and their potential for transferability to guide other similar initiatives. While studies often utilize researcher-derived measures of feasibility , key campaign features identified in the present study were purposefully participant-driven . However, due to the self-selected nature of the study sample and proportion of participants with prior suicide prevention and/or health care experience, a limitation is that the findings may not be indicative of all individuals’ experiences. In addition, as participants were recruited from a campaign mailing list, the perspectives of individuals who did not register and provide a contact email may have been omitted. That many participants were women  is also notable and raises important questions about their role in men’s suicide prevention. Women are important allies in men’s health who have long taken on advocacy and caregiving roles. It is important to ensure that traditional femininities are not being perpetuated to compensate (or excuse) unhealthy masculine cultures. Work is still needed to encourage men to adopt active and primary roles in mental health promotion and early intervention. In addition, many participants had prior experience with suicide prevention. Finally, while the diverse contexts in which the campaign was promoted hold promise for broader applications, the challenges for proving attribution of outcomes to specific participation patterns limits the evaluation of Buddy Up.Men’s suicide prevention campaigns have demonstrated promising results . As new Click here for additional data file.Supplemental material, sj-docx-1-jmh-10.1177_15579883231209189 for “Hey Amir, How Are You REALLY Doing?”: Participant Perspectives of a Peer-Based Suicide Prevention Campaign for Men by Paul Sharp, Patricia Zhu, John S. Ogrodniczuk, Zac E. Seidler, Michael J. Wilson, Krista Fisher and John L. Oliffe in American Journal of Men's Health