Kirsten Bell
University of British Columbia, Anthropology, Department Memberedit
- editdeleteTaylor & Francis/Routledge, Critical Public Health, Associate Editoradd
- Critical Public Health, Medical Anthropology, Sociology of Smoking, Medical Sociology / Anthropology, Critical Medical Anthropology, Anthropology of smoking, and 18 moreSociology of Health, Social Studies Of Science, Anthropology of Science, Sociology of the Body, Medical Sociology, Anthropology of ethics and morality, Anthropology of Ethics, IRB Regulations, Comparative Disciplinary Methods and Ethics; Institutional Review Boards (IRBs), The anthropology of the awkward, Female genital cutting, Genital Cutting, Cancer culture, Sociology of Drugs and Alcohol, Drug Policy, Anthropology of Biomedicine, Anthropology of Addiction, and Sociology of Addictionedit
- Kirsten Bell is a Research Associate in the Department of Anthropology at the University of British Columbia. Prior ... moreKirsten Bell is a Research Associate in the Department of Anthropology at the University of British Columbia. Prior to arriving in Canada in 2006 she held lectureships in anthropology departments at Macquarie University in Australia (2003-2005) and the University of Northern Colorado (2000-2002). A social/cultural anthropologist by training (PhD: James Cook University, 2000), Kirsty originally conducted fieldwork on new religious movements in South Korea. She continued to conduct fieldwork in South Korea until 2005, but over the past nine years has moved exclusively into the anthropology and sociology of biomedicine and public health. Her current research interests could be politely described as eclectic, and range from work on cancer and tobacco (these sound more related than they are in the ways she writes about them) to addiction, genital cutting, obesity and research ethics. If you ask Kirsty, she will tell you that the common underlying thread is an interest in the political uses of the concepts of health and lifestyle, but such proclamations have an air of desperation and she doesn't fully believe them herself (nor does she understand why she is attempting to write this bio in the third person). She has recently realized that she is quite interested in the production of scientific knowledge and optimistically hopes this may serve as some sort of unifying theme in her work.edit
Although drinking, smoking and obesity have attracted social and moral condemnation to varying degrees for more than two hundred years, over the past few decades they have come under intense attack from the field of public health as an... more
Although drinking, smoking and obesity have attracted social and moral condemnation to varying degrees for more than two hundred years, over the past few decades they have come under intense attack from the field of public health as an ‘unholy trinity’ of lifestyle behaviours with apparently devastating medical, social and economic consequences. Indeed, we appear to be in the midst of an important historical moment in which policies and practices that would have been unthinkable a decade ago (e.g., outdoor smoking bans, incarcerating pregnant women for drinking alcohol, and prohibiting restaurants from serving food to fat people), have become acceptable responses to the ‘risks’ that alcohol, tobacco and obesity are perceived to pose.
Hailing from Canada, Australia, the United Kingdom and the USA, and drawing on examples from all four countries, contributors interrogate the ways in which alcohol, tobacco and fat have come to be constructed as ‘problems’ requiring intervention and expose the social, cultural and political roots of the current public health obsession with lifestyle.
No prior collection has set out to provide an in-depth examination of alcohol, tobacco and obesity through the comparative approach taken in this volume. This book therefore represents an invaluable and timely contribution to critical studies of public health, health inequities, health policy, and the sociology of risk more broadly.
Hailing from Canada, Australia, the United Kingdom and the USA, and drawing on examples from all four countries, contributors interrogate the ways in which alcohol, tobacco and fat have come to be constructed as ‘problems’ requiring intervention and expose the social, cultural and political roots of the current public health obsession with lifestyle.
No prior collection has set out to provide an in-depth examination of alcohol, tobacco and obesity through the comparative approach taken in this volume. This book therefore represents an invaluable and timely contribution to critical studies of public health, health inequities, health policy, and the sociology of risk more broadly.
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Editorial
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Ulysses contracts are a particular type of advance directive that has been advocated for use in mental health settings and addictions treatment. Taking their name from the legend of Ulysses, such contracts are distinctive insofar as they... more
Ulysses contracts are a particular type of advance directive that has been advocated for use in mental health settings and addictions treatment. Taking their name from the legend of Ulysses, such contracts are distinctive insofar as they are designed to thwart certain anticipated future wishes rather than realize them. In this paper, I consider what Ulysses contracts reveal about contemporary conceptions of addiction and the self. Drawing on discussions of Ulysses contracts in the psychiatric and addictions literature, as well as historical and contemporary examples of such, I show that Ulysses contracts are premised on a split between the present ‘rational’ self and the future ‘irrational’ self, thereby reproducing a very particular notion of addiction—one that serves to naturalize certain ways of thinking about freedom, choice, coercion, and the self.
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In the era of evidence-based health care, conferences aimed at disseminating scientific knowledge perform an essential role in shaping policy and research agendas and transforming physician practice. Drawing on observations at two U.S.... more
In the era of evidence-based health care, conferences aimed at disseminating scientific knowledge perform an essential role in shaping policy and research agendas and transforming physician practice. Drawing on observations at two U.S. cancer prevention conferences aimed at knowledge translation, we examine the ways that evidence regarding the relationship between cancer and lifestyle is articulated and enacted. We show that characterizations of the evidence base at the conferences far outstripped what is presently known about the relationship between cancer and lifestyle. The messages presented to conference participants were also personalized and overtly moralistic, with attendees engaged with not merely as practitioners but as members of the public at risk for cancer. We conclude that conferences seeking to bring together knowledge “makers” and knowledge “users” play a potentially important role in the production of scientific facts and are worthy of further study as distinct sites of knowledge production.
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Editorial
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The idea that drug use in ‘softer’ forms leads to ‘harder’ drug use lies at the heart of the gateway theory, one of the most influential models of drug use of the twentieth century. Although hotly contested, the notion of the ‘gateway... more
The idea that drug use in ‘softer’ forms leads to ‘harder’ drug use lies at the heart of the gateway theory, one of the most influential models of drug use of the twentieth century. Although hotly contested, the notion of the ‘gateway drug’ continues to rear its head in discussions of drug use—most recently in the context of electronic cigarettes. Based on a critical reading of a range of texts, including scholarly literature and media reports, we explore the history and gestation of the gateway theory, highlighting the ways in which intersections between academic, media and popular accounts actively produced the concept. Arguing that the theory has been critical in maintaining the distinction between ‘soft’ and ‘hard’ drugs, we turn to its distinctive iteration in the context of debates about e-cigarettes. We show that the notion of the ‘gateway’ has been transformed from a descriptive to a predictive model, one in which nicotine is constituted as simultaneously ‘soft’ and ‘hard’—as both relatively innocuous and incontrovertibly harmful.
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In this article, I examine anthropology's embrace of the informed consent doctrine at the end of the 1990s. Although acknowledging its utility in resolving the tensions between disciplinary ideals of openness in field research and the... more
In this article, I examine anthropology's embrace of the informed consent doctrine at the end of the 1990s. Although acknowledging its utility in resolving the tensions between disciplinary ideals of openness in field research and the diverse array of contexts in which anthropologists now work, I argue that it has not been in our best interest to co-opt the concept. Bringing together the prior critiques of the informed consent doctrine's application to ethnography, I criticize the tendency of some ethnographers to characterize ethnographic practice as “insuperably flawed,” pointing instead to the problems with the doctrine itself. I tease out underlying assumptions about the nature of research (and researchers and research subjects) that it presumes, and I conclude by suggesting the need for anthropology to take a principled stance against the informed consent doctrine.
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In recent years, HIV/AIDS programming has been transformed by an ostensibly ‘new’ procedure: male circumcision. This article examines the rise of male circumcision as the ‘right’ HIV prevention tool. Treating this controversial topic as a... more
In recent years, HIV/AIDS programming has been transformed by an ostensibly ‘new’ procedure: male circumcision. This article examines the rise of male circumcision as the ‘right’ HIV prevention tool. Treating this controversial topic as a ‘matter of concern’ rather than a ‘matter of fact’, I examine the reasons why male circumcision came to be seen as a partial solution to the problem of HIV transmission in the twenty-first century and to what effect. Grounded in a close reading of the primary literature, I suggest that the embrace of male circumcision in HIV prevention must be understood in relation to three factors: (1) the rise of evidence-based medicine as the dominant paradigm for conceptualising medical knowledge, (2) the fraught politics of HIV/AIDS research and funding, which made the possibility of a biomedical intervention attractive and (3) underlying assumptions about the nature of African ‘culture’ and ‘sexuality’. I conclude by stressing the need to expand the parameters of the debate beyond the current polarised landscape, which presents us with a problematic either/or scenario regarding the efficacy of male circumcision.
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Numerous observers have commented on the cultural prominence of breast cancer in North America. However, although popular and biomedical conceptions of cancer survivorship have been influenced to an inordinate degree by breast cancer, few... more
Numerous observers have commented on the cultural prominence of breast cancer in North America. However, although popular and biomedical conceptions of cancer survivorship have been influenced to an inordinate degree by breast cancer, few researchers have examined the impact of dominant discourses on people diagnosed with other forms of cancer. Drawing on interviews with 32 Canadian men and women with a history of cancer conducted between 2010-2013, I demonstrate that breast cancer became central to their own experiences of cancer, providing an important lens through which to understand the effects of the disease. The effects of these comparisons were diverse, leading some participants to want to differentiate themselves from this implicit norm, leading others to downplay the seriousness of their own forms of suffering, and amplifying a sense of shame and stigma in yet others.
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‘Thirdhand smoke’, the designated term for the cigarette smoke toxicants that linger on room and car surfaces long after the smoke itself dissipates, is a concept that has gained increasing prominence in tobacco control policy and... more
‘Thirdhand smoke’, the designated term for the cigarette smoke toxicants that linger on room and car surfaces long after the smoke itself dissipates, is a concept that has gained increasing prominence in tobacco control policy and research over the past six years. In this paper, I track the emergence of thirdhand smoke as a social and scientific concept, conducting a critical analysis of newspaper reports and references to the term in the academic and policy literature. Demonstrating that claims about the health effects of thirdhand smoke occurred in the absence of evidence of harm, I examine the broader sociopolitical conditions that enabled the concept to become meaningful (and useful). I show that some of the concept’s legitimacy came from its presentation as a natural extension of secondhand smoke, and its framing as a particular threat to babies and children. However, I argue that the experiential, embodied dimension of thirdhand smoke itself was crucial to its success.
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Over the past two decades, molecular technologies have transformed the landscape of cancer diagnosis, treatment and disease surveillance. However, while the effects of these technologies in the areas of primary and secondary cancer... more
Over the past two decades, molecular technologies have transformed the landscape of cancer diagnosis, treatment and disease surveillance. However, while the effects of these technologies in the areas of primary and secondary cancer prevention have been the focus of growing study, their role in tertiary prevention remains largely unexamined. Treating this topic as a problematic to be conceptually explored rather than empirically demonstrated, this paper focuses on the molecularisation of tertiary prevention, especially the growing use of molecular biomarkers to monitor disease recurrence. Taking a semiotic approach, I speculate on the potential meanings of molecular biomarkers for people living with and beyond cancer and suggest the meanings of these technologies may differ in important ways for those on both sides of the risk divide: i.e., those ‘at risk’ for cancer and those living with realised risk. While they may intensify a sense of ‘measured vulnerability’, by indexing cancer’s presence they may also prove reassuring. Moreover, as an invisible but ostensibly ‘transparent’ sign, in some contexts they appear to enable cancer survivors to challenge biomedical decision-making. In the light of recent oncological debates about the value of these biomarkers in tertiary prevention, I conclude by suggesting that signs can never be reduced to their ‘objective’ biomedical denotation in spite of professional attempts to expunge meaning and value from care.
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The Canadian city of Vancouver was very early to introduce extensive smokefree legislation. Smoking has been banned in all indoor locations for well over a decade and tobacco control advocates have also recently begun to push for the... more
The Canadian city of Vancouver was very early to introduce
extensive smokefree legislation. Smoking has been banned in all
indoor locations for well over a decade and tobacco control
advocates have also recently begun to push for the expansion of
such legislation into outdoor spaces in the city. Drawing on a 6-
month period of observation of smokers and “not-smokers” on their
lunch breaks at office sites in downtown Vancouver, I examine the
ways that smokers engage with outdoor public space. I show that
while smokers continue to make material claims to such space,
these claims have become increasingly tenuous. I argue that
tobacco “denormalization” strategies provide essential context for
understanding outdoor smoking bans and raise ethical questions
about the form of de-facto prohibition they appear to encourage.
extensive smokefree legislation. Smoking has been banned in all
indoor locations for well over a decade and tobacco control
advocates have also recently begun to push for the expansion of
such legislation into outdoor spaces in the city. Drawing on a 6-
month period of observation of smokers and “not-smokers” on their
lunch breaks at office sites in downtown Vancouver, I examine the
ways that smokers engage with outdoor public space. I show that
while smokers continue to make material claims to such space,
these claims have become increasingly tenuous. I argue that
tobacco “denormalization” strategies provide essential context for
understanding outdoor smoking bans and raise ethical questions
about the form of de-facto prohibition they appear to encourage.
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Purpose: This article examines the relationship between tobacco control and tobacco harm reduction, illuminating the differences and similarities between them. Design/methodology/approach: Drawing on published sources, I conduct a... more
Purpose: This article examines the relationship between tobacco control and tobacco harm reduction, illuminating the differences and similarities between them.
Design/methodology/approach: Drawing on published sources, I conduct a critical analysis of the prevailing discourses on tobacco control and tobacco harm reduction.
Findings: Although tobacco control and tobacco harm reduction differ in their views on the resolutions to the tobacco ‘problem’, they manifest similar underlying assumptions about the nature of ‘the smoker’ and are equally silent on the topic of pleasure.
Originality/value: This article emphasises the need for tobacco harm reduction to take pleasure seriously and highlights the limitations of approaches focused exclusively on risk and harm reduction.
Design/methodology/approach: Drawing on published sources, I conduct a critical analysis of the prevailing discourses on tobacco control and tobacco harm reduction.
Findings: Although tobacco control and tobacco harm reduction differ in their views on the resolutions to the tobacco ‘problem’, they manifest similar underlying assumptions about the nature of ‘the smoker’ and are equally silent on the topic of pleasure.
Originality/value: This article emphasises the need for tobacco harm reduction to take pleasure seriously and highlights the limitations of approaches focused exclusively on risk and harm reduction.
Research Interests: Harm Reduction, Sociology of Smoking, Anthropology of smoking, Drug User Organising, Critical Theories of Drug Use, and 2 moreCritique of the Dominant Medical or Pathologising Paradigm of Drug Use and Application of Foucault's Work to the Nature and Social Status of Illicit Drug Use and Illicit Drug Users
In recent years, tobacco research has become an increasingly politicized field, with ‘legitimate’ research on this topic expected to further the goals of tobacco control. This paper presents an overview of the state of field of social... more
In recent years, tobacco research has become an increasingly politicized field, with ‘legitimate’ research on this topic expected to further the goals of tobacco control. This paper presents an overview of the state of field of social science studies on tobacco and critiques the growing polarity evident in scholarship on this topic. Moving beyond mainstream public health perspectives, I outline a body of research that challenges dominant understandings of tobacco use and tobacco control. This research can be classified into three main categories: studies that interrogate conceptions of why people smoke, those that examine the impacts of tobacco control policy on smokers, and studies embracing intellectual and philosophical perspectives (especially phenomenology and social constructionism) that place them outside of a public health frame. I end with a broader discussion of the growing instrumentalization of social science research and the need to resist prescriptions that seek to dictate the appropriate form and content of scholarly work.
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Over the past year or so, electronic cigarettes, more commonly known as 'e-cigarettes', have achieved widespread visibility and growing popularity. These products, which deliver nicotine via an inhaled mist, have caused no small amount of... more
Over the past year or so, electronic cigarettes, more commonly known as 'e-cigarettes', have achieved widespread visibility and growing popularity. These products, which deliver nicotine via an inhaled mist, have caused no small amount of controversy in public health circles, and their rise has been accompanied by energetic debate about their potential harms and benefits. Interspersed with an analysis of current media coverage on e-cigarettes and the response of mainstream tobacco control and public health to these devices, this article examines the emergence of nicotine as both as an 'addiction' and a treatment for addiction. We argue that by delivering nicotine in way that resembles the visual spectacle and bodily pleasures of smoking, but without the harms of combustible tobacco, e-cigarettes highlight the complex status of nicotine as both a poison and remedy in contemporary public health and tobacco control. In consequence, they jeopardize the carefully drawn distinctions between 'good' and bad' forms of nicotine.
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As numerous scholars have noted, cancer survivorship is often represented in popular discourse as providing an opportunity for a physical, emotional, and spiritual makeover. However, this idea that cancer enables the self to be remade on... more
As numerous scholars have noted, cancer survivorship is often represented in popular discourse as providing an opportunity for a physical, emotional, and spiritual makeover. However, this idea that cancer enables the self to be remade on all levels is also increasingly evoked in the field of psychosocial oncology. Exploring cancer survivorship as a biopolitical phenomenon, I focus on two concepts that have become central to understandings of the disease: the “teachable moment” and “post-traumatic growth.” Drawing primarily on representations of cancer survivorship in the clinical literature, I suggest that cancer is increasingly seen to present a unique opportunity to catalyze the patient’s physical and psychological development. In this framework, the patient can no longer be relied upon to transform him or herself: this change must be externally driven, with clinicians taking advantage of the trauma that cancer entails to kick-start the patient into action. Broadening my analysis to the concepts of “trauma” and “development” writ large, I go on to suggest that survivorship discourse seems to partake of a larger and relatively recent meta-narrative about development—both individual and societal—and the positive opportunity that trauma is seen to present to stimulate reconstruction on a grand scale.
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Evidence-based medicine (EBM) has been one of the most important movements in clinical medicine and public health in recent years. At the heart of the EBM movement lies the Cochrane Collaboration, an influential organisation that produces... more
Evidence-based medicine (EBM) has been one of the most important movements in clinical medicine and public health in recent years. At the heart of the EBM movement lies the Cochrane Collaboration, an influential organisation that produces systematic assessments of healthcare interventions known as Cochrane reviews. Although Cochrane methods were initially designed to test the efficacy of medical therapies, the desire for ‘evidence-based' practice has pushed the movement far beyond its initial scope into the assessment of complex social phenomena. Through an examination of one particular Cochrane review, Physician advice for smoking cessation, this paper highlights the limitations of EBM ‘creep', and some of the more problematic conceptions of human nature underwriting Cochrane principles and methodologies.
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General practitioners are often exhorted to routinely counsel patients who smoke about quitting in light of current evidence-based medicine (EBM) guidelines suggesting that such brief interventions provide an easy and effective way of... more
General practitioners are often exhorted to routinely counsel patients who smoke about quitting in light of current evidence-based medicine (EBM) guidelines suggesting that such brief interventions provide an easy and effective way of increasing quit rates. Drawing on semi-structured interviews conducted with 25 smokers and 10 general practitioners (GPs) in British Columbia, Canada, this article explores smokers’ and GPs’ perspectives on smoking cessation interventions in primary care settings. Study findings indicate that both patients and GPs believe smoking is best broached when it is patient-initiated or raised in the context of smoking-related health issues, and there was a broader consensus that the role of doctors is to provide education and information rather than coercing smokers to quit. However, smokers wanted further recognition of the difficulties of quitting smoking and many questioned the competence of GPs to deal with addiction-related issues. Similar barriers to smoking cessation were raised by smokers and GPs – primarily inadequate time and resources. Based on these findings, we argue that the assumption that primary care consultations provide an important venue for encouraging smokers to quit deserves reconsideration based on the complexity of this issue, the circumstances in which most GPs practice, and the danger of alienating smokers. Questions are raised about whether current EBM guidelines are an adequate tool for guiding individual clinical interactions between GPs and smokers.
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Illicit drug users are frequently identified as a ‘vulnerable population’ requiring ‘special protection’ and ‘additional safeguards’ in research. However, without specific guidance on how to enact these special protections and safeguards,... more
Illicit drug users are frequently identified as a ‘vulnerable population’ requiring ‘special protection’ and ‘additional safeguards’ in research. However, without specific guidance on how to enact these special protections and safeguards, research ethics committee (REC) members sometimes fall back on untested assumptions about the ethics of illicit drug use research. In light of growing calls for ‘evidence-based research ethics’, this commentary examines three common assumptions amongst REC members about what constitutes ethical research with drug users, and whether such assumptions are borne out by a growing body of empirical data. The assumptions that form the focus of this commentary are as follows: (i) drug users do not have the capacity to provide informed consent to research; (ii) it is ethically problematic to provide financial incentives to drug users to participate in research; and (iii) asking drug users about their experiences ‘re-traumatizes’ and ‘re-victimizes’ them.
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Drug users are generally seen as a vulnerable population requiring special protection in research; however, to date there has been little empirical research into the ethics of research with illicit drug users. Moreover, the available... more
Drug users are generally seen as a vulnerable population requiring special protection in research; however, to date there has been little empirical research into the ethics of research with illicit drug users. Moreover, the available research has tended to treat ‘drug users’ as a homogenous category, and fails to consider potential gender differences in users’ experiences. Drawing on focus groups with twenty-seven female drug users in Vancouver, Canada, this study examines women’s experiences of research and what they see as ethical and respectful engagement. Many study participants talked about feeling dehumanized as a result of prior research participation. Women were critical of the assumption that drug users lack the capacity to taken part in research, and affirmed the appropriateness of financial incentives. A variety of motivations for research participation were identified, including a desire for financial gain and altruistic concerns such as a desire to help others. These findings suggest that women drug users’ views on ethical research differ from prevailing assumptions amongst institutional review boards about how research with such populations should proceed
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Since the mid-1990s, the position that ‘no amount of secondhand smoke is safe’ has achieved hegemonic status in the field of public health. This has bolstered efforts in the tobacco control community to advocate for smoke-free legislation... more
Since the mid-1990s, the position that ‘no amount of secondhand smoke is safe’ has achieved hegemonic status in the field of public health. This has bolstered efforts in the tobacco control community to advocate for smoke-free legislation and a variety of countries around the world have implemented indoor smoking bans, with many others presently following suit. This article examines why secondhand smoke has been such a central focus in tobacco control and public health policy, despite the limitations of the available evidence base on its health impacts. I argue that public health responses to secondhand smoke can only be understood in relation to the liminal and transitive qualities of cigarette smoke and its capacity to dissolve the boundaries between bodies. My key goal is to illustrate the influence of cultural assessments about the nature of ‘risk’ on epidemiological standards of evidence. I contend that the subjectively experienced abjectness of cigarette smoke far more than the ‘objectively’ demonstrable harms to health it causes ultimately explains both popular and public health responses to the substance.
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Although the value of the PSA (prostate-specific antigen) test as a cancer-screening instrument remains hotly contested, over the past two decades its usage has become commonplace. While most men diagnosed with prostate cancer will die... more
Although the value of the PSA (prostate-specific antigen) test as a cancer-screening instrument remains hotly contested, over the past two decades its usage has become commonplace. While most men diagnosed with prostate cancer will die with rather than of the disease, widespread PSA screening has led to an attendant increase in cancer diagnoses and the usage of aggressive treatments to ‘combat’ it. Despite the central (if controversial) role that PSA now plays in the diagnosis of prostate cancer and monitoring for recurrence, few studies have set out to explore its role in men's experiences of the disease. Drawing on ethnographic fieldwork at a prostate cancer support group in western Canada, we seek to delineate the meanings the PSA test holds for prostate cancer survivors. For many men in the study, their PSA levels were seen to provide an objective indicator of the presence or absence of cancer, with important implications for their subjective experience of cancer diagnosis and survivorship.
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For the majority of people diagnosed with metastatic cancer, there is little hope of a disease-free future. Drawing on ethnographic fieldwork at a support group for women with metastatic cancer, we examine the relationship between... more
For the majority of people diagnosed with metastatic cancer, there is little hope of a disease-free future. Drawing on ethnographic fieldwork at a support group for women with metastatic cancer, we examine the relationship between metastases and mothering. We argue that the experience of raising children while living with a terminal illness crystallizes cultural expectations about mothering based on an essentialist model of parenthood whereby the person best suited to raise children is their biological mother. These expectations create an irresolvable gap between discourse and experience that both increases the suffering of women raising children and generates an internal hierarchy of suffering among women with cancer metastases that hinges on the distinction between those who have dependent children and those who do not.
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Over the past decade, the strategy of ‘denormalising’ tobacco use has become one of the cornerstones of the global tobacco control movement. Although tobacco denormalisation policies primarily affect people on the lowest rungs of the... more
Over the past decade, the strategy of ‘denormalising’ tobacco use has become one of the cornerstones of the global tobacco control movement. Although tobacco denormalisation policies primarily affect people on the lowest rungs of the social ladder, few qualitative studies have explicitly set out to explore how smokers have experienced and responded to these legislative and social changes in attitudes towards tobacco use. Drawing on a qualitative study of interviews with 25 current and ex-smokers living in Vancouver, Canada, this paper examines the ways they interpret and respond to the new socio-political environment in which they must manage the increasingly problematised practice of tobacco smoking. Overall, while not opposed to smoking restrictions per se, study participants felt that recent legislation, particularly efforts to prohibit smoking in a variety of outdoor settings, was overly restrictive and that all public space had increasingly been ‘claimed’ by non-smokers. Also apparent from participants’ accounts was the high degree of stigma attached to smoking. However, although the ‘denormalisation’ environment had encouraged several participants to quit smoking, the majority continued to smoke, raising ethical and practical questions about the value of denormalisation strategies as a way of reducing smoking-related mortality and morbidity.
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In recent years, addictions policy has stressed the need to counteract stigmatization in order to promote public health. However, as recent observers have noted, through the widespread implementation of tobacco ‘denormalization’... more
In recent years, addictions policy has stressed the need to counteract stigmatization in order to promote public health. However, as recent observers have noted, through the widespread implementation of tobacco ‘denormalization’ strategies, tobacco control advocates appear to have embraced the use of stigma as an explicit policy tool. In a recent article, Ronald Bayer (2008) argues that the mobilization of stigma may effectively reduce the prevalence of smoking behaviors linked to tobacco-related morbidity and mortality and is therefore not necessarily antithetical to public health goals. This commentary takes up this question of whether stigmatizing smoking may ultimately serve the interests of public health. Through an examination of the unique contours of tobacco control policy, we suggest that stigmatizing smoking will not ultimately help to reduce smoking prevalence amongst disadvantaged smokers – who now represent the majority of tobacco users. Rather, it is likely to exacerbate health-related inequalities by limiting smokers’ access to healthcare and inhibiting smoking cessation efforts in primary care settings.
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"Objectives To analyse evidence on the effectiveness of intensive NHS treatments for smoking cessation in helping smokers to quit. Methods A systematic review of studies published between 1990 and 2007. Electronic databases were... more
"Objectives To analyse evidence on the effectiveness of intensive NHS treatments for smoking cessation in helping smokers to quit.
Methods A systematic review of studies published between 1990 and 2007. Electronic databases were searched for published studies. Unpublished reports were identified from the national research register and experts.
Results Twenty studies were included. They suggest that intensive NHS treatments for smoking cessation are effective in helping smokers to quit. The national evaluation found 4-week carbon monoxide monitoring validated quit rates of 53%, falling to 15% at 1 year. There is some evidence that group treatment may be more effective than one-to-one treatment, and the impact of ‘buddy support’ varies based on treatment type. Evidence on the effectiveness of in-patient interventions is currently very limited. Younger smokers, females, pregnant smokers and more deprived smokers appear to have lower short-term quit rates than other groups.
Conclusion Further research is needed to determine the most effective models of NHS treatment for smoking cessation and the efficacy of those models with subgroups. Factors such as gender, age, socio-economic status and ethnicity appear to influence outcomes, but a current lack of diversity-specific analysis of results makes it impossible to ascertain the differential impact of intervention types on particular subpopulations. "
Methods A systematic review of studies published between 1990 and 2007. Electronic databases were searched for published studies. Unpublished reports were identified from the national research register and experts.
Results Twenty studies were included. They suggest that intensive NHS treatments for smoking cessation are effective in helping smokers to quit. The national evaluation found 4-week carbon monoxide monitoring validated quit rates of 53%, falling to 15% at 1 year. There is some evidence that group treatment may be more effective than one-to-one treatment, and the impact of ‘buddy support’ varies based on treatment type. Evidence on the effectiveness of in-patient interventions is currently very limited. Younger smokers, females, pregnant smokers and more deprived smokers appear to have lower short-term quit rates than other groups.
Conclusion Further research is needed to determine the most effective models of NHS treatment for smoking cessation and the efficacy of those models with subgroups. Factors such as gender, age, socio-economic status and ethnicity appear to influence outcomes, but a current lack of diversity-specific analysis of results makes it impossible to ascertain the differential impact of intervention types on particular subpopulations. "
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Despite ongoing controversies regarding the impact of lifestyle factors such as body weight, diet and exercise on health, this framework has become increasingly prominent in understandings of cancer aetiology. To date, little... more
Despite ongoing controversies regarding the impact of lifestyle factors such as body weight, diet and exercise on health, this framework has become increasingly prominent in understandings of cancer aetiology. To date, little consideration has been given to the impacts of such discourses on people with a history of cancer. Drawing on an ethnographic study of cancer survivors, I explore the constitutive dimensions of these discourses and the ways that they shape the subjectivities of women and men with a history of the disease. Overall, the study participants evidenced a complex and ambivalent engagement with such discourses. While they were generally unwilling to accept that their lifestyle had an impact on the development of their cancer, to varying degrees they endorsed the idea that weight, diet and exercise affected cancer progression. However, this acceptance was generally borne of an active desire to gain control over the uncertainty of living with the disease and was mediated by other aspects of the experience of surviving cancer.
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"Despite recent critiques of contemporary obesity discourses that link ‘modern Western lifestyles’ to an ‘obesity epidemic’, the population's weight remains a central concern of current dietary guidelines. Food choices that are considered... more
"Despite recent critiques of contemporary obesity discourses that link ‘modern Western lifestyles’ to an ‘obesity epidemic’, the population's weight remains a central concern of current dietary guidelines. Food choices that are considered beneficial to maintaining a certain weight are understood to play a key role in one's health. This concern reflects medico-moral assumptions about the properties of food and what people should eat.
However, the impact of obesity discourses on different individuals and social groups is rarely considered, although there is some evidence that people do generate, reflect and resist the norms and standards set for them, including those that relate to food/weight. In this paper, we will examine the perspectives on fatness and food choice amongst Black and White women and men living in Vancouver and Halifax, Canada.
With this examination, we will challenge conventional assumptions about the singular ‘modern Western lifestyle’ that leads to obesity concerns by teasing out some of the social, cultural and political contexts within which people conceptualise issues regarding weight and make their food choices. By examining the experiences of both women and men we will also provide important insights into the gendered ways in which people engage with obesity discourses and the injunction to ‘eat healthily’ as a form of weight management."
However, the impact of obesity discourses on different individuals and social groups is rarely considered, although there is some evidence that people do generate, reflect and resist the norms and standards set for them, including those that relate to food/weight. In this paper, we will examine the perspectives on fatness and food choice amongst Black and White women and men living in Vancouver and Halifax, Canada.
With this examination, we will challenge conventional assumptions about the singular ‘modern Western lifestyle’ that leads to obesity concerns by teasing out some of the social, cultural and political contexts within which people conceptualise issues regarding weight and make their food choices. By examining the experiences of both women and men we will also provide important insights into the gendered ways in which people engage with obesity discourses and the injunction to ‘eat healthily’ as a form of weight management."
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Backgound: The undertreatment of pain has increasingly been framed as both a public health problem and a human rights issue. The application of rights-based discourses to the field of pain management has provided an important means of... more
Backgound: The undertreatment of pain has increasingly been framed as both a public health problem and a human rights issue. The application of rights-based discourses to the field of pain management has provided an important means of critiquing “opiophobia” amongst healthcare professionals and challenging current criminal–legal and regulatory sanctions on the distribution of opiate medications. This movement would therefore appear to align with harm reduction advocacy and longstanding criticisms of international drug policies. However, discourses on pain management rest on moral as well as medical assumptions about who has pain and who needs drugs.
Methods: In this paper, we critically examine discourses on pain management and addiction exemplified in academic and clinical literature produced by and for physicians providing guidance on the provision of opiates for the relief of chronic pain.
Results: Our analysis reveals that discourses on pain management and the right to pain relief reify distinctions between the ‘deserving pain patient’ and the ‘undeserving addict’, serving both to further stigmatise people labelled as ‘addicts’ and delegitimise claims to pain they might voice.
Conclusion: Present efforts to secure access to pain relief as a human right are likely to undermine, rather than advance, the rights of so-called ‘drug addicts’.
Methods: In this paper, we critically examine discourses on pain management and addiction exemplified in academic and clinical literature produced by and for physicians providing guidance on the provision of opiates for the relief of chronic pain.
Results: Our analysis reveals that discourses on pain management and the right to pain relief reify distinctions between the ‘deserving pain patient’ and the ‘undeserving addict’, serving both to further stigmatise people labelled as ‘addicts’ and delegitimise claims to pain they might voice.
Conclusion: Present efforts to secure access to pain relief as a human right are likely to undermine, rather than advance, the rights of so-called ‘drug addicts’.
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Over the past few decades, three issues have emerged as threats to the health of infants and children in western, industrialised countries: the developmental impact of alcohol use in pregnancy (Foetal Alcohol Spectrum Disorder, or FASD),... more
Over the past few decades, three issues have emerged as threats to the health of infants and children in western, industrialised countries: the developmental impact of alcohol use in pregnancy (Foetal Alcohol Spectrum Disorder, or FASD), children's exposure to second-hand smoke in the home, and childhood overnutrition and obesity. The definitive role of drinking during pregnancy, exposure to second-hand smoke and overnutrition on negative health outcomes in infants and children remains the subject of considerable debate. Nevertheless, all three issues have been medicalised and criminalised: framed as looming health emergencies that require immediate intervention and, increasingly, legislation. However, it is our contention that the alarm these health ‘threats’ currently generate has many of the characteristics of a moral panic. In this paper we unpack the discourses surrounding these three issues, and explore the common focus on maternal responsibility and the ways in which these movements serve to covertly marginalise and stigmatise particular groups of women.
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It has long been recognised that cancer is an extraordinarily culturally charged disease. However, while studies have provided valuable insights into the embodied experience of cancer, far less research exists on cancer patients' and... more
It has long been recognised that cancer is an extraordinarily culturally charged disease. However, while studies have provided valuable insights into the embodied experience of cancer, far less research exists on cancer patients' and survivors' perceptions of the treatments they receive and the meanings they assign to these treatments. This paper focuses specifically on chemotherapy – a highly feared form of treatment that is often popularly depicted to be worse than the experience of cancer itself. Drawing on ethnographic fieldwork over an 8-month period at a cancer support group in western Canada, this article explores patient perceptions of adjuvant chemotherapy. I argue that a widespread cultural model of chemotherapy exists that emphasises the value of suffering as a means of tracking treatment effectiveness and the possibility of cure. However, this framework diverges from biomedical understandings of treatment in important respects, with implications for patient anxiety levels during treatment and their subjective assessments of the future risk of recurrence. Overall, research findings highlight the need to pay closer attention to the meanings patients assign to cancer treatments and call for further research in this area.
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The objective of this study was to study differently composed cancer support groups to generate insights into what groups are attractive to the widest range of participants, and how they might be best structured and composed. This study... more
The objective of this study was to study differently composed cancer support groups to generate insights into what groups are attractive to the widest range of participants, and how they might be best structured and composed. This study applied a qualitative design utilizing participant observation at three cancer support groups (a group for women with metastatic cancer, a colorectal cancer support group, and a group for Chinese cancer patients) and in-depth interviews (N = 23) with group members as the primary data collection methods. Despite the diverse composition of the groups, their perceived benefits were similar, and informants highlighted the information, acceptance, and understanding they received in the support group environment. However, gender and cultural differences were found in attendance patterns and the desired content of group meetings. Importantly, participants’ motivations for attending cancer support groups also changed as they moved through the treatment trajectory: over time the need for information was at least partially replaced by a need for support and understanding. This study supports prior research findings that there is no ideal support group, nor is there a “magical formula” for attracting and retaining a diverse audience. However, including an educational component in support groups may increase the participation of currently underrepresented populations such as men and patients from culturally diverse backgrounds.
This study examines the impact of cancer on family relationships among members of a Chinese cancer support group. A qualitative research design was used, including participant observation of 96 participants at group meetings over an... more
This study examines the impact of cancer on family relationships among members of a Chinese cancer support group. A qualitative research design was used, including participant observation of 96 participants at group meetings over an 8-month period and in-depth interviews with seven group members. Findings indicated that family members were integral to the support group, constituting almost 40% of the participants. Patients in the group expressed concerns about family, with family members identified as having “equal suffering” when caring for patients. Notably, among both patients and family members, there was a strong emphasis on the need to conceal emotion, coupled with a focus on instrumental support in caregiving. Furthermore, patients’ anxiety about “burdening” their family appeared to inflate their own experience of distress, as patients and their family carers both sought to maintain a positive front. The findings highlight the need for practitioners to focus on the entire family when designing interventions to help patients cope with cancer. More important, interventions need to be culturally sensitive that will empower patients and family members in living with the illness.
This article explores the ways that participants in a Chinese cancer support group talk about food, diet, and eating. An ethnographic research design was used, including participant observation at a Chinese cancer support group over an... more
This article explores the ways that participants in a Chinese cancer support group talk about food, diet, and eating. An ethnographic research design was used, including participant observation at a Chinese cancer support group over an 8-month period and key informant interviews with 7 members of the group. Food, eating, and diet were a recurrent focus of discussion at support group meetings throughout the fieldwork period. The ways in which support group participants talked about food centered on 3 distinct but interconnected themes: the prevalence of eating issues as an adverse effect of cancer and its treatment, the importance of eating ability, and questions and concerns connected with the differing and often contradictory cultural models of diet that they were exposed to. Culturally specific understandings of the relationship between food and health informed Chinese patients' experience of eating issues during cancer treatments and their ongoing concern with food and nutrition after the completion of treatment. Health professionals need to pay more attention to the meanings and attributes of food and eating beyond their physiological properties, and further research needs to be conducted with other immigrant populations with culturally distinct understandings of food.
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This article assesses whether the Fagerstrom Test for Nicotine Dependence (FTND), adequately reflects sex, gender and diversity related differences in nicotine dependence. Available studies on the FTND were reviewed and a sex, gender and... more
This article assesses whether the Fagerstrom Test for Nicotine Dependence (FTND), adequately reflects sex, gender and diversity related differences in nicotine dependence. Available studies on the FTND were reviewed and a sex, gender and diversity analysis (SGBA) of this instrument was conducted. Results indicate that sex and gender differences in nicotine dependence may undermine the ability of the FTND to present an adequate picture of dependence. Conducting a SGBA on this Fagerstrom test reveals that sex and gender differences likely limit the ability of this instrument to present an accurate picture of dependence in diverse groups. Further research is needed to enhance the sensitivity of the FTND.
In this article we argue that the complex connections between gender and fatness have not been fully examined, particularly in so far as they relate to men. We consider the role of early feminist literature in establishing the idea that... more
In this article we argue that the complex connections between gender and fatness have not been fully examined, particularly in so far as they relate to men. We consider the role of early feminist literature in establishing the idea that the fear of fatness is fundamentally tied up with patriarchy and the ways this also underwrites more recent examinations of fatness and gender. Moreover, we assert that popular feminist scholarship has actively produced the assumption that weight is not only a women's issue, but that it is tied up with the very construction of femininity. Through an examination of the cultural history of fatness we show that men have also been caught up in the drive to reshape the body over the last century. However, their concerns have remained largely hidden, framed as they often are in the lexicon of ‘fitness’ and ‘muscularity’. An examination of the limited published material on male concerns with fat reveals that for many men fatness is feminizing – and undermines normative forms of masculinity in threatening ways. We call for further research that considers both female and male experiences of fatness, given the limitations of approaches that focus merely on one or the other.
Research Interests:
This article explores dominant discourses surrounding male and female genital cutting. Over a similar period of time, these genital operations have separately been subjected to scrutiny and criticism. However, although critiques of female... more
This article explores dominant discourses surrounding male and female genital cutting. Over a similar period of time, these genital operations have separately been subjected to scrutiny and criticism. However, although critiques of female circumcision have been widely taken up, general public opinion toward male circumcision remains indifferent. This difference cannot merely be explained by the natural attributes and effects of these practices. Rather, attitudes toward genital cutting reflect historically and culturally specific understandings of the human body. In particular, I suggest that certain problematic understandings of male and female sexuality are deeply implicated in the dominant Western discourses on genital surgery.
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Since its inception, Chondogyo has self-consciously maintained an identity as a ‘new’ and ‘modern’ Korean religion. These claims have seen ongoing efforts to rationalize religious practice and theology and purge the movement of... more
Since its inception, Chondogyo has self-consciously maintained an identity as a ‘new’ and ‘modern’ Korean religion. These claims have seen ongoing efforts to rationalize religious practice and theology and purge the movement of ‘anti-modern’, superstitious elements. This paper explores the differing receptions of ecstatic trance and pilgrimage: the two major forms of embodied religious experience in Chondogyo. While the former is treated with ambivalence and is often connected with backward superstition, the latter has been actively promoted as a ‘legitimate’ (and modern) form of religious experience. Through a comparison of these practices, I explore the ways in which they intersect with, bolster and challenge conceptions of Korean modernity.
This paper explores the reasons why Cheondogyo is lionized in contemporary nationalist discourse, when it has such a small following in South Korea today. I argue that Cheondogyo's continuing presence in nationalist and tourist... more
This paper explores the reasons why Cheondogyo is lionized in contemporary nationalist discourse, when it has such a small following in South Korea today. I argue that Cheondogyo's continuing presence in nationalist and tourist publications can be readily comprehended in light of its connection with the Donghak Revolution of 1894.
In the post-colonial era, Donghak/Cheondogyo was embraced by both the North and South Korean states, each seeking to claim a connection with the movement in order to legitimize their respective political goals. More recently, this legacy has also been claimed by the minjung movement as evidence of an incipient minjung consciousness.
These political appropriations have ensured that Cheondogyo maintains a level of legitimacy denied to other new religions of Korea. However, the political acceptance of Donghak/Cheondogyo has come at the expense of its religious legitimacy. Thus, while its connection with the Donghak Revolution may have "made" Cheondogyo into a key historical artifact, it has simultaneously been "unmade" as a religious movement with any real relevance to the present.
In the post-colonial era, Donghak/Cheondogyo was embraced by both the North and South Korean states, each seeking to claim a connection with the movement in order to legitimize their respective political goals. More recently, this legacy has also been claimed by the minjung movement as evidence of an incipient minjung consciousness.
These political appropriations have ensured that Cheondogyo maintains a level of legitimacy denied to other new religions of Korea. However, the political acceptance of Donghak/Cheondogyo has come at the expense of its religious legitimacy. Thus, while its connection with the Donghak Revolution may have "made" Cheondogyo into a key historical artifact, it has simultaneously been "unmade" as a religious movement with any real relevance to the present.
Research Interests:
"Volume 21, issues 1 and 2 feature special sections that include the following papers: 1) Editorial: Alcohol, tobacco, obesity and the new public health by Kirsten Bell, Amy Salmon & Darlene McNaughton 2) Drugs’ pleasures by Robin... more
"Volume 21, issues 1 and 2 feature special sections that include the following papers:
1) Editorial: Alcohol, tobacco, obesity and the new public health by Kirsten Bell, Amy Salmon & Darlene McNaughton
2) Drugs’ pleasures by Robin Bunton & John Coveney
3) Smoking causes creative responses: on state antismoking policy and resilient habits by Simone Dennis
4) Truth, belief and the cultural politics of obesity scholarship and public health policy by Michael Gard
5) Legislating abjection? Secondhand smoke, tobacco control policy and the public's health by Kirsten Bell
6) Deconstructing behavioural classifications: tobacco control, ‘professional vision’ and the tobacco user as a site of governmental intervention by Michael Mair
7) Addiction and personal responsibility as solutions to the contradictions of neoliberal consumerism by Robin Room
8) Neoliberalism, public health, and the moral perils of fatness by Kathleen LeBesco
9) Aboriginal mothering, FASD prevention and the contestations of neoliberal citizenship by Amy Salmon
10) From the womb to the tomb: obesity and maternal responsibility by Darlene McNaughton"
1) Editorial: Alcohol, tobacco, obesity and the new public health by Kirsten Bell, Amy Salmon & Darlene McNaughton
2) Drugs’ pleasures by Robin Bunton & John Coveney
3) Smoking causes creative responses: on state antismoking policy and resilient habits by Simone Dennis
4) Truth, belief and the cultural politics of obesity scholarship and public health policy by Michael Gard
5) Legislating abjection? Secondhand smoke, tobacco control policy and the public's health by Kirsten Bell
6) Deconstructing behavioural classifications: tobacco control, ‘professional vision’ and the tobacco user as a site of governmental intervention by Michael Mair
7) Addiction and personal responsibility as solutions to the contradictions of neoliberal consumerism by Robin Room
8) Neoliberalism, public health, and the moral perils of fatness by Kathleen LeBesco
9) Aboriginal mothering, FASD prevention and the contestations of neoliberal citizenship by Amy Salmon
10) From the womb to the tomb: obesity and maternal responsibility by Darlene McNaughton"
Research Interests:
This special issue includes the following papers: Editor's Introduction KIRSTEN BELL AND SIMONE DENNIS The Making and Changing of Smoking Persons in Public Health Policy and Practice: Ethnography of a World-First Illicit... more
This special issue includes the following papers:
Editor's Introduction
KIRSTEN BELL AND SIMONE DENNIS
The Making and Changing of Smoking Persons in Public Health
Policy and Practice: Ethnography of a World-First Illicit Tobacco
Program
SUSANA CARRO-RIPALDA, ANDREW J. RUSSELL, SUE LEWIS,
and SERENA HECKLER
“They Don’t Live in My House Every Day”: How Understanding
Lives Can Aid Understandings of Smoking
JUDE ROBINSON and CLARE HOLDSWORTH
Golden Chocolate Olive Tobacco Packaging Meets the Smoker You
Thought You Knew: The Rational Agent and New Cigarette
Packaging Legislation in Australia
SIMONE DENNIS
Where There’s Smoke There’s Fire: Outdoor Smoking Bans and
Claims to Public Space
KIRSTEN BELL
After the Smoke has Cleared: Reflections From a Former Smoker
and Tobacco Researcher
REBECCA J. HAINES-SAAH
Editor's Introduction
KIRSTEN BELL AND SIMONE DENNIS
The Making and Changing of Smoking Persons in Public Health
Policy and Practice: Ethnography of a World-First Illicit Tobacco
Program
SUSANA CARRO-RIPALDA, ANDREW J. RUSSELL, SUE LEWIS,
and SERENA HECKLER
“They Don’t Live in My House Every Day”: How Understanding
Lives Can Aid Understandings of Smoking
JUDE ROBINSON and CLARE HOLDSWORTH
Golden Chocolate Olive Tobacco Packaging Meets the Smoker You
Thought You Knew: The Rational Agent and New Cigarette
Packaging Legislation in Australia
SIMONE DENNIS
Where There’s Smoke There’s Fire: Outdoor Smoking Bans and
Claims to Public Space
KIRSTEN BELL
After the Smoke has Cleared: Reflections From a Former Smoker
and Tobacco Researcher
REBECCA J. HAINES-SAAH
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