Is it safe to vape? Analyzing online forums discussing e-cigarette use during pregnancy

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

Mealtime duration in problem and non-problem eaters

Young children commonly encounter difficulties at mealtimes, which are important to address early to avoid the maintenance of problematic eating behaviour. Among these are drawn-out meals, which some research has associated with more mealtime problems. However, research on meal duration, and therefore guidelines for appropriate meal length, is lacking. This research aimed to compare the meal duration of problem-eaters and controls, and to examine changes to meal length among problem-eaters following a parenting intervention. The mealtimes of 96 problem-eaters and 105 controls were examined via parent-report and in-home observations; meal length was also compared amongst problem-eaters who had received intervention and a waitlist control. Meal duration was similar across groups, though problem-eaters engaged in more aversive behaviour and less eating than controls. Observed eating and mealtime behaviour altered following intervention but not duration. Parents who reported meal length as a specific concern had longer meals and reported less successful feeding than those that did not. These results suggest that what is happening during the meal may better distinguish problem-eaters than duration alone

Is it the nicotine? Australian smokers’ accounts of nicotine addiction and the implications for smoking cessation

Since the 1980s, it has been widely accepted that nicotine is an addictive drug. While discussions of smoking inevitably lead smokers to reflect on their addiction, smokers’ perceptions of nicotine addiction specifically are rarely studied. Smokers’ understandings of nicotine addiction are increasingly relevant in light of the emergence of electronic cigarettes and other cessation aids containing nicotine, and their potential use as long-term replacements for cigarettes. This article is based on a thematic discourse analysis of interviews with 29 smokers from a large metropolitan city in Australia. We explore how smokers negotiate the concept of nicotine addiction in relation to themselves and other smokers, and how this influences their views of smoking cessation methods. Starting with the image of a nicotine addict, we show how participants accept or distance themselves from this image by re-framing the source of their addiction as habit-addicted, rather than nicotine-addicted. We also discuss the function of ‘habit talk’ as a way of contextualising their addiction, and report on how notions of addiction shape participants' views of cessation methods. Finally, we discuss the implications of these findings for future research and for health professionals working with smokers

Differential access to health care and support? A qualitative analysis of how Australian smokers conceptualise and respond to stigma

Scholarship on stigma, originally theorised as a ‘mark’ of social disgrace or difference, has since moved away from individual-level analyses to consider the socio-cultural context in the ‘marking’ of groups of people. In response to this theoretical shift, scholars have demonstrated how extensive tobacco denormalisation policies have contributed to the stigmatisation of smokers, documenting smokers’ experiences of stigma across a number of developed countries. We extend this analysis to the Australian context, examining smokers’ constructions of stigma and their reactions to policies that would give smokers differential access to healthcare. Based on 29 interviews with Australian smokers, we focus on what constitutes evidence of stigma and how participants use social comparisons to respond to stigma. We then explore an assumption underpinning participants’ accounts of stigma: that only smokers committed to cessation are ‘deserving’ of treatment. We close by discussing theoretical perspectives and opportunities in stigma research and the need to extend a stigma lens to study emerging public health issues, such as electronic cigarettes

Investigating guidelines for children's mealtime duration

It is highly common for young children to exhibit some form of problematic behaviour during mealtimes. Furthermore, it is imperative to combat mealtime difficulties early on via interventions to avoid the maintenance of problematic eating behaviour, and to reduce the potential for such problems to generalise outside of the mealtime context. The central aim of this research was to determine variations of meal duration in two groups, problem-eaters and controls. Furthermore, we aimed to establish guidelines surrounding an appropriate meal length for young children. In-home mealtime observations were conducted for 42 problem-eaters and 28 controls, in order to examine meal length. A bimodal distribution was anticipated to reflect the meal duration of children with mealtime difficulties. Consequently it would be possible to differentiate between problem-eaters and controls based on meal duration. Additionally, it was hypothesised that problem-eaters would engage in a higher proportion of aversive behaviours as the meal goes on. Results revealed that duration alone could not accurately differentiate between problem-eaters and controls, however the rate of aversive behaviour over time was more informative in differentiating between the groups. Post hoc analyses showed that meal duration and reported aversive behaviour differed between the children whose parents reported meal length as a specific problem and those that did not. This finding indicated that parents who reported meal length concerns also reported a higher frequency of aversive behaviour overall compared to those that did not report meal length concerns. These latter results point to the complexity of conceptualising mealtime difficulties by parents and health professionals. Suggestions for future research as well as the implications of this research for guidelines and clinicians are discussed

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

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

A story of stigma: Australian women's accounts of smoking in pregnancy

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

"But I Am Not One to Judge Her Actions": Thematic and Discursive Approaches to University Students' Responses to Women Who Smoke While Pregnant

Qualitative methodologies offer various approaches to interpreting qualitative data. Here we consider how different approaches to interpreting the same data can be useful in learning about the scope and utility of qualitative methods and in exploring the role of reflexivity in analytic decision making and interpretation. We apply both thematic and discourse analyses to university students' responses to an open-ended question about women who smoke while pregnant. We show how our interpretations differ when analytic attention is paid to the content (thematic analysis) versus the rhetorical function (discourse analysis) of participants' responses. We also show how reflexivity, compatible with our discursive analysis, allowed us to identify the local discursive context in which the data were produced and therefore how participants oriented to this context. We use our learning experience as a way of showcasing the value of dynamic and reflexive approaches to qualitative data

Researching stigma as an outsider: considerations for qualitative outsider research

In this article, we discuss a number of important considerations that we have encountered in the process of researching health stigma topics as “outsiders”: researchers (personally) unfamiliar with the experience or topic under study. In particular, we discuss the importance of the following: a reflective stance, challenging negative representations, flexible and sensitive recruitment strategies, validating experiences of stigma, and participant control and power. We see these points as particularly important in the context of researching stigma as outsiders, where our privilege may contribute to unhelpful, narrow, de-politicized or overly simplistic representations of particular “groups” or experiences. We share these considerations in hope of assisting other researchers to reflect on, and articulate, how they negotiate their positionings within their research and the ways in which they shape and construct the research agenda and, by implication, the people or topics under examination