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
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.
“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!!!
I am so grateful for this chance to confess to you active social scientists about my applied anthropology career crisis, and explore with you potential ways to weather and even prevent such a crisis for me, perhaps for you someday, and maybe even for the discipline.
Many people study anthropology and we embrace it as part of our identity. In fact, per the National Science Foundation and the National Center for Educational Sciences, an estimated 400,000 people in the United States have anthropology degrees, including about 20,000 PhDs and 50,000 masters, presumably many in applied anthropology. Further, the American Anthropological Association (AAA) boasts over 10,000 members and the Society for Applied Anthropology (SfAA) about 2,500.
Of AAA members, 75% are employed in higher education or students of anthropology, and it’s safe to assume that these folks practice anthropology daily. What about those who aren’t in academia? What do they do? Just about anything and nearly everything, with more or less success at incorporating our anthropology learnings in a sustained way. Those of us not in academia work for governments, development agencies, NGOs, tribal and ethnic associations, advocacy groups, social-service, health, and educational agencies, and businesses. These organizations often have a different set of values, methods, and priorities that compete with our applied anthropology tenets. And this culture clash sets us dyed-in-the-wool anthropologists up for conflict.
Take, for example… me! I was an applied medical anthropologist before I even heard of the term. I came of age on the Navajo Reservation, hearing stories from my step-mom, an Indian Health Service doctor. As a high school student, I pondered ways to prevent kids from being bounced out of pick-up truck beds. I envisioned policy to enable my friends preparing for military deployment to both take peyote in their protection ceremony and pass their pre-deployment drug test. I devised a group prescription system that would allow my high school girlfriends to obtain and take birth control pills together as a community, a way that would prevent more pregnancy than each of us playing roulette by taking turns popping out pills from a single, shared pill pack. Continue reading
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.
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
I was just finishing up an in-depth individual interview for our LGBTQ Adults and Tobacco Stigma study. I announced that I had one last question. “Do you have any feedback for me about the interview or the study?” We sometimes get responses like, “The survey was too long,” or “You didn’t ask me enough about [a specific topic]. This participant, a woman about my age, a lesbian of color, responded differently. “No. It was really good,” she said. “I didn’t feel uncomfortable at all.” She said this with an inflection of surprise. I paused for a moment. This was the first time during the interview that I really didn’t know what to say. I wanted to say something like, “That makes me really happy to hear, because it’s profoundly important for me as a researcher and as a person to affirm the dignity of others as they share their stories.” Instead, I responded with a weak, “Thank you for sharing that.”
But I knew in that moment that there was so much more to her statement. I wanted to begin the interview all over again. I wanted to know why she was so surprised that she had not been made to feel uncomfortable. I wanted to know when, where, how often she finds herself in situations where she is being paid to share her stories and experiences and thoughts, but feels uncomfortable doing so. I wanted to know why she chose to share that observation with me. As a researcher, I could have responded with, “Tell me more about that” or even “Have there been times when you did feel uncomfortable?” Instead, I responded with a weak, “Thank you for sharing that.”
Our study investigates not just tobacco-related stigma, but also various ways in which people who have been marginalized experience stigma in other aspects of their lives. In this moment, I was reminded, as a researcher and as a person, how important it is to affirm each person’s story. But I was also reminded how easy it is to silence a person simply because you are not quite sure how to ask them to say more.
Beginning in October 2014, our team at the Center for Critical Public Health set out to investigate how gender overlaps with ideas around alcohol use. Using an interview-based approach, we’ve now interviewed roughly one hundred and sixty 18-25 year-olds living in the Bay Area. As part of our interview schedule, we created a photo elicitation activity, where participants are asked questions based on photographs presented by the interviewer. For the next few months we piloted different types of images, ranging from advertisements to candid images found on open source image sites. We’ve used multiple photos since the start of the project; some were dropped along the way, and a few have been altered to examine specific ideas of interest. The photo elicitation activity has proven to be a helpful strategy for discussing gendered issues with participants who are reluctant to talk about gender differences during the normal question-answer sections of our schedule.
Two items of particular interest were pivotal in designing our photo elicitation activity:
1) Participants gave particularly interesting responses to a Facebook-embedded photo we were using, and
2) Participants were generating a significant amount of discussion around their own social media use.
Since social media seemed both interesting and relevant to so many of our participants, we decided to embed some of our photographs into different social media platforms, creating both an Instagram and Snapchat photos. As the project continued, our discussions regarding participants’ social media use were unique enough that we expanded the interview schedule to include specific social media questions in the open-ended portion as well. The following is a summary of findings that have emerged thus far, keeping in mind that interviews are ongoing and that deep analysis of the data has yet to commence.
Overwhelmingly, the most popular way in which alcohol experiences are shared online is through visual media. Still-capture photos were identified as the primary means of posting, sharing, and otherwise exposing people in one’s social network to alcohol-based activities. While it was acknowledged that this happens across a variety of different platforms, Snapchat and Instagram were highlighted as the two most frequently used social media platforms for sharing alcohol-related experiences online. These standards relate to discourses connected to social risk, social acceptability, and internet culture. Notably, people’s comfort in sharing alcohol-based information varies based on their perceptions of risk, which seem to fall on a spectrum of Facebook (most risky) > Instagram > Snapchat (least risky).
This risk management seems to revolve around the user’s own self-monitoring, as they seek benefits from sharing ‘fun’ information with their social network, while keeping in mind the potential consequences that could emerge if that same network disapproves of that shared information. By posting acceptable information, participants have described these positives results in terms of social capital. Direct positives on many of these platforms include receiving friend requests and gaining followers, and real-life positives discussed were linked to a person’s increased popularity online. On the other hand, by posting material that is seen as taboo by the online community, users expect to receive negative feedback and possible scrutiny by friends and acquaintances alike. These standards seem to be determined by the online cultures that exist for each platform, and each of these were described as unique social environments. How each person describes their standards and protocol is unique, but below is a rundown of each photo we use and some of the themes that have emerged so far. Continue reading
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