Truth-telling, trust and e-cigarettes

Truth-telling, trust and e-cigarettes

Headshot of Dana Scully from The X-Files, with caption "MULDER, THE TRUTH IS OUT THERE, BUT SO ARE LIES."

Lange, M. (1994, February 11). The X-Files. Young at Heart. 20th Century Fox Television.

It should go without saying that public health institutions and researchers have an obligation to tell the truth. In principle, there aren’t many stakeholders in e-cigarette research who would argue otherwise. But questions about whose truth and how information about e-cigarettes should be communicated have been highly controversial.

Partly this is because e-cigarettes haven’t been around long (relatively speaking), and research takes time.

But while influential figures on all sides of the e-cigarette debate in the US have increasingly acknowledged a body of evidence that vaping is less harmful than combustible cigarettes, the US public has increasingly come to believe the opposite. It’s unlikely that this outcome results from even-handed cautions against jumping to conclusions. People have been inundated with a particular message about the current state of research on vaping, and that message is false. Continue reading

Who does research on the researcher?

Who does research on the researcher?

Photo of antique typewriter holding a sheet of paper that has "What's your story" typed on it

(Image in public domain)

Since February of last year, I have been talking to Black and Latina women from the Bay Area about their perceptions of and experiences with police. These women that I have had the pleasure of speaking with have all been between the ages of 18-25. As I have sat with stories of their interactions with police, as well as their views of police and policing today, I couldn’t help but think: How have I not have had the experiences that these women have had?

I am a part of the same demographic of women who have participated in these interviews: young, in her mid-ish 20s, Black and from Oakland. Questions of how I have not had experiences similar to the young women of Color I’ve interviewed, as well as acknowledging my role as a researcher, dawned upon me during two separate interviews when two Black women from Oakland asked me if I had ever been stopped by police. When I gave them an answer and inquired about why they had asked, they followed up with statements like: “You’ve only been in a traffic stop, huh?” or “You don’t look like you’ve been stopped by the police because you look like you went to college.”

These statements not only provided a fraction of these women’s perceptions of and experiences with policing, but also provided some insight into the role(s) of a participant and a researcher. I was glad that these women asked me questions as I had asked them many. I was elated that they knew they had the space to ask me questions. I have done many interviews where participants felt that I was looking for a particular answer or felt pressured to answer questions in a particular manner.

As a qualitative researcher, I am interested in the experiences and narratives that others share with me; but I realized that I often miss other narratives and experiences as well: How does a participant see me as a researcher? What do they think my stories are and how does this influence how we interact with one another? What does all of this mean in regard to “building rapport”?

As much as I can understand and acknowledge esoteric statements and experiences of those I relate to, I realized that barriers can still exist: I am still a researcher and I am still the one asking the questions.

Welcome to the Neighborhood!

Welcome to the Neighborhood!

“I think moving to the Bay Area, moving to Berkeley and Oakland and being in the East Bay where there is more exposure to just more self-love culture and what that looks like, and then also just witnessing my queer friends and kind of being an observer of the queer community and really admiring and wondering where all of these people got their strength from to be themselves in the world. I remember asking myself who told them that they were – I don’t remember what I thought. I think I thought, who told them that they were so fabulous?”                                                                                            –Kimmy, 30

 

As an interviewer for our LGBTQ Adults and Tobacco Stigma study, I heard countless stories like the one above. Stories of heartbreak and struggle and triumph and solidarity and love.  While each story was different, a distinct pattern emerged.  I was reminded over and over again just how important a sense of community is.  When I asked our participants what was most needed in the Bay Area LGBTQ+ communities, so very many of them expressed a desire for a central place to access medical, housing, job, and mental health resources.  A central place to meet people and socialize.  A central place to simply “be themselves in the world.”  On September 7, the Oakland LGBTQ Community Center opened its doors.  From all of us at the Center for Critical Public Health: Welcome to the neighborhood!!!

Smoking in the wrong bathroom

Smoking in the wrong bathroom

Restroom gender and no-smoking signs

How wrong is the wrong bathroom?
(Image CC BY-SA Critical Public Health Research Center)

Max told me a lot about smoking. And gender. And freedom.

I wanted to talk with this participant all day, but Max is in a band and had to leave to get ready for a gig.

I felt connected to Max in a way I can’t make sense of with words, plus the politics of trying to name that connection are complicated, and even more so by the professional/official context of our conversation. Max expressed experiences that are intimate to my heart and have become foundational to my identity and sense of the world – yet we use different names to describe them. I wanted to share my own experiences and ask what Max thought the difference was, but those are my personal interests and biases that I’m supposed to keep out of the interview: it’s about the participant, not about me. We both got emotional during the interview – sometimes for different reasons, sometimes the same.

At one point though, Max seamlessly boiled down so many of the things we’d been talking about into a rhetorical question that made me laugh louder than I normally would in an interview. The phrase was so relevant I didn’t even realize how truly apt it was to our study on stigma and tobacco control in LGBTQ+ communities until afterwards.

Max said, “Are you smoking in the right bathroom?”

To me, as a trans man and as a smoker, this question consolidates a constellation of others, many of which are accusatory rather than inquisitive.

“Are you in the right bathroom?”
You’re in the wrong bathroom.

“Are you supposed to be in here?”
You don’t belong here. You don’t look right.

“Are you a boy or a girl?”
You aren’t good enough at either; you have failed to give me necessary information about your humanity.
Also, what’s in your pants?
What kind of genitals do you have?
Do you have a penis? Do you have a vagina?
You don’t have a penis.
You don’t have a vagina.
You’re not a real woman/you’re not really a woman.
You’re not a real man/you’re not really a man

“Are you smoking?”
You shouldn’t be smoking. Are you stupid? Do you want to die?
Do you want to kill me?
Are you just rude and careless?

“Are you smoking inside?”
Are you insane? Reckless?
That’s illegal, you’re a criminal, and a menace.
And an idiot jerk.

Are you smoking in the bathroom?
You’d better not be.

Are you in the wrong bathroom?
You’d better not be.

Some of this constellation of questions and accusations is also internal. Am I in the right bathroom? Which is the right bathroom? How wrong is the wrong bathroom? Am I allowed to be here? What’s wrong with me? I don’t feel like I belong here. Am I safe here? What should I do? I don’t know what to do. I should probably just hold it. Should I just go have a cigarette? I could use a cigarette.

When is it okay to police other people? Their bodies? When does your health come before theirs? How do I explain the similarities of this kind of policing – of genders, of bodies, of behavior, of smoking, of the morality of health – without equating them?

These aren’t all the questions. Not all of these questions are always asked, or even relevant. Most of them never get answered. Sometimes when they are I wish they hadn’t been.

I am very grateful for the honesty, earnestness, depth and complexity that Max brought to our interview. I won’t soon forget it.

We’re all freaks here: Queer community, punk identity & cigarettes

We’re all freaks here: Queer community, punk identity & cigarettes

We're all freaks here. ('Identity', X-Ray Spex)

Today I’m interviewing Tabatha, a young woman in her 20s with a cloud of curly red-tinted hair, who wears a jacket and skirt with combat boots and a septum ring. Her nails are painted in elaborate two-tone patterns, and her voice is low and husky. Tabatha identifies strongly with the Bay Area punk community, describing the punk ethos as come-as-you-are, a place for “freaks.” “We’re all freaks here,” she says.

Tabatha also identifies as: queer, sexually compatible with all genders but homoromantic, femme, cis, and a woman of color. She describes herself as “white passing” and says that she is privy to racist conversations among white people who assume that she is white. Similarly, she says that she is not perceived as queer as often as women who look more butch; she “passes” as straight, and finds herself reminding straight people that they’re talking to someone queer.

In the queer community, though, she says being femme can be hard to navigate. She’s in a double bind where she’s seen as not-really-femme if she makes the first move to initiate a relationship — yet since she is also seen as not-really-queer, other women don’t make the first move either. In that context, passing as an insider can leave her caught between worlds.

Tabatha started smoking when she was 12. She likes the aesthetics of cigarettes, and says that the smokers of her 12-year-old imagination were artists, writers, musicians and thinkers. Romantic outsiders, people who did not expect to live long. She says she did not expect to live long either. Continue reading

Stories have weight

Stories have weight

The past two years have been exciting for our team at the Center. Our first project interviewing Black youth about stigma and tobacco use has been eye opening, and we’re spending most of our time now coding interview transcripts and conducting analyses. We’ll be posting more on that in the future. We’ve also started a new project on Intoxication and Gender (Geoffrey Hunt is the Principal Investigator on that one) which will be included on the website soon. And, we are cautiously optimistic about the potential funding for two additional projects coming on board in the next few months. It’s been busy but so rewarding.

Because of all of these new projects, we’ve spent a lot of time thinking about ways to disseminate our research—that is after all an important part of our projects. But, questions have come up over the course of the past two years that we take with us as we start up new projects and develop new approaches to dissemination.

One issue in particular, that we’ve been thinking a lot about recently, is how to be both transparent in our research process (e.g., by sharing anonymized fieldnotes from our researchers, audio segments from interviews) while also not misleading the public about the results of our research. How do you showcase an interviewee’s perspectives in a way that both validates her lived experience but doesn’t lend more weight to her experience compared to others who participate in the project? We’ve rightly received criticism about this exact question in reviews of our grant applications and responded by talking about disclaimers and such that we can put up on the website.

But I’m not sure that’s sufficient. It’s funny because over the course of my career I have heard qualitative researchers talk about how we have to struggle to highlight the results of our work within a society that values numbers. But in our experience so far with dissemination, people’s stories have weight. I have never liked to talk about qualitative data as “stories”—it feels like it invalidates qualitative data as scientific knowledge. But interestingly in this context of online dissemination, when we have shared segments of our participants’ “stories”, they have reach and, perhaps one day as our social media network expands, they will have power.

Our goal is explicitly to highlight participants’ voices so that their perspectives about issues relevant to public health are highlighted. But what if one participant’s voice is heard above all others, and yet doesn’t represent the experiences of the group? As a qualitative researcher, I believe that a single experience is important. But what if a single person is an extreme outlier—the perspective may be interesting, but what if that extreme outlier is interpreted in such a way that it is presumed by the public to be representative? What do we do with that? Continue reading

Getting to a place of stability

Getting to a place of stability

Tower of Jenga blocks

CC BY-SA Guma89

This respondent was a foster youth who recently transitioned to independent status in terms of the state. She had been on the streets in the past, but she currently lives with her girlfriend and attends a vocational program to be a chef.

She said she smokes to relieve stress. “The City is losing manners… value and dignity,” she feels, and she said there isn’t much respect anymore. She smokes when feeling disrespected, and got a cannabis card to keep from “spazzing out” from work stressors.

She gave up drinking recently, but is surrounded by people who still imbibe and says she experiences pressure to go out socially where she may be tempted to drink. When she drinks, she smokes more. She said she’s not ready to quit smoking yet, but she is monitoring her smoking. She also enjoys vaping, but says vaping is, “kinda like halfways…not as fulfilling as a whole cigarette.” She noted trends that at first vaping was supposed to be better for you, but that now it seems e-cigarettes are not as good for you.

For single Black mothers and young Black men, she believes, it can take a long time to get to a place of stability (financially, emotionally and with family) to feel able to quit. By the time one gets to that place, generally one has children already, and they’ll have seen what you’re doing and be emulating it.  Of kids, she noted: “You see it, you do it.”

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