RHP&EO is the electronic journal of the International Union for Health Promotion and Education

•  Retour en français
• Apoye en el español

Using the Internet in qualitative public health research: A comparison of Chinese and Australian young women's perceptions of tobacco use

Fiona Stewart PhD, Elizabeth Eckermann PhD, Kai Zhou MD

Publication Date: 29 December 1998

Abstract

As a key form of communications technology, the internet has created new methodological approaches for the social sciences and may prove useful for cross-cultural research purposes. In this paper the use of the internet in public health research is explored. The notion of "risk society" (Beck 1992) has provided the broader theoretical framework for this investigation of a small, purposive sample of twelve and thirteen year old women’s perceptions of tobacco in China and Australia.

Funded by the Western Pacific Regional Office of the World Health Organization (WHO), the study involved the experimental conduct of "virtual focus groups". The core business of this paper is to report the usefulness of the internet as a public health research tool. Secondly, the discussion addresses some of the methodological issues which internet use may present. Finally, the paper concludes with a discussion of the implications of internet use for health promotion and education, especially in relation to issues such as capacity-building for ‘at risk’ populations.

Key words:

Health Promotion, Risk, Internet, Young Women, Smoking

Introduction

The mass media are a powerful means of education. As an educational tool the mass media can be an instrument for educators and governmental and non-governmental institutions for the advancement of women and for development. Computerized education and information systems are increasingly becoming an important element in learning and the dissemination of knowledge ... [and have] the ability to shape values, attitudes and perceptions of women and girls in ... positive ... ways (Para 77, Beijing Platform For Action, 1995).

In recent times the internet has opened an important space for researchers in facilitating the creation of new methodological approaches for the social sciences and for cross-cultural research purposes (Gaiser, 1997) which have implications for health promotion and education. The core business of this paper is to explore the usefulness of the internet as a public health research tool. Secondly, the paper addresses some of the methodological issues which internet use may present. It does this by highlighting and examining the type of data which can be obtained (eg. young women’s knowledge of, and attitudes towards smoking).

The final focus of the paper is the range of implications of internet use for health promotion and education, especially in relation to capacity-building for ‘at risk’ populations (see Beijing Platform for Action, 1995 for a discussion of young women). In this respect, the democratizing potential of the internet (eg. the legitimation of knowledge sources see Hardey, 1998), may open up opportunities for specific groups (eg. young women) to have an input into health promotion programmes which target them. However, it is acknowledged that ‘"netizenship" (citizenry of the Internet) ‘does reflect ‘a certain level of access to technological resources (including computing skills) not yet universally available’ (Gaiser, 1997:138).

For the study at hand, the notion of "risk society" (Beck 1992) provided the broad theoretical framework for an investigation of the health risk practice of smoking among a small, non-representative sample of thirty-two, twelve and thirteen year old young women (eight per country) in Australia (Geelong), Malaysia (Kuching), the Republic of Fiji Islands (Suva) and the People’s Republic of China (Beijing). Funded by the Western Pacific Regional Office of the World Health Organization, the study involved the experimental conduct of four virtual focus groups of eight participants. In this paper, discussion is focused upon a comparison of the on-line discussion between the Chinese and Australian sites only.

Although the primary aim of the study was to investigate the usefulness of the internet as a research instrument, this small pilot study was able to generate valuable data comparing young women's health risk perceptions, both between country and as a result of different methodological approaches. Due to the exploratory nature of the study and given the small numbers of young women involved, there has been no attempt to recruit a representative sample from the diversity of racial, ethnic and social class backgrounds of each country. The authors acknowledge this a priori limitation of their data.

Furthermore, young women’s use of the internet in studies such as this not only addresses the aims of strategic United Nations directions such as the Beijing Platform for Action in relation to capacity-building for young women, but may ultimately assist with the provision of integrated and mutually reinforcing sets of experiences which have been found to be key in developing health promotion activities among young people (Nutbeam 1997).

Social Science Research and the Internet

Technology in general, and computer mediated communication in particular (CMC), have recently been argued to present a unique opportunity for the fostering of relationships, communication, community and cooperation (Spender 1997; Hardey, 1998) in both research and practice. Furthermore, Argyle and Shields (1996) have suggested that technology can "mediate presence", thus creating new ways for people to be present and to interact with our bodies and with each other. In short, the internet is being celebrated as an important new tool in the social science and cross-cultural methodological toolkit which has applications in education.

On a practical level, the internet has been found to provide immediate and accessible feedback to both researcher and participant alike as dialogues are created in a combination of "times" with varying purposes and aims (Hewson et al. 1996). The cost effectivity of the internet as a distributive mechanism for self-report questionnaires, for example, has also been noted. Other issues which support the use of the internet in research activities may include: its minimal cost to the researcher (as travel costs associated with interviewing can be minimised), the fact that participation may occur at the participants' leisure (complications associated with organising suitable interview times may be circumvented), participation may occur in the participants' own locale (interview or focus group venues need no longer be arranged), participants may be called for on-line, participation organised through email correspondence and, finally, results and findings may be published and distributed on-line (Gaiser, 1997). The virtual research study appears thus arrived. Before documenting the technical aspects of the aforementioned study, the following discussion provides a brief review of the literature pertaining to smoking and young women in China and Australia.

Smoking and Young Women

The Chinese Experience

In the People’s Republic of China, tobacco is now acknowledged as a growing epidemic in schools with 75 per cent of adult smokers having started smoking between the ages of fourteen and twenty-four years. Because of this trend, adolescent smoking has attracted increasing attention in China with many studies of middle school students' knowledge, attitude, behaviour and risk factors of smoking being undertaken. Although boys are often the main subjects, girls' perceptions of smoking and their actual health practices are becoming an important part of these studies.

Prevalence

Because of the different definition of "smoking" in each study, as well as the different geographical areas investigated, the smoking rates of school girls vary from 2 per cent to 11 per cent among those aged twelve to eighteen years, with the average being about 3 per cent. However, this rate increases rapidly with age (Niu et al. 1995) with one Beijing investigation showing the percentages of girls who had tried smoking as 6 per cent in Grade Six, 11 per cent in Grade Eight and 15 per cent in Grade Ten. Girls have been found to often start smoking between the ages of ten and fourteen years, with many intending to continue smoking. Of those girls who have been found to smoke, over 70 per cent smoke "occasionally" or have tried it at least once.

Perceptions and Knowledge

Although most Chinese girls know that smoking is dangerous to their health, those who try it do so because they are curious or succumb to peer pressure to smoke (Bi and Sun 1995; Niu et al. 1995; Yu, et al. 1988). In the survey by Niu et al. (1995), 50 per cent of the junior school girls kept smoking because they thought it "interesting" and 20 per cent because their friends smoked. For senior school girls, 25 per cent thought smoking "interesting" with 25 per cent thinking it "fashionable". A further 25 per cent were found to think smoking "charming".

The attitude of girls toward smoking can be argued to contribute directly to their behaviour in relation to tobacco use. If young women agree with the positive evaluations of smoking such as "smoking could make one feel relaxed", "smoking can help one concentrate on thinking", "smoking makes it easy to communicate with others" and "smoking make one look mature", then they have been found to be more likely to smoke.

External Influences

Furthermore, Chinese studies have found young women's attitudes and behaviour to be affected by their parents, friends and teachers, (Sun, et al. 1997; Wang and Li 1996). Parental education level, socio-economic status and child-raising and educational methods have also been reported to be closely related to children's smoking habits. On the other hand, tobacco advertising and smoking scenes in films or plays have also been found to have an impact on adolescents' behaviour (Sun and Ye 1997).

The Australian Experience

In Australia, smoking has long been the target of health promotion activities at all levels of government. For many years now, legal sanctions prohibiting the public advertisement of tobacco products, along with their sale to young people, have been both in force and enforced. However, while smoking among the general population has continued to decrease, it remains a common practice among Australian young people (Heaven 1996; Laslett and Rumbold 1998). Some researchers suggest patterns of smoking to be well established by 15 years of age (Gliksman et al. 1989). A 1993 New South Wales study by the Health, Drug and Alcohol Directorate found that 40 percent of 17 year old male students and 31 percent of 17 year old female students use tobacco at least weekly (Cooney et al. 1993).

Prevalence

Studies focusing upon the prevalence of smoking among young women report it to be a common activity (Blaze-Temple et al. 1987; Laslett and Rumbold 1998; Odgers 1998) with approximately one third smoking weekly by fifteen years (Gliksman et al. 1989). Indeed, more recent studies report tobacco to be the most often-tried drug by young people (Odgers 1998). More generally, it is reported that approximately half of all adult smokers began to smoke before the age of eighteen years. According to the Victorian Health Promotion Foundation (1996), the earlier one takes up smoking and the longer one is exposed to tobacco, the more likely one is to become a "career" (ie. lifelong regular) smoker. It has been estimated that approximately 70 per cent of young people under eighteen years of age have smoked tobacco at some time with between 30 per cent and 40 per cent smoking on a weekly basis (SADAIC 1987).

Perceptions and Knowledge

For young women, smoking has been found to be associated with "feeling part of a group", it gives them something "to do" and makes them "feel adult". Although most young people are able to recognise that smoking is harmful to one's health, the rate of smoking among females has remained static (Hill et al. 1988; Laslett & Rumbold, 1998; Odgers, 1998). Despite the established likelihood of adolescent smoking developing into a lifelong habit, most younger smokers believe they will give up before age 30 (Centre for Adolescent Health 1996).

External Influences

In Australia, external influences upon smoking have been found to include: unemployment and the likelihood of family members or peers smoking. Class and cultural factors have also been found to play a significant role in young people’s smoking patterns (AYPAC 1996) with young people from working class backgrounds taking up smoking at a higher rate than those from the middle classes.

In conclusion, although estimates of smoking rates among girls and young women have been reported as significantly higher in Australia than China, it would appear that young women in both countries perceive smoking in remarkably similar ways (eg. feeling mature). In this regard their perceptions and knowledge of tobacco use attest to a globalised pattern of a possible high risk behaviour. Furthermore, young women’s perceptions of smoking in both countries are likewise influenced by the behaviour of those around them and by socio-demographic indicators such as class and ethnicity. The congruence between Chinese and Australian young women’s perceptions of tobacco highlights the usefulness of an interactive comparative study of their attitudes and perceptions in a health educating and promoting role.

Method

The following section documents the technological aspects of the study undertaken.

Study Background

The study "Young Women and Perceptions of Health Risk" was conducted in Synchronous or "real" time (where messages are read by others participating in the group as they are typed by participants) on 21 March 1998. In the course of preparations for the study the participating WHO centre in Beijing (along with the other countries) was provided with an account on the Host server (firstclass.deakin.edu.au). Information technology staff in Beijing downloaded (and installed) the FirstClass software from the Deakin University web address. Standard ethical procedures were followed with written consent being obtained from both the participants and their parents at each of the four sites.

Conferencing Technologies

For this study, a "parent" conference, within which the chat rooms would be situated, was established on the host computer and was called "RiskStudy". Within that area four sub-conferences of Red, Blue, Yellow and Green were created. Although it was the intention of the study to have four teams operational at each location, Red, Blue, Yellow and Green, this was later modified due to limitations in equipment. In both Geelong and Beijing there were four chat rooms with eight young women at each site. They participated in groups of two using four terminals. A total of 16 young women were involved.

Role of the Facilitator

In the course of the link-up there was a designated facilitator at each site who oversaw the link-up. However, there was only one coordinating facilitator who participated in the on-line discussion. The first author fulfilled the role of faciliator and was based in Geelong. In her role as on-line faciliator, she entered and exited the chat rooms at will but only contributed minimally to the discussion. For the on-line focus groups, the primary role of the facilitator was to ensure that all discussion topics were covered. One interesting result of the on-line focus group was the altered ability of the facilitator, when compared to conventional f2f focus groups. In the on-line environment, probing of the participants’ responses proved difficult because of the speed of the interaction and the disembodied nature of the enterprise.

Apart from the actual chat rooms, other areas were created for Asynchronous communication which could continue unsupervised after the reserach had been completed. Here, a welcoming message was posted by the facilitator which was then read by the participants as they came on-line. Areas which were created for Synchronous communication (Chat) were the chat rooms which were used as the basis for the research. Participants entered these areas in order to participate in the on-line discussion.

Face-to-face (f2f) focus groups

Prior to the on-line focus groups, face-to-face or f2f focus groups were conducted at each of the venues. The first author was responsible for the recruitment of eight, twelve and thirteen year old young women in Geelong while the third author took responsibility for Beijing. At both locations, the young women were recruited using the "snowball method" and hence through the personal and professional contacts of the authors. The face-to-face focus groups lasted approximately one and a half hours. The Geelong focus group was conducted in English while the Beijing group was conducted in Chinese. The first author conducted the group in Geelong and the third author conducted the Beijing focus group.

The focus groups were conducted using five scenarios which illustrated the various health risks associated with smoking, alcohol, stress, nutrition and sexuality. Hypothetical situations with fictional characters were created in order to provide focal points for discussion and to encourage the young women to express their views. The scenarios provided appropriate points for exploration from a cross-cultural perspective and ensured overall comparability of a set number of issues. Several weeks prior to the on-line session, the scenarios were emailed to all the study contacts (including Beijing) for approval, where appropriate, and for cultural modification where necessary.

The virtual focus group

Using the Firstclass Conferencing software, and working in pairs, participants were able to enter the areas and participate in any one of four chat rooms - blue, red, yellow and green. A welcoming message was posted in the asynchronous area by the first author in her role as virtual facilitator and "controller". This message outlined the aims of the discussion groups and the expectations of the researchers and was required reading of the young women before they proceeded with their group discussions.

Chatting in the chat room

The chat rooms were configured to allow private access only and allowed immediate interaction as whatever was typed appeared on the screen. In this regard, chat rooms offer a more immediate version of email. As Argyle and Shields (1996) have noted "there are no delays between when you finish a sentence and when you see it". The problems with such an approach, particularly when working with interpreters and translators as was the case in Beijing, are not only that the fastest typist may say the most but that delays are experienced. Although, as Morgan (1988) has noted in regard to conventional f2f focus groups this is not necessarily a problem. That said, in the on-line focus group, the traditional role of the facilitator in structuring and steering discussion can be challenged as the more vocal participants may "speak" three lines to the slower typist or less vocal participant's one. In these on-line groups an inequitable dialogue often did result.

It was hoped the virtual focus groups in this study would cover all five health risk issues, although the scenarios themselves were not intended for virtual focus group use. Furthermore, although it was anticipated that the virtual groups would last approximately one hour, their duration was almost two hours. The young women's participation in the groups can be characterised as both a serious exchange of information and entertaining. As Spender (1997) has indeed suggested, the internet is eminently suited to the conversations of young women.

At the conclusion of the on-line session, the dialogue which had taken place in the chat rooms was saved by the controller/facilitator as a "Word" file. This file was then emailed to the faciliators in the remaining three sites. This provided an automatic and immediate transcript of the discussion which took place. The following discussion of smoking focuses upon the similarities and differences in the Chinese and Australian young women's perceptions of smoking. Furthermore, the data generated provide a useful preliminary step towards assessing the viability of virtual focus groups as a cross-cultural, public health research tool.

Results and Discussion

Smoking and Young Women

Virtual Focus Groups

As noted above in other studies, young women are likely to be aware of the risk practice of smoking, even if they have not personally been involved. Following the f2f focus group discussions, both the Chinese and Australian young women were quick to explain smoking in terms of it being "cool".

blue oz: Ok, the first thing that we talked about was smoking. We found that teenagers seem to smoke more because they find it cool, and don't seem to see the risks at hand

blue oz: We've heard that a lot of people in China smoke, is this true?

blue Beijing: Yes.

blue oz: Do you smoke?

blue Beijing: I think smoking will do harm to people's health

blue oz: Yes, we thought the same

blue oz: What did you discuss about smoking?

blue Beijing: We are not smokers. But Wang's father is a smoker

blue oz: We discussed health problems, and that peer pressure is usually the cause

blue Beijing: There are many poisons in cigarettes

blue oz: Yes, and nicotine is the most addictive part. Do you think smoking is cool? A lot of people at our school seem to think so

blue Beijing: I think we should not be persuaded by someone around us. We don't think smoking is cool.

blue Beijing: Are there many students smoking in your school?

blue oz: Yes, at least half. Just anyone smokes. They usually smoke to feel cool, and because they are addicted

blue Beijing: Are the feeling of "cool" the most important reason for your classmates to smoke?

blue oz: Some of them only do it to feel cool, but most are addicted and cannot stop. They try but it is very hard

All the young women in the Blue Chat room both recognised and named the harmful side-effects of smoking. In this respect, all participants revealed high levels of knowledge about the nature of smoking (eg. addictive potential and poisonous nature of nicotine) and ostensible acceptance of the messages of anti-smoking health promotion campaigns. Similarly, the young women also each recognised that external forces such as peer pressure may encourage some young women to smoke. They also seemed to agree that this was lamentable (including amongst parents), although the Chinese young women were perhaps more adamant in their objection.

Whereas the Australian young women seemed more likely to consider smoking to be "cool", the Chinese young women were far less likely, stating emphatically "we don’t think smoking is cool". This may have been because of the presence of adult interpreters in translating the young women's thoughts. Whether the Chinese young women felt the need to espouse the correct view at this stage remains unclear. It is also unfortunate that whilst the Australian young women spoke of smoking's common place among their schoolmates, the Chinese experience remains unknown.

As if to push their point further, or rather to test the adamant nature of the Chinese young women's rejection of smoking, the Australian young women again pressed the Chinese young women.

blue Beijing: We have never tried drinking or smoking

blue oz: Are you sure? Come on, you can tell us!

blue Beijing: Yes, we are sure that we never tried smoking

In another focus group, the same subject material was discussed with similar emphases.

Red Oz: First topic smoking. We think that smoking is bad because it causes diseases such as lung cancer. It rots away your lungs. People smoke to be cool. What did you learn about smoking?

Red Beijing: Smoking is harmful to the health. How about you?

Red Oz: None of us like smoking. We have not tried smoking and we don't want to.

Whereas the dialogue from both the Blue and Red Chat Rooms reveals parallel issues, confirming the potential of qualitative research methods to tap into prominent and important themes, the dialogue recorded in the face-to-face focus groups reveals a somewhat less formal but no more interactive exchange of views and information. The following section provides a brief overview of the face-to-face interactions within each of the sites.

Face-To-Face Focus Groups

Examination of the data generated by the f2f focus groups provides a useful foil for establishing some of the advantages and disadvantages of on-line methodologies. For this reason particularly, it is an important reference point for the on-line data obtained.

Perceptions of Dangers of Smoking

At a broader level, and without exception, all the participants in the face-to-face focus groups, regardless of location, appeared knowledgeable of the dangers of smoking. In this regard the Australian young women stated:

AustA: It seems a lot more people are aware off the risks, um and stuff but a lot of people still ignore the risks.

AustB: Like the initial messages on the packets. People know about those but they don't worry. They don’t worry what other people say.

The Chinese young women too, began their discussion by condemning smoking as bad for one’s health.

ChinaB: Smoking is dangerous to health. I once read a report, it said there are more than 3000 kinds of harmful composition in the smoke. It is not only harmful to smokers but also to others.

ChinaC: I know that a passive smoker is two times more dangerous than the smoker herself. Smoking is not good to the smokers or to others.

At no time in either group did the young women deny the deleterious impact of smoking upon health status. This alone suggests that health promotion messages have been effective in highlighting the dangers of smoking, if not convincing young women to refrain outright.

Influence of External Factors such as film

In order to investigate young women’s recognition that individual smoking practice may have external or socio-cultural origins, the scenario included a prompt about the role of film in young women’s perceptions of smoking. This was intended as a deliberate attempt to provoke discussion in this area.

When asked if films may influence young women’s smoking the behaviour, the following discussion evolved among the Australian young women:

AusB: Yes [they are a] little bit [influenced]. Because if you like a person, like someone that you love and say they smoke then you'll try smoking, you try and dress the same and try to be like them.

AusA: But a lot of them don't actually smoke in films, they just pretend, but if actor was actually a smoker then they would smoke probably in the films and that.

AusG: I wonder if they smoke when they're not in the film. Because how else would you learn to smoke with such style?

AusB: Probably half of them don't even smoke

In contrast, while one vocal young woman in the Chinese focus group stated:

ChinaG: Li Sha and Chen Hong think they would like the girls in the film if they smoke. It reflects that there are many smoking scenes in the films which is not good for children. Smoking should be paid much more attention by the society.

Another agreed with the Australian group’s views:

ChinaH: Currently everybody knows that smoking endangers health, so why does Li Sha still start to smoke? I think she could be affected by film stars who she likes most of whom smoke. She imitates them.

While the Australian young women were quick to note the attraction of smoking when it is portrayed glamorously, the Chinese young women diverged in their recognition of the influence of representations of smoking upon young women.

Peer Group Pressure and For Acceptance

A further issue which the scenario raised and which was discussed in both the Chinese and Australian face-to-face groups concerned the association of smoking with peer group acceptance and a "cool" image. In this respect all the young women recognised these factors in young people’s use of tobacco. When asked why Li Sha and Chen Hong would still want to smoke, despite knowing the dangers involved, the Chinese young women replied:

ChinaD: To be fashionable, or so-called "cool".

ChinaB: May be she thinks it is cool to smoke, so, she will be out of fashion if she doesn't smoke.

ChinaE: She goes after the fashion, blindfold.

The Australian young women were likewise ready to identify the need for peer acceptance and a suitable self-image as prime motivators in the smoking practices of young women such as themselves. When asked why Lisa and Gloria might smoke, even when they knew of tobacco’s harmful effects, they replied:

AusB: To try it out, to be cool, to do something deceiving, they were just curious

AusA: A lot of people start smoking to act cool and then when they want to stop they can't because they’re addicted to them and it's also like addictive and like stress relief like if you have any worry. It makes them feel good.

AusE: Yes but smoking doesn't usually relief stress.

AusD: It does.

AusE: I don't think it does its the nicotine that makes them feel better.

Influence of Smoking Father on Daughter’s Habits

When discussion turned to the impact of Lisa’s father smoking upon Lisa, discussion in both face-to-face groups were in agreement. For example, in the Australian group, the participants stated:

AusG: Probably depends what they think of it, they could be influenced by their father because, like she's around her father lots.

AusB: I'd hate it

AusE: So would I. People might think if they don't know enough about to smoking, they might think if my dad does it, it shouldn't be that bad you know, I suppose I could do it too.

In the China group, discussion was similar:

ChinaG: They are affected by Li Sha’s father. He should not smoke before his child. If he wants smoking, he can go outside home.

ChinaH: H: I think Li Sha’s father should tell Lisa not to be like him. He ought to quit smoking gradually and set a good model to Li Sha.

Censoring of parent’s behaviour indicates an almost religious fervor in both the Australian and Chinese young women’s assimilation of, and advocacy for, anti-smoking messages.

Developing/Kicking the Habit

Both focus groups concluded with the young women being asked if they thought the characters in the scenario would continue to smoke. While the Chinese young women stated:

ChinaE: It's hard to say. Quitting smoking is not an easy thing. Maybe they will smoke from now on.

ChinaF: If quitting smoking is so hard, the only way is not to start at all.

The Australian young women went into considerably more detail:

AusB: If they're just doing it to be cool and they don't have to do it then it annoys us because that's pretty dumb.

AusD: They say they do [want to quite], but they actually don't. They sort of, they tried it. Like nearly everyone who smokes says ‘I'm going to quit’, then they try and quit and they don't even last day. A lot of people don't want to quit.

AusB: But they say they do.

AusA: Some people just say that they do is at social events that parties and stuff but sometimes it gets too addictive and they can't.

Both the Chinese and the Australian young women were clearly aware of the addictive effects of nicotine and this aspect of smoking they saw as just as dangerous as the harmful health sequelae.

Conclusion

The above brief excerpts reveal numerous issues for explication and for future investigation. While, at this preliminary stage, the data are too brief for in-depth analysis, its obtainment supports the use of the internet as a viable methodological approach in cross-cultural research. This is especially since its yielding of different reactions from the traditional face-to-face focus group methods. Within the constraints of the use of translators and an excited group of teenage girls, the generation of any data was indeed welcome.

In particular, what is of note is the similarity of the public discourse concerning the harmful nature of smoking of which the young women in both China and Australia made use. In this regard, the effectiveness of the health education message of smoking, as an activity harmful to one's health, appears high in this part of the world. A globalization of risk is perhaps apparent here, even if this has not yet translated into individual practices (since the Australian young women admit to smoking at some time).

Methodological Issues

This exploratory study has generated numerous methodological issues demanding further investigation, especially where on-line focus groups are concerned. Among such issues are the highly-interactive and fast-moving medium of internet communication. Unlike in f2f focus groups, when virtual focus group dialogue changes topic quickly, the faciliator may not be able to return discussion to the original topic. Gaiser (1997), too, has noted the danger of acquiring poor quality or only surface data. This claim holds some credence where the findings of this study are concerned. The type of data generated seems in part a result of the facilitator’s inability to exert sufficient direction and/or control over the discussion, as would otherwise have been possible with f2f focus groups. As a result, the focus groups changed topic frequently and often at a furious pace generating, at times, a chaotic interaction.

A further problem involves the time spent on translation prior to the typing of reply sentences. Instead of the focus groups experiencing maximum interactivity, the Australian young women were dominant in their contributions. However, while one sided contributions in on-line focus groups may be unique to those working across languages, they are not unique because the groups are conducted on-line. That said, differing proficiency of participants’ typing skills will always be an important factor in achieving a highly interactive on-line discussion.

Implications for Health Promotion and Education

The final aspect of the study concerns its potential as a health intervention strategy. In this regard, the research process can be hypothesised as effective in reinforcing health promoting messages (ie. smoking is bad for you), particularly given the common agreement among the young women. The on-line environment appears to provide participants with a sense of bravado in challenging pressures to smoke (Peer, advertising etc) and in confronting others who smoke, such as parents. That this pilot study is small, however, signals the need for the data generated to be used cautiously in regard to broader generalisations.

Finally, the young women's eagerness to participate in the on-line focus groups and the immediate gratification they received from ‘speaking’ to young women in other Western Pacific countries appears enormous. The success of the session in both achieving a link-up and an active exchange of views and information points to possibilities for similar, cost-effective research with any variety of populations in the future. It helps also to close the gap between theory and practice in relation to participatory research.

References

1. Argyle, K. and Shields, R. 1996. Is there a Body on the Net? In Cultures of Internet: Virtual Spaces, Real Histories, Living Bodies, ed. R. Shields: 58-63. London: Sage.

2. Australian Youth Policy and Action Coalition (AYPAC) 1996. Adolescent Health in Australia. In Adolescent Health, ed. K. Healey: 1-4. Melbourne: The Spinney Press.

3. Beck, U. Risk Society. Cambridge: Polity Press.

4. Bi, P. and Sun, Y. H. 1995. Epidemics research about smoking behaviour and motive of school students in He Fei city. Journal of Chinese School Health. 16, no. 1: 40-41.

5. Centre for Adolescent Health. 1996. The Health of Young People in Victoria. University of Melbourne.

6. Coggan, C., Disley, B., Patterson, P. and Norton, R. 1997. Risk Taking Behaviours in a Sample of New Zealand Adolescents. Australian and New Zealand Journal of Public Health. 21, no. 5: 455-461.

7. Cooney, A., Dobbinson, S. and Flaherty, B. 1993. Drug Use by NSW Secondary Students: 1992 Survey. Paper prepared for the NSW Health, Drug and Alcohol Directorate.

8. Fang, X. Y., Li, X. M. and Dong, Q. 1996. The study on adolescent smoking and it's relevant factors. Chinese Mental Health Journal. 10, no. 2: 77-80.

9. Gaiser, T.J. 1997 Conducting On-Line Focus Groups. Social Science Computer Review. Vol.15 No.2, Summer 1997;135-144.

10. Finlayson, R., Reynolds, I., Rob, M and Muir, C. 1987. Adolescents: their Views, Problems and Needs - a Survey of High School Students. Sydney: Ku-ring-gai Area Health Service.

11. Glicksman, M., Dwyer, T., Wlodarczyk, J. and Pierce, J. 1989. Cigarette smoking in Australian schoolchildren. Medical Journal of Australia. 150: 81-84.

12. Gray, D. Morfitt, B. Ryan, K. and Williams, S. 1997. The use of tobacco, alcohol and other drugs by young Aboriginal people in Albany, Western Australia. Australian and New Zealand Journal of Public Health. 21, no. 1: 71-76.

13. Hardey, M. 1998. The Social Context of Health. Buckingham, Open University Press.

14. Heaven, P. 1996. Adolescent Health The Role of Individual Differences. London: Routledge.

15. Hill, D., White, V. and Gray, N. 1988. Measures of Tobacco Smoking in Australia 1974-1986 by means of a Standard Method. Medical Journal of Australia. 149: 10-12.

16. Hewson, C., Laurent, D. and Vogel, C. 1996. Proper methodologies for psychological and sociological studies conducted via the internet. Behaviour Research Methods, Instruments and Computers, 28, no. 2: 186-191.

17. Laslett, A. and Rumbold, G. 1998. The Epidemiology of Australian Drug Use. In eds M. Hamilton, A. Kellehar and G. Rumbold Drug Use in Australia A Harm Minimisation Approach. Melbourne: Oxford University Press: 30-47.

18. Morgan, D. 1988. Focus Groups and Qualitative Research. Thousand Oaks. Sage.

19. Morris, M. and Ogan, C. 1996. The internet as mass medium. Journal of Communication, 46, no. 1: 39-50.

20. Niu, S. R., Guan, N. Y., Tian, B. C., Guan, J. H., Wang, H. X. and Liu, Y. L., and Lu, Z. Z. 1995. Smoking prevalence surveys among 30,000 young students. Journal of Hygiene Research. 24, no. 1: 15-17

21. Nutbeam, D. 1997. Promoting Health and Preventing Disease: An International Perspective on Youth Health Promotion. Journal of Adolescent Health. 20, no. 5: 396-402.

22. Odgers, P. 1998 Adolescent substance Use. In eds M. Hamilton, A. Kellehar and G. Rumbold Drug Use in Australia A Harm Minimisation Approach. Melbourne: Oxford University Press: 111-129.

23. South Australian Drug Abuse Information Centre (SADAIC) 1987. Youth: Alcohol and Other Drug Use in South Australia. Parkside: South Australia.

24. Spender, D. 1997. The Position of Women in Information Technology - Or Who Got There First and With What Consequences? Current Sociology, 45, no. 2: 135-47.

25. Sun, J. C. and Ye, G. J. 1997. Mass media and adolescent smoking. Journal of Chinese School Health. 18, no. 2: 98-99.

26. Sun, J. C., Ye, G. J., Chu, Q. M. and Yang, Y. Z. 1997. Psychosocial factors to the smoking behaviour of high school students. China Public Health. 13, no. 1: 21-22.

27. Turner, B.S. 1994. Preface to P. Falk The Consuming Body. London, Sage.

28. Victorian Health Promotion Foundation 1996. Young People's Health. Vic Health Newsletter. 4, 3-5.

29. Wang, M. J. and Li, B. L. 1996. Factor analyses of smoking behaviour of middle school students. Chinese Journal of Behavioural Medical Science. 5, no. 4: 226-228.

30. Yu, J. Y., Li, Y., Zhou, E. S., Liu, X. H., Wang, H. X. and Li, M. H. 1998. The situation and effects of adolescent smoking in Wu Han city. China Public Health. 14 no. 1: 4-55.

Appendix I

Smoking Scenario

Lisa(Li Sha)'s father is a heavy smoker. He buys his cigarettes each week in big cartons. He keeps them in a special cupboard at home. Lisa's friend Gloria (Chen Hong) has always wanted to try smoking. So, Lisa borrows one packet of her father's cigarettes from her father's cupboard. After school one day, Lisa and Gloria teach themselves to smoke. Now they think they are really cool and just like the girls see in the films.

In this story, how many different types of risk can you think of about what Lisa and Gloria do?

[ Home ] [ Up ] [ IUHPE ] [ Our Mission ] [ Editorial Board ] [ Reviews ] [ IJHP Articles ]

Copyright © 1999-2001 Reviews of Health Promotion and Education Online,
Last modified: June 21, 2001

Internet Explorer 5.0 or later version gives the optimal visual effect of this website.