Britta Wigginton

Recruiting Online: Lessons From a Longitudinal Survey of Contraception and Pregnancy Intentions of Young Australian Women

Recruitment of young people for epidemiologic research remains challenging, with marked decreases in the effectiveness of face-to-face, mail, and telephone recruitment methods. We report on the implementation and feasibility of an innovative and flexible approach used to recruit participants for a longitudinal cohort study about contraceptive use and pregnancy (the Contraceptive Use, Pregnancy Intention, and Decisions (CUPID) Study). Australian women aged 18-23 years were recruited using a range of online, networking, and offline methods, including social media (primarily Facebook (Facebook Inc., Menlo Park, California; http://www.facebook.com)), face-to-face events, distribution of promotional material, and media releases. Over the course of the 1-year recruitment period (beginning in September 2012), a total of 3,795 eligible women were recruited to complete the online survey, at a cost of approximately A

A story of stigma: Australian women’s accounts of smoking during pregnancy

11 per participant. This sample was found to be broadly representative of the Australian population of women aged 18-23 years in terms of demographic characteristics, with the exception of an overrepresentation of tertiary-educated women (88.7% compared with 72.6%). This study demonstrated that although current recruitment strategies are required to be innovative and flexible in order to engage young people in epidemiologic research, representative samples can be achieved online at reasonable cost.

Stigma and hostility towards pregnant smokers: does individuating information reduce the effect?

A substantial minority of Western women smoke during pregnancy. Understanding smoking from these women’s point of view may provide a richer understanding of experiences that are very often silenced, and provide some explanation for why pregnant women smoke despite widely disseminated public health campaigns urging them to stop. Strong social pressures directed at women to stop, justified mainly by arguments of protecting the foetus, are reinforced through the policing of women’s bodies, which is particularly powerful during pregnancy. This emerges in the form of criticism, confrontation and judgement, irrespective of individual women’s contexts and social backgrounds. Interviews with 11 Australian women who had smoked during recent pregnancies were conducted to explore their smoking-related experience of stigma. Thematic analysis examined their perceptions of stigma and surveillance, in the strong anti-smoking climate of Australia. Women’s talk constructed medical and social pressures as two separate dimensions of stigma, which they accepted or resisted, or – at times – did both. They also used discursive strategies to negotiate their position as ‘good mothers’ despite stigma, and spoke about the need to manage the contexts in which they smoked. The women’s talk suggests that directive, critical public health campaigns, and the associated social stigma, may actually make it harder for some to stop smoking. More supportive approaches that move away from a focus on individual responsibility, and from the assumption that pregnant women need to be coerced into healthy decision-making, might better assist some pregnant smokers to seek cessation support.

‘I think he is immune to all the smoke I gave him’: how women account for the harm of smoking during pregnancy

Australia is at the forefront of tobacco control, yet 17% of Australian women smoke during pregnancy. Negative attitudes to smoking are intensified when the smoker is pregnant, consistent with a discourse that encourages surveillance of pregnant women. Such overt anti-smoking attitudes create a context which may make it difficult for pregnant smokers to seek assistance to stop. However, there is little evidence on the extent to which pregnant smokers are stigmatised by community members. We used vignettes to examine the degree of smoking-related stigma expressed by 595 Australian university students who rated a woman, described as a mother who was smoking or not, and pregnant or not. Further, we examined whether provision of individuating information reduced the degree of stigma. Mothers described as smokers were rated more negatively than those not, particularly if they were pregnant: smokers were perceived as unhealthy, and also as bad mothers. Provision of individuating information slightly reduced these effects. These findings support the view that smokers – particularly if pregnant – are subject to negative moral judgement. Our findings contribute to the ethical debate about stigma-inducing tobacco control efforts, and suggest that anti-smoking campaigns that contextualise smoking in pregnancy might reduce stigma and assist cessation.

Online Research Methods in Psychology: Methodological Opportunities for Critical Qualitative Research

Despite women’s awareness of the risks of smoking in pregnancy to the developing foetus, a significant minority continue to smoke during pregnancy. In this article, we use a discourse analytic approach to analyse interviews with 12 Australian women who smoked during a recent pregnancy. We used these data to examine how women accounted for their smoking and identities in the light of the implicit but ever-present discourse that smoking in pregnancy harms babies. We found that the women in our study deployed two rhetorical devices in their talk, ‘stacking the facts’ and ‘smoking for health’, allowing them to situate their smoking within a discourse of risk or as a potential benefit to their health. Women ‘stacked the facts’ by citing personal observable evidence (such as birthweight) to draw conclusions about the risks of smoking in pregnancy to the baby. ‘Stacking the facts’ allowed women to show how they had evaded the risks and their babies were healthy. This device also allowed women to deny or cast doubt over the risks of smoking in pregnancy. Women’s accounts of ‘smoking for health’ involved positioning quitting as stressful and, as a result, more harmful than continuing to smoke a reduced amount. We found complex and counter-intuitive ways in which women dealt with the discourse that smoking in pregnancy harms babies and how these ways of accounting served to protect their identities. We argue that health promotion messages conveying the risks of smoking in pregnancy would benefit from contextualising these messages within women’s personal accounts (e.g. by ‘stacking the facts’ or ‘smoking for health’) and hence providing more ‘realistic’ health risk messages.

Recruiting young women for health surveys: traditional random sampling methods are not cost-effective.

This special issue showcases the contributions of mostly early career researchers to illustrate the methodological opportunities and challenges that arise in doing critical qualitative research on the Internet. As we discuss, the articles included in this special issue demonstrate innovative qualitative methods that can be applied to Internet research and the steps that need to be taken to conduct rigorous and ethical qualitative research, from a critical psychological perspective. This special issue focuses on a range of methodological issues that can arise while conducting qualitative research online. The authors are seen to acknowledge the power relations that shape online spaces and relationships, and to reflexively and continually consider their roles in data collection or generation. The articles presented in this special issue also highlight ways in which critical qualitative researchers can innovatively negotiate the ethical issues that can occur within a dynamic context, and challenge the status quo through conducting this type of research. Online spaces continually change and present ongoing opportunities and challenges for researchers, yet, this special issue illustrates how critical qualitative researchers are well equipped to continue developing this line of research.

How do women manage the spoiled identity of a ‘pregnant smoker’? An analysis of discursive silencing in women's accounts

Melissa L. Harris,1 Danielle Herbert,2 Deborah Loxton,1 Annette Dobson,3 Britta Wigginton,4 Jayne C. Lucke4,5 1. Research Centre for Gender, Health and Ageing, Faculty of Health and Medicine, University of Newcastle, New South Wales 2. School of Public Health & Institute of Health and Biomedical Innovation, Queensland University of Technology 3. School of Population Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland 4. UQ Centre for Clinical Research, The University of Queensland 5. Australian Research Centre in Sex, Health and Society, Faculty of Health Sciences, La Trobe University, Victoria

Is It Safe to Vape? Analyzing Online Forums Discussing E-Cigarette Use during Pregnancy

Drawing on public and private accounts of smoking during pregnancy (interviews, survey responses, and a public media article), we examine how women discursively manage the ‘spoiled’ identity associated with inhabiting the body of a ‘pregnant smoker’. We focus on two salient identities ‘the silenced smoker’ and ‘the bad mother’ and explore the discursive and material consequences of these identities. We found that references to smoker and maternal identities were largely absent in womens accounts, and discuss how these absences enabled women to evade stigma and the rhetorical harm of these identities. Further, we discuss the material consequences of stigma including womens need to conceal their ‘pregnant smoker’ body in the face of heightened surveillance. We propose ‘discursive silencing’ to explain how dominant motherhood and anti-smoking discourses serve to render womens experiences as ‘untellable’ and therefore reduce womens capacity to seek help or support to quit smoking.

The feminisation of contraceptive use: Australian women’s accounts of accessing contraception

INTRODUCTION Electronic cigarette (e-cigarette) use, or vaping, is increasing against a backdrop of declining smoking rates. E-cigarettes contain fewer toxicants than cigarettes, but their appearance and mode of use has the potential to satisfy the habitual aspects of smoking. To date, we know little about lay perceptions of the safety of using e-cigarettes in pregnancy. METHODS We conducted a thematic discourse analysis of 13 online discussion forum threads that discussed e-cigarette use during pregnancy. We focused on the major discursive strategies that forum posters used to debate the safety of e-cigarette use during pregnancy. RESULTS We identified three distinct ways in which forum posters debated the safety of using e-cigarettes during pregnancy: 1) quitting (nicotine) cold turkey is unsafe, 2) vaping is the lesser of two evils, and 3) vaping is not worth the risk. CONCLUSIONS Discussions about the safety of e-cigarettes drew on the premise that 1) immediate cessation of nicotine was potentially harmful and unsafe, 2) e-cigarettes were a harm reduction tool, or 3) vaping could be dangerous and should be avoided. Although these arguments are not necessarily specific to pregnancy (beside mentions of fetal-specific risks), this analysis points to the need to educate and support women about harm reduction options. IMPLICATIONS Health professionals should be aware that some women may be currently using or considering using e-cigarettes in an effort to quit or reduce smoking. It is important that health professionals are equipped to educate women with accurate, up-to-date, and balanced information about the risks and benefits of e-cigarette use during pregnancy.

A qualitative analysis of women's explanations for changing contraception: the importance of non-contraceptive effects

The oral contraceptive pill remains the most widely used contraceptive method. We consider The Pill’s depiction as variously revolutionary and liberating, oppressive for women, and more recently, a ‘lifestyle drug’. Drawing on discourses of (hetero)sex, heterosexuality and gender performance, we discuss how contraceptive use has been feminised and consider the current gap in understanding how women negotiate their positioning as responsible for contraception. To begin to fill this gap, we conducted a thematic discourse analysis using 75 free-text responses (to a general question in a wider contraceptive survey) to explore how women account for their agency and responsibility in discussions of accessing contraception. We identified two themes: responsibility for education and information and ‘finding contraceptive fit’. Women’s discussions of responsibility for education and information highlight the need for transparency from educational bodies, which are positioned as lacking in their delivery of contraceptive information. Women describe “finding contraceptive fit” as an embodied process of experimentation with contraception to ultimately find one with minimal negative side effects. We situate our findings within critiques of the gendered nature and production of health, conceptualising contraceptive use as a distinctly feminine practice, which promotes self-surveillance and embodied awareness.