Artigos de revistas sobre o tema "Female Medical Education Society (Boston, Mass.)"

The process of the formation of ethnic identities in Turkey was fairly intricate with the influence of migrations, conflicts and newly adopted ideologies. The differential demographic development between the three main ethnclass groups in the country was one of the main reasons that led to political and social tensions causing political and social crises in Turkish society. While the fertility of the secular part of society was in the process of constant stagnation after World War II, the more traditional part of society experienced a demographic growth that was accompanied by mass migrations to large cities and political mobilization of the economically neglected newly formed urban and young population, which led to electoral homogenization and social divisions in Turkish society. Fertility among ethnic Turks converged at the commencement of the XXI century, but the demographic transition has stalled among the Kurdish population due to economic underdevelopment, female illiteracy and the survival of traditional institutions of patriarchy. While at the given period, the total fertility rate (TFR) of ethnic Turks fell to 1.88, in the Kurdish provinces, it was still over 4, although in 2020 it fell to around 3. Turkey went through one of the fastest processes of the society modernization with a fast urbanization and education of the population in the last two decades, where the share of the population living in cities surpassed 80% and as one of the highest in Europe was followed by a further decline in fertility, an increase in secularity among youth and with new forms of political mobilization. Also, Turkey is facing one of the biggest refugee crises in the world with around 4 million refugees, mostly from Syria.

Background: Cancer awareness and emphasis on preventive oncology is an essential weapon in our war against cancer. Globally the approach towards cancer awareness is non-targeted with mass media and social media coverage being unselective. This study aimed to demonstrate the disparities prevalent in society especially in a developing country with regard to cancer awareness for two of the commonest female cancers and suggested measures to increase the efficacy of awareness programs in the urban and suburban population of a typical third world Indian metropolitan city.Methods: In a cross-sectional study conducted between January 2021 to June 2021, 119 suitable female patients attending the gynaecology OPD of a medical college and hospital were randomly selected. Informed consent was taken and their knowledge/awareness about preventive oncology in carcinoma breast and carcinoma cervix (two most common cancers in Indian women) was documented using pre tested and pre structured questionnaire. The results were analysed by suitable statistical tests.Results: Higher education and socio-economic condition was associated with increased levels of awareness for preventive measures of carcinoma breast and carcinoma cervix. Within each educational strata, higher socio-economic status predicted for increased awareness for risk factors, screening tests and vaccination.Conclusions: Subtle differences in the patterns and degree of awareness in common female cancers were noticed with regard to educational and socio-economic standards in the studies population. These have widespread implications in planning awareness programs in resource constrained setting to ensure most efficacious utilization of Cancer awareness and Prevention programmes.

ImportanceFertility status is a marker for future health, and infertility has been associated with risk for later cancer and diabetes, but associations with midlife cardiovascular health (CVH) in female individuals remain understudied.ObjectiveTo evaluate the association of infertility history with CVH at midlife (approximately age 50 years) among parous individuals.Design, Setting, and ParticipantsProject Viva is a prospective cohort study of pregnant participants enrolled between 1999 and 2002 who delivered a singleton live birth in the greater Boston, Massachusetts, area. Infertility history was collected at a midlife visit between 2017 and 2021, approximately 18 years after enrollment. Data analysis was performed from January to June 2023.ExposuresThe primary exposure was any lifetime history of infertility identified by self-report, medical record, diagnosis, or claims for infertility treatment.Main Outcomes and MeasuresThe American Heart Association’s Life’s Essential 8 (LE8) is a construct for ranking CVH that includes scores from 0 to 100 (higher scores denote better health status) in 4 behavioral (diet, physical activity, sleep, and smoking status) and 4 biomedical (body mass index, blood pressure, blood lipids, and glycemia) domains to form an overall assessment of CVH. Associations of a history of infertility (yes or no) with mean LE8 total, behavioral, biomedical, and blood biomarker (lipids and glycemia) scores were examined, adjusting for age at outcome (midlife visit), race and ethnicity, education, household income, age at menarche, and perceived body size at age 10 years.ResultsOf 468 included participants (mean [SD] age at the midlife visit, 50.6 [5.3] years) with exposure and outcome data, 160 (34.2%) experienced any infertility. Mean (SD) LE8 scores were 76.3 (12.2) overall, 76.5 (13.4) for the behavioral domain, 76.0 (17.5) for the biomedical domain, and 78.9 (19.2) for the blood biomarkers subdomain. In adjusted models, the estimated overall LE8 score at midlife was 2.94 points lower (95% CI, −5.13 to −0.74 points), the biomedical score was 4.07 points lower (95% CI, −7.33 to −0.78 points), and the blood subdomain score was 5.98 points lower (95% CI, −9.71 to −2.26 points) among those with vs without history of infertility. The point estimate also was lower for the behavioral domain score (β = −1.81; 95% CI, −4.28 to 0.66), although the result was not statistically significant.Conclusions and RelevanceThis cohort study of parous individuals found evidence for an association between a history of infertility and lower overall and biomedical CVH scores. Future study of enhanced cardiovascular preventive strategies among those who experience infertility is warranted.

ObjectiveOverweight and obesity have been shown to be related to multiple chronic conditions, leading to a heavy economic burden on society throughout the world. This study aims to estimate the prevalence of overweight and obesity and determine potential influencing factors among adults in Xinjiang, northwest China.DesignA community-based observational study.SettingThe First Affiliated Hospital of Xinjiang Medical University.MethodsIn total, 14 618 adult participants (7799 males; 6819 females) aged over 35 years were recruited from the Cardiovascular Risk Survey conducted in 2010. Data were obtained from face-to-face interviews and physical examinations. The sample was used to estimate the prevalence of overweight (body mass index (BMI) 24–28 kg/m2) and obesity (BMI ≥28 kg/m2) in Xinjiang Province. Influencing factors were analysed based on statistical methods.ResultsIn Xinjiang Province, the overall prevalence of overweight was 36.5% (male 40.1%; female 33.4%), and the prevalence of obesity was 26.5% (male 27.2%; female 25.8%). The prevalence of both overweight and obesity were higher in women than in men (p<0.001). The main influencing factors for overweight and obesity were sex, age, race, marital status, education level, occupation, smoking, drinking, hypertension, diabetes and dyslipidaemia (p<0.05).ConclusionsThis study estimated that the prevalence of overweight and obesity among adult residents of Xinjiang Province, northwest China, was high. These data suggest that efforts related to the prevention and control of overweight and obesity should be a public health priority in northwest China.

Background: Overweight and obesity kill about 2.8 million adults worldwide a year, and contributes to a host of debilitating chronic illnesses, yet obesity is still not typically a focus of medical student training, or continuing education for physicians. The consequences affect an individual physically, financially, and emotionally. The broader society is affected since obesity threatens national security and public safety by reducing the numbers of military and safety officials who are fit for duty and places a huge burden on the healthcare system. Objective(s): The aim of this study is to determine the mediating role of food addiction and commitment to physical activity. Methodology: The descriptive correlational design has been considered a subtype of correlational research, with its primary purpose being to examine relationships between and among variables and it is referred to occasionally as simple correlational design. The study included a convenience sample of male and females middle school students who agreed to participate in this study. The study subjects were recruited from eight public middle schools. The sample size was determined using G*Power software based on an effect size of 0.25, alpha error probability of 0.05, a power of 0.95, five groups. Thus, the recommended sample size would be 304. Considering an attrition rate of 20%, additional 61 subjects would be required. As such, the recommended sample size would be 365. The final sample size is 380. Results: There is a statistically significant difference in commitment to physical activity between gender groups (p-value = 0.005). While there is no statistically significant difference in commitment to physical activity among grade groups. Conclusion: Male students have greater tendency for food addiction than female students. Male students have greater commitment to physical activity than female students. Recommendations: There is a need for the community health nurses to collaborate with the officials in the Ministry of Health (School Health), mass media, and directorates of education to raise students and school officials’ health awareness of the value of adhering to healthy diet and healthy weight. Keywords: Physical Activity, Food Addiction, Weight Trend, Middle School Students.

Aim. To study the factors associated with the intermediate probability of heart failure (HF) with preserved ejection fraction (HFpEF) according to the H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure) in asymptomatic patients in rotation work conditions in the Arctic.Material and methods. In the polar village of Yamburg (68° 21’ 40” northern latitude), 100 men and 80 women with grade 1, 2 hypertension and normotensive persons were examined on the basis of the Medical Unit of OOO Gazprom Dobycha Yamburg. All patients underwent echocardiography using generally accepted methods of imaging and data processing, according to European Society of Echocardiography guidelines. To calculate the probability of HFpEF, the H2FPEF score was used. The Bruce protocol treadmill test was performed. The SF-36 (Health Status Survey) questionnaire for assessment of life quality was used.Results. Group 1 included 95 male and female patients with a low probability of HF (H2FPEF score — 0-1), group 2 — 85 patients of both sexes with an intermediate probability of HF (H2FPEF score — 2-5). Group 2 patients were older (p=0,038), worked longer on a shift (p=0,0143), and had higher ambulatory systolic (p=0,0001) and diastolic blood pressure (p=0,0013) with a higher body mass index (BMI) (p=0,0001). Based on the odds ratio (OR) analysis, the factor most strongly influencing the intermediate probability of HFpEF was BMI (OR=1,261, 95% confidence interval (CI): 1,140-1,393). SF-36 questionnaire revealed intergroup differences only on the role functioning scale (p=0,013) with lower values in group 2. In the logistic regression model, dyspnea during the treadmill test occupied a leading position as follows: OR=8,952; 95% CI: 3,454-15,197 (p<0,0001). The second place was taken by inotropic reserve value (OR=1,020; 95% CI: 1,006-1,035 (p=0,005), which was higher in group 2 and was regarded as one of the compensatory mechanisms for adapting to stress. In the group 2, echocardiography revealed significant differences in terms of left ventricular (LV) myocardial mass (p=0,0002), LV internal area (p=0,0002), isovolumic relaxation time (p=0,003), and ratio of transmitral diastolic flow rate to mean mitral annulus velocity (p=0,0001), which indirectly indicates the presence of LV diastolic dysfunction.Conclusion. There are following factors associated with H2FPEF intermediate probability of HFpEF in asymptomatic patients on shift in the Arctic: BMI, length of shift, dyspnea and an increase in inotropic reserve during exercise due to a decrease in adaptive potential, impaired LV diastolic function. Initiating management strategies that target identified factors in patients with asymptomatic HF may slow symptomatic disease progression in shift workers in the Arctic region.

Background:There are known and established risk factors for gout flares; however, no study has examined the factors specifically associated with a polyarticular gout flare.Objectives:Evaluate risk factors of a polyarticular gout flare in a longitudinal study of individuals with gout.Methods:We used data from the Boston Online Gout Study, a longitudinal internet-based case-crossover study, where gout patients with at least one flare within the past year were enrolled across the US. Participants (N=903) were followed prospectively for 1 year via the internet to collect information on gout flares and related data including number and specific joints involved, medical comorbidities, diet, exercise and medications.A polyarticular gout flare was defined as having 3 or more joints involved during a patient-reported flare period. Individuals with at least one flare (to determine flare pattern) during follow-up were included in the analysis. Univariable associations were first assessed to determine factors were associated with polyarticular joint flares. was used to adjust for confounders. When assessing the association of each risk factor with prevalent polyarticular joint involvement, we used multivariable logistic regression, adjusting specific confounders guided by causal diagram.Results:There were 724 participants with at least one flare with a mean and median age of 55 years. The cohort was 78% male and 89% White with a mean gout disease duration of 8.1 years (median 5). 197 (27%) had a polyarticular gout flare. In univariable analysis (Table 1), female sex, osteoarthritis, obesity, heart failure, hypertension, chronic kidney disease and gout related medication use were each associated with higher odds of polyarticular gout flare, whereas higher education, alcohol use at study enrollment and aspirin use were associated with lower odds. In multivariable analysis, obesity, osteoarthritis and heart failure remained associated with a higher odds of polyarticular gout flare, whereas education remained inversely associated.Conclusion:In this prospective cohort of gout patients, obesity, heart failure and osteoarthritis were independently associated with higher odds for polyarticular gout flares. Female sex was also positively associated, whereas higher education was protective. The positive association with gout-related medications likely reflects residual confounding by indication. If confirmed, these findings would help identify those at risk for polyarticular flares to help improve clinical care.Table 1.Associations with Polyarticular Gout Flare (≥ 3 joints)Risk FactorUnivariable OR (95% CI)Age- and Sex-Adjusted OR (95% CI)Multivariable OR* (95% CI)Age ≥ 55 years (vs < 55)0.82 (0.59,1.14)0.77 (0.56,1.08)0.70 (0.49,1.01)Female Sex1.51 (1.04,2.22)1.55 (1.03,2.32)1.21 (0.78,1.88)White Race (vs Non-White)0.89 (0.54,1.48)0.93 (0.56,1.54)0.75 (0.44,1.28)Education (vs High School or Less)Some college0.63 (0.37,1.07)0.53 (0.37,1.07)0.68 (0.39,1.17)College0.45 (0.25,0.78)0.46 (0.26,0.81)0.49 (0.27,0.88)Post-graduate0.42 (0.25,0.72)0.44 (0.26,0.76)0.48 (0.28,0.84)Body Mass Index (kg/m2) at Enrollment (vs < 25)25-29.91.69 (0.85,3.33)1.77 (0.89,3.51)1.82 (0.90,3.65)≥ 302.38 (1.24,4.58)2.30 (1.19,4.43)2.19 (1.12,4.28)Alcohol Use at Enrollment (vs. Non-Use)0.60 (0.40,0.89)0.60 (0.40,0.91)**Gout Duration ≥ 5 years (vs < 5)0.85 (0.61,1.18)0.93 (0.66,1.31)0.95 (0.66,1.35)Presence of Comorbidities at Enrollment (vs Absence)Osteoarthritis2.35 (1.45,3.81)2.37 (1.43,3.95)2.39 (1.42,4.04)Heart Failure2.06 (1.11,3.81)2.21 (1.17,4.17)2.03 (1.06,3.91)Hypertension1.61 (1.08,2.40)1.69 (1.10,2.60)**Chronic Kidney Disease1.97 (1.03,3.78)2.11 (1.09,4.11)**Medication Use at Enrollment (vs No Use)Allopurinol1.58 (1.13,2.22)1.59 (1.13,2.23)**Diuretics1.53 (1.06,2.21)1.59 (1.06,2.38)**Oral Steroids2.21 (1.16,4.18)2.26 (1.19,4.31)**Aspirin0.68 (0.47,0.98)0.72 (0.49,1.07)***Mutually adjusted for the variables in this column**Not included in modelAcknowledgements:NIH P50AR060772.Disclosure of Interests:Jonathan Dau: None declared, Natalie McCormick: None declared, Sarah Stratton: None declared, Chio Yokose: None declared, Clara Chen: None declared, Tuhina Neogi Shareholder of: Lilly, EMD Merck Serono, Novartis, Regeneron, Pfizer/Lilly, David Hunter Shareholder of: Pfizer, Lilly, Merck Serono, Kenneth Saag Consultant of: Arthrosi, Horizon Therapeutics plc, Atom Bioscience, LG Pharma, Takeda, Mallinkrodt, SOBI, Grant/research support from: Horizon Therapeutics plc, Shanton, SOBI, Yuqing Zhang: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, Vaxart, Grant/research support from: Ironwood, Horizon.

Abstract Introduction: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) was recently recognized by the WHO as a lymphoma presenting a median of 8 years after insertion of breast implants for reconstructive surgery following breast cancer, for prophylactic mastectomy due to high genetic risk of breast cancer, e.g. BRACA1/2 mutations, or for other cosmetic reasons. The American Society of Plastic Surgeons BIA-ALCL Global Network reports there are 1,158 known cases of BIA-ALCL and 35 deaths across 46 countries worldwide as of January 28, 2022. Approximately 80% of Australian women present with a peri-implant effusion whereas in the USA, 30% present with a mass +/- lymphadenopathy. Five-year overall survival is 90.1% when disease is confined to a peri-implant effusion and capsule but 72.4% when disease extends beyond the capsule. Therefore, we set out to develop a diagnostic test for early disease detection in peri-implant effusions. Experimental procedure: Our initial publications from the USA and Italy revealed higher mean concentrations of IL-9, IL-10 and IL-13 in BIA-ALCL than in more common benign effusions due to capsule contracture, leakage, trauma and infection. To validate these findings in a larger number of patients, mostly from another geographic region (Australia), we evaluated cryopreserved peri-implant effusions of 25 patients with BIA-ALCL and 30 patients with benign seromas collected at Macquarie University Medical School in Sydney AU and Rhode Island Hospital in the USA. Informed consent and Institutional approvals were obtained. Cytokine concentrations were determined with the Biolegend Human Th Cytokine 12 plex multianalyte flow assay kit (Cat. No. 741028), San Diego, USA. Results: The results show that mean levels of IL-9, IL-10 and IL-13 were elevated 72-, 716- and 22-fold, respectively, in BIA-ALCL compared to benign effusions, and each cytokine separated the two groups with little overlap (P &lt; 0.0001), Mann-Whitney test. For IL-10, there was 92% sensitivity, 100% specificity, Youden Index (YIA08_92), cut-off value 150pg/ml; for IL-9, 96% sensitivity, 80% specificity (YI=76) cut-off value 88pg/ml; for IL-13, 76% sensitivity, 96.7% specificity, (YI= 72.7) cut-off value 714pg/ml. Furthermore, the geometric mean of the 3 cytokines has an area under the Receiver Operated Curve (AUROC) value of 0.9947 with 100% sensitivity and 96% specificity (Youden index of 96). Only one other cytokine, IFNgamma, showed significant diagnostic value.Conclusions: Measurement of a panel of 12 cytokines representing different T helper subsets discriminates with high sensitivity and specificity peri-implant effusions of BIA-ALCL from benign peri-implant effusions, facilitating early diagnosis with potential for curative surgery. The consistent cytokine profile of IL-9, IL-10 and IL-13 in malignant peri-implant effusions in this and 2 previous studies of 40 patients across 3 continents suggest that a specific immune response to unique etiologic agent(s) is an early event in the pathogenesis of BIA-ALCL. Citation Format: Marshall E Kadin, Helen Hu, Elena Elena Shklovskaya, Anand Deva, Mark Dooner, Haiying Xu. Diagnosis of breast implant associated anaplastic large cell lymphoma by analysis of cytokines in peri-implant effusions [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A08.

Objectives: The objective of the study is to determine the nutritional status of elderly resident in nursing home through anthropometric measurements (Body Mass Index, mid-upper arm circumference) dietary pattern and food intake and clinical appearance in Baghdad city. Methodology: A descriptive (cross sectional) design was carried throughout the present study to assess the nutritional status of nursing home residents in Baghdad City. This study started in March 22th, 2010 through July 29th, 2010. Probability" random sample of (50) older adults were selected out of nursing home residents in Baghdad City for the present study. The sample was assigned to the study according to the following inclusive criteria, Older adult age was (60-86) years old, who are on unhealthy Status in Nursing Home Residence. Data were collected through the use of the questionnaire and interview, and analyzed through the application of descriptive and inferential statistical data analysis which reveals: demographic characteristic analysis of the sample concerned. Results: the majority of the sample age is (70-74) years inferential (30%), the majority of study sample (62%) are male and the remaining are female, relative subjects level of education is that the greater number of them are illiterate and they are accounted for the indication of clinical appearance the majority for easy hair loss and bleaching nails (24%), show that the majority of BMI are within fourth categories groups and accounted for over weight(30%), the majority of MUAC within three groups and accounted for normal (82%). Conclusion: their current medical problems, are overweight and taking medication. Most of the old age residents are not a customer for vitamins and minerals intake. Most of the old age residents are losing hair easily and bleaching nails. Recommendations: Work on the coordination between the role of the state and civil society institutions and the Ministry of Social Affairs and the Ministry of Health for the purpose of direct supervision on the needs and problems of residents in the role of the state, the researchers recommend conduct a comparative study on the situation nutrition among the elderly living in nursing homes and the elderly living in the community.

Examining how the female body and lifecycle were constructed within 19th-century Scottish psychiatry, and the wider significance of such portrayals, this article situates the Period Products (Free Provision) (Scotland) Act within a much longer history that presents menstruation as a problem. We highlight the historical resonance of two prominent features of the Act and the debates leading to it: the enduring tension between views of menstruation as a normal versus a pathological process, and the perceived deleterious impact of menstruation upon female education and, by extension, women’s status. By 1900, Scottish psychiatry had achieved professional status. Asylums were recognised as the officially approved response to madness, and mass institutionalisation allowed the medical profession unparalleled opportunities to observe, classify and treat those deemed insane. Madness as a ‘female malady’, with doctors portraying the female sex as more vulnerable to insanity in publications and clinical documentation, largely due to their reproductive system, has become a popular theme in historical scholarship. This article examines how 19th-century psychiatry depicted the biological ‘crises’ of the female lifecycle and the extent to which menstruation was conceptualised as a pathological process. The widely cited and prolific medical writer, Thomas Clouston—physician-superintendent of the Royal Edinburgh Asylum (1873–1908), Scotland’s largest and most prestigious asylum—offers a particularly illuminating case study. An advocate of managing mental health holistically, Clouston advised society on healthy living through adherence to respectable Victorian standards. In his policing of social norms, he became a prominent spokesperson for limiting female education to protect women during the ‘dangerous’ transition from childhood to womanhood.

AbstractBackgroundOne of the significant outcomes of health education is health literacy (HL), which should be expanded to improve health promotion.ObjectiveThe aim of this study was to assess HL and its relationship with Body Mass Index (BMI) in female adolescent students.SubjectsThis study was conducted on 235 female students (aged 13–15 years) which were selected with cluster sampling.MethodsFor assessing HL, the Newest Vital Sign (NVS) was used and BMI Z-score was evaluated following the World Health Organization (WHO) guidelines. Data were analyzed using SPSS version 16.ResultsBased on this study’s results, 11.5%, 37% and 51.5% of adolescents had adequate HL, limited HL and inadequate HL, respectively. There was a negative correlation between adolescents HL and BMI, rs= −0.233 (p < 0.001).ConclusionMost of adolescents had limited HL and students with higher BMI had a worse HL score. As a matter of fact, as adequate HL has a significant role for promoting health in the society policy makers must design educational programs for adolescents especially in non-medical settings such as schools where adolescents spend most of their time.

Introduction: Cardiopulmonary resuscitation (CPR) education plays a critical role in reducing cardiovascular deaths. Thus, it is crucial that trainees engage in practice simulations that accurately replicate a cardiovascular emergency. Recent work has shown that certain demographic groups such as Black Americans and women are less likely to receive efficient CPR, and technique may vary on individuals who have an increased body mass index or who are pregnant. Poor representation of these groups in the manikins used for CPR simulation may play a substantial role in these inequities. Hypothesis: There is a deficiency in the diversity of race, gender, and body habitus of manikins used for CPR training in North and South America. Methods: Institutions, businesses, and non-governmental organizations which administer CPR certification in North and South America were identified for survey distribution through a collaboration with the Inter-American Society of Cardiology. A survey was administered using the online platform Qualtrics (Provo, USA) consisting of 18 questions about manikin supply, usage, and diversity. Results and Conclusions: A total of 52 survey responses were received from North America (n=20; 854 total manikins) and South America (n=32; 1,169 total manikins). Of the total manikins (n=2,023), 318 (16%) were non-white, 114 (6%) were female, 20 (1%) represented a non-lean body habitus, and 18 (1%) were pregnant. The importance of diverse manikin representation in simulation training is underscored by literature detailing deficiencies in CPR initiation and associated outcomes in individuals who are not lean white males. Yet, the majority of manikins used in North and South America still disproportionally represent this population. It is pertinent that manikins used for CPR training reflect all populations at risk for major adverse cardiovascular events.

BackgroundThe effect of sex and age on chronic post-thoracic surgical pain (CPTP) at rest and with activity remains unclear. The main purpose of this study was to investigate the relationship between the incidence of chronic postoperative pain (at rest and with activity) and sex/age differences.MethodsThis was a single-center retrospective study that included adult patients who had undergone elective thoracic surgery. Patients were divided into two groups based on sex. Demographic and perioperative data were collected, including age, sex, education level, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) physical status, and medical history (hypertension, diabetes mellitus). Chronic postoperative pain data were collected by telephone follow-up.ResultsAmong the 3,159 patients enrolled, 1,762 were male, and 1,397 were female. After creating a matched-pairs cohort, 1,856 patients were analyzed. The incidence of CPTP at rest was 14.9% among males and 17.8% among females (p = 0.090). The incidence of CPTP with activity was 28.4% among males and 35.0% among females (p = 0.002). We analyzed three different models after propensity matching to validate the stability of the prediction model between sex and CPTP, and female sex was a significant predictor of CPTP with activity 3 months after surgery. Further analysis showed that females in the 45-55-year-old age group were more prone to develop CPTP.ConclusionFemales have a higher incidence of chronic postoperative pain with activity after thoracic surgery. Females in the 45-55-year-old age group are more prone to develop CPTP than females in other age groups.

ObjectiveTo determine the feasibility of a multidisciplinary comprehensive feeding intervention to improve the perioperative intake of calories and proteins in patients admitted for elective gastro‐intestinal surgery in a referral hospital. Secondary outcomes examined included feeding route and anthropometrics.MethodsThis is a three‐month quasi‐experimental study of consecutive patients admitted for GI surgery receiving standard hospital nutrition care (n= 46) in 2013 vs. a comprehensive feeding protocol (n=62) in 2014 (Fig. 1). ASPEN nutrition guidelines were used. Data included age, sex, mid‐upper‐arm circumference, weight, height, dietary intake, feeding route, length of stay, and post‐op complications. Calories and protein intake were calculated using a Vietnam Food Analysis software developed by the National Institute of Nutrition (NIN), Vietnam. Body Mass Index (BMI) was calculated in kg/m2 and classified using WHO references. Descriptive analysis and Wilcoxon rank sum tests were used.ResultsParticipants in the standard group were 55.5±14.8 y, 52% female, had a BMI of 18.8±2.7 kg/m2, and length of stay (LOS) was 12.6±5.6 days. Their pre‐op weight, height, and BMI were similar but they differed by MUAC (23.2±3.0 vs. 25.0±2.4 mm, p<0.0001). The intervention group received 30±6 kcals/kg and 1.37±0.27 g protein/kg vs. 15±6 kcals/kg and 0.61±0.26g protein/kg), p<0.0001 in the standard group. Parenteral nutrition was discontinued on day 5 in 61(100%) patients in the intervention vs. 28(65%) in the standard group (P<0.0001). Although there was no significant change in weight and MUAC during the hospitalization, more subjects lost greater than 10 % weight (n=4/46, 91%) in the intervention vs. the standard group (n=62 (100%), p=0.031). No adverse events were identified.ConclusionsThe implementation of an evidence‐based nutrition support feeding protocol is feasible in Vietnam. This study illustrates the impact a multifaceted approach including service, education, and research can have on improving hospital based clinical nutrition in Vietnam.Support or Funding InformationThis study was performed with the Abbott Fund Institute of Nutrition Science: a partnership between Boston University School of Medicine, BMH, the National Institute of Nutrition, Hanoi Medical University, and the Abbott Fund, the philanthropic foundation of Abbott, to advance nutrition care in Vietnam hospitals.

AbstractIn 2021, the International Diabetes Federation (IDF) reported that the prevalence of diabetes in Pakistan was 9.6%, higher than the global average. However, adherence to treatment guidelines, e.g., American Diabetes Association and Pakistan Endocrine Society and prescription patterns for Oral anti-diabetes (OAD), is poorly understood in Pakistan. Therefore, this study aimed to examine the prescribing practices of anti-diabetic medications, an association of lifestyle modification with drugs prescribed, and their effectiveness in preserving ideal glycemic levels in diabetic patients undergoing treatment in tertiary care teaching hospitals in rural and urban Pakistan. In this cross-sectional study, data were collected from prescriptions of outpatient diabetic patients from different rural and urban tertiary care hospitals between October 2021 and February 2022. 388 participants were enrolled in the study for a detailed interview on prescription evaluation and glycemic control. The coinvestigators conducted an interview with the patient and used a pre-validated questionnaire to collect the data. The relationship between following treatment guidelines and clinical and demographic factors was found using chi-square tests for bivariate analyses. The study reported that out of 388, the mean ages of the patients were 48 ± 12.4, and the majority were female. It was observed that 60.1% and 66.5% have uncontrolled fasting and random blood glucose, respectively. The education level of the study participants was also below par to have a complete understanding of the medical condition and self-management therapy. Even though they were taking the right medications—an average prescription regimen included 5.08 medications—52.1% of the studied people had glycated haemoglobin (HbA1c) levels higher than the therapeutic threshold set by the International Diabetes Federation. In this modern era, it was observed that the prescribing trend was still focused on traditional therapeutic options Biguanides, sulfonylureas, and dipeptidyl peptidase-4 inhibitors were prescribed in 64.6% of the patients. A significant association was found between glycemic control and body mass index, adherence to lifestyle modifications, and the number of medications prescribed (p-value < 0.05). The study reveals that Pakistan's prescribing practices do not align with international and national guidelines, leading to a high prevalence of uncontrolled diabetes and widespread use of polypharmacy among patients. To address this issue, policymakers should prioritize establishing a comprehensive national diabetes action plan. Additionally, there is a pressing need to develop diabetes education and awareness programs emphasizing the importance of lifestyle modifications for effective diabetes management.

The Cancer Mukt Jagrukta Abhiyan-Arunachal Pradesh is a joint project by Government of Arunachal Pradesh, Mon Indigenous Culture & Welfare Society, Chabbi Sahayog Foundation and Dev Desh Vaidyakiya Shaikshanik Samajik Pratishthan with the aim to create awareness about cancer prevention, early detection, and treatment among the residents of Arunachal Pradesh. The project will involve conducting awareness campaigns, providing training and education to healthcare professionals, and establishing cancer screening and treatment center's in the state. Cancer incidence and its related mortality has been a public health concern for Arunachal Pradesh in India. However, there is a lack of evidence about the knowledge, attitude and practice (KAP) for cancer risk factors, screening programme and preventive behavior – especially among indigenous tribal populations. A health camp based survey was conducted from 21st November 2023 to 28th November 2023 among an indigenous population of Tawang District Arunachal Pradesh. Snowball sampling was used to enroll 705 participants (233 were male and 472 were female). Univariate and bivariate analyses were conducted using SPSS version 23 to test the hypothesis of KAP. (There is no difference in the level of knowledge / in the attitude / level of practice among study participants with respect to any independent (socio-demographic and other) factors.) The Papumpare Cancer Registry reported the highest cancer density among women and the second highest among men among all population-based cancer registries in India (Indian Council of Medical Research, Report of National Cancer Registry Programme, Bengaluru, India 2020). Knowledge about the cause of cancer and risk factors was poor among the respondents. Attitude towards screening was negative . Practice levels to prevent cancer were also low. More than 50% of the cases were treated outside the state and at private hospitals. Knowledge about cancer symptoms and risk factors was limited in the population. There is a need for more effective health promotion services in the state. Mass screening facilities and behavioral change activities are required and could be disseminated through social media platforms. Our analysis of a north-eastern region of India, which has unique geographical and cultural characteristics, informs future policy designs and other related studies for controlling cancer in the area

Pornography is neither a documentary media genre that documents what real sex in everyday life looks like, nor is it a pedagogical or moral media genre aimed at showing what ideal sex (in terms of health or morality) should look like. Instead, pornography is a fictional media genre that depicts sexual fantasies and explicitly presents naked bodies and sexual activities for the purpose of sexual arousal (Williams, 1989; McKee et al., 2020). Regarding media ethics and media effects, pornography has traditionally been viewed as highly problematic. Pornographic material has been accused of portraying sexuality in unhealthy, morally questionable and often sexist ways, thereby harming performers, audiences, and society at large. In the age of the Internet, pornography has become more diverse, accessible, and widespread than ever (Döring, 2009; Miller et al., 2020). Consequently, the depiction of sexuality in pornography is the focus of a growing number of content analyses of both mass media (e.g., erotic and pornographic novels and movies) and social media (e.g., erotic and pornographic stories, photos and videos shared via online platforms). Typically, pornography’s portrayals of sexuality are examined by measuring the prevalence and frequency of sexual practices and related gender roles via quantitative content analysis (for research reviews see Carrotte et al., 2020; Miller & McBain, 2022). It should be noted that the conceptual differentiation between erotica and pornography is complex and that “pornography” remains an ideologically charged, and often negatively connotated, concept. Hence, the research literature sometimes uses the broader and more neutral term “sexually explicit material” (SEM) in place of “pornographic material” (McKee et al., 2020). Furthermore, it must be emphasized that in the context of content analyses of SEM the focus is typically on legal pornography. Legal visual pornography is produced with adults who have given their informed consent for their image to be recorded, and then disseminated and marketed as SEM. Illegal pornography is usually beyond the scope of media content research, as the acquisition and use of illegal material would be unethical and illegal for researchers (e.g., the analysis of so-called “child pornography”, or what might be more accurately labeled “images of child sexual abuse”). Criminological and forensic research projects are exceptions to this rule. Field of application/theoretical foundation: The theories applied in pornographic media content research primarily come from four academic disciplines: communication science, psychology, sex research, and gender studies. These different theories are fairly similar in their core assumption that pornography users’ sexual cognitions and behaviors are molded by the ways in which sexuality is portrayed in pornographic material. Some of the theories also explain the typical content of pornography and point to the fact that audiences might not only be influenced by pornography but can also shape porn production through their preferences. All theories demand content analyses of pornographic material to back up their predictions. General Media Effects Theories Cultivation Theory and Social Cognitive Theory are the most commonly used media effects theories, irrespective of specific media content. They are often applied to pornographic material. Cultivation Theory (CT) was developed by communication researcher George Gerbner in the 1960s (Gerbner, 1998). CT claims that heavy media users’ perceptions of the prevalence of different societal phenomena (e.g., crimes) are shaped by the prevalence with which these phenomena occur in the media they consume (e.g., cop shows on TV). Applied to pornography, CT predicts that heavy users of pornography will severely overestimate the prevalence of sexual practices that are rare in reality, but widespread in pornography. Young people who lack real life sexual experience are regarded as particularly vulnerable for sexual cultivation effects in terms of biased perceptions of the popularity and normalcy of different performances of sexuality (e.g., name calling and slapping during sex). Another classic media effects theory that is widely adopted in pornography research is psychologist Albert Bandura’s Social Learning Theory (Bandura, 1971), later re-labeled as Social Cognitive Theory (SCT; Bandura, 2001). SCT claims that people imitate the behaviors of media role models. Applied to pornographic material, SCT predicts that media audiences will develop more favorable attitudes towards, and engage more frequently in, sexual behaviors portrayed positively in sexually explicit material. Such sexual imitation effects may influence not only attitudes toward, and engagement in, sex acts represented in pornography (e.g., anal sex), but also gender role behaviors (e.g., men acting dominantly, women acting submissively during sex), safer sex measures (e.g., lack of condom use), bodily appearance (e.g., breast augmentation), and consent communication (e.g., lack of explicitly asking for, or giving, consent to engage in different sex acts). Sexual Media Effects Theories While CT and SCT are broad media effects theories applicable to pornography as well as many other types of media content, Sexual Script Theory and the 3AM specifically address sexual media and their effects. Sexual Script Theory (SST) was developed by sociologists John Gagnon and William Simon in the 1970s (Gagnon & Simon, 1973; Simon & Gagnon, 2003; Wiederman, 2015). SST argues that human sexuality is not merely a biological instinct, but a highly complex set of cognitions and behaviors shaped by symbolic, social and cultural factors: People develop ideas about how to have sex in terms of organized cognitive schemas or “scripts” that reflect intra-psychic desires (e.g., their sexual fantasies), social norms (e.g., peers’ and partners’ sexual expectations), and cultural influences (e.g., representations of sexuality in the media they consume). SST stresses that the intra-psychic, social, and cultural determinants of individuals’ sexual scripts mutually influence each other and can change over time (Simon & Gagnon, 2003). However, in pornography research, usually only the third element of the theory (cultural influences through media representations of sexuality) is considered. Applied to pornography, SST predicts that sexual scripts presented in pornographic material (e.g., spontaneous anal sex with strangers without condoms or overt consent communication) can shape individuals’ sexual scripts. The Acquisition, Activation, and Application Model of Media Sexual Socialization (3AM) was developed more recently by communication researcher Paul Wright as a specification of SST regarding media influence (Wright, 2011). According to the 3AM, sexually explicit media content shapes cognitive schemas of sexuality in three ways: Pornography can foster the creation of new schemas (schema acquisition), it can prime extant schemas (schema activation), and it can facilitate the utilization of extant schemas to inform attitudes and behaviors (schema application). The 3AM differentiates between specific scripting effects of pornography (e.g., engaging in condom-free casual anal sex without sufficient consent communication after having observed this exact sexual script multiple times in pornography) versus abstract scripting effects (e.g., adopting a more permissive sexual worldview after having observed many people engaging in unrestricted sex in pornography). The aforementioned general and sexuality-specific media effects theories have been used predominantly to predict negative (unwanted, harmful) effects such as dangerously distorted views of sexuality and gender roles as well as engagement in risky or violent sexual behaviors, while potential positive effects have been mostly ignored. Only recently, has serious consideration been given to the beneficial effects of pornography use (e.g., sexual identity validation, sexual empowerment, improved couple communication, sexual skill acquisition, etc.) in the research literature (e.g., Döring, 2021; Döring & Mohseni, 2018; Döring et al., 2021; Kohut & Fisher, 2013; Kohut et al., 2017; Miller et al., 2018; Tillmann & Wells, 2022). Depending on specific negative and/or positive effect assumptions, different aspects of the representation of sexuality will be measured (e.g., expressions of aggression during sex or different types of sexual stimulation techniques). Gender Role, Feminist and Queer Theories Typically, analysis of the ways in which sexuality is represented in pornography involves considerations of gender relations, therefore gender role theories and feminist theories of gender (in-)equality are frequently drawn upon (e.g., Eagly, 1987). There are two main reasons for this additional theoretical focus on gender: 1) Most SEM depicts heterosexual encounters, hence the portrayal of sexuality in pornography implies a portrayal of sexual gender relations (Williams, 1989). 2) Gender relations in the media are often asymmetrical, depicting men and women in superior and subordinate positions, respectively. Such patriarchal gender relations are expected to be reflected, or even exaggerated, in pornographic material. Radical feminist approaches in particular characterize pornography as a portrayal of sexual degradation of women by men, that is so harmful to society that it should be prohibited (e.g., MacKinnon, 1991). Other feminist approaches are also critical of asymmetric gender relations in traditional mainstream pornography and call for more gender equality in SEM, such as in feminist pornography (Williams, 1989). Feminist criticism of gender roles and relations in pornography does not address the demographic variable of sex/gender alone, but also covers other diversity dimensions such as age, race/ethnicity, or disability. According to the analytical framework of intersectionality, the subordination and discrimination of women in society and media representations particularly affect those women who have multiple marginalized demographic characteristics (e.g., the representation of white women in pornography differs from that of black or Asian women; Fritz et al. 2021). Queer theory is also concerned with different racial/ethnic and sexual identities of women and their participation and representation in pornography (Ingraham 2013). Content analyses of pornography need to take into consideration that pornography is becoming increasingly diverse (Miller & McBain, 2022). Hence, content analyses need to differentiate between various pornographic sub-genres such as commercial heterosexual mainstream pornography (traditionally targeting men) versus, for example, women-friendly and couple-oriented pornography, feminist pornography, queer pornography, fetish and kink pornography, or authentic amateur and DIY (do it yourself) pornography in the form of visual or text pornography (Döring, 2021; McKee et al., 2008). Gender role, feminist, and queer theories predict that gender relations in mainstream pornography are more asymmetrical, stereotypical and patriarchal than in women- and couple-friendly, feminist and queer pornography. Sexual Fantasy and Desire Theories The above-mentioned effect theories do not address and explain the main intended effect of pornography, namely immediate sexual arousal, pleasure and satisfaction. The theories focus on linking the fictional pornographic content directly with real life opinions and behaviors, but mostly ignore the links between fictional pornographic content and sexual fantasies. Research shows that many sexual fantasies of people of all genders are unrealistic, extreme, clichéd, violent and norm-violating and that norm-violation is often what makes them arousing (e.g., Bivona et al., 2012; Critelli & Bivona, 2008; Joyal, 2015). The same might be true for pornographic content. Hence, measuring pornography, a fictional media genre, against standards of realism, health and morality might not always be in line with the main entertainment purpose of the genre. Erotizing the forbidden and dangerous (e.g, sex with family members, with mysterious strangers, with authority figures, with non-human creatures) is a common trope of sexual fantasies, hence meaningful variables to measure pornographic portrayals of sexuality could be derived from, and related to, theories of sexual fantasy and desire (e.g., Salmon et al., 2019; Stoller, 1985). Indulging in unrealistic and norm-violating fantasies and fictional media contents is part of media entertainment and may not necessarily lead to norm-violating behaviors. Competent media users should be able to differentiate between fiction and reality. Mold Theories versus Mirror Theories When analyzing and criticizing sexuality portrayals in pornography, it is important to realize that media do not just uni-directionally influence public opinions and behaviors (mold theory). Rather, media also bi-directionally reflect existing sexual relations and fantasies (mirror theory). Recent sex surveys, for example, demonstrate that engagement in consensual BDSM (Bondage/Discipline, Dominance/Submission, Sadism/Masochism) practices and rough sex (e.g., name calling, spanking, hair pulling) is fairly widespread in the general population and enjoyed by all genders (e.g., Burch & Salmon, 2019; Herbenick et al., 2021a, 2021b; Strizzi et al., 2022). Hence, it might not always be the adult industry that influences audiences’ sexualities, but also audiences’ sexual interests that influence porn production. Particularly in the digital pornography market, producers and vendors can easily analyze audience preferences through the analysis of search terms and download statistics and adopt their content accordingly. Furthermore, general beauty trends in society (e.g., regarding shaving of pubic and body hair, growing of beards, or multiple tattoos and other body art) might be mirrored in pornography (through its selection and presentation of performers) rather than of generated by it. References/combination with other methods of data collection: Manual quantitative content analyses of pornographic material can be combined with qualitative (e.g., Keft-Kennedy, 2008) as well as computational (e.g., Seehuus et al., 2019) content analyses. Furthermore, content analyses can be complemented with qualitative interviews and quantitative surveys to investigate perceptions and evaluations of the portrayals of sexuality in pornography among pornography’s creators and performers (e.g., West, 2019) and audiences (e.g., Cowan & Dunn, 1994; Hardy et al., 2022; Paasoonen, 2021; Shor, 2022). Additionally, experimental studies are helpful to measure directly how different dimensions of pornographic portrayals of sexuality are perceived and evaluated by recipients, and if and how these portrayals can affect audiences’ sexuality-related thoughts, feelings, and behaviors (e.g., Kohut & Fisher, 2013; Miller et al., 2019). Example studies for manual quantitative content analyses: Acknowledging the multidimensionality and complexity of portrayals of sexuality in pornography, a recent research review identified eight main dimensions of analysis (Miller & McBain, 2022) that are adopted and extended in this DOCA entry as: 1) violence, 2) degradation, 3) sex acts, 4) performer demographics (sex/gender, age, race/ethnicity), 5) performer bodily appearance, 6) safer sex practices, 7) relational context of sex, and 8) consent communication. Example studies and measures for all eight dimensions of pornographic portrayals of sexuality are presented in separate DOCA entries. Eight Dimension of Portrayals of Sexuality in Pornography DOCA entry 1) Violence Portrayals of Sexuality in Pornography: Violence 2) Degradation Portrayals of Sexuality in Pornography: Degradation 3) Sex Acts Portrayals of Sexuality in Pornography: Sex Acts 4) Performer Demographics Portrayals of Sexuality in Pornography: Performer Demographics 5) Performer Bodily Appearance Portrayals of Sexuality in Pornography: Performer Bodily Appearance 6) Safer Sex Practices Portrayals of Sexuality in Pornography: Safer Sex Practices 7) Relational Context of Sex Portrayals of Sexuality in Pornography: Relational Context of Sex 8) Consent Communication Portrayals of Sexuality in Pornography: Consent Communication References Bandura, A. (1971). Social learning theory. General Learning. Bandura, A. (2001). Social cognitive theory of mass communication. Media Psychology, 3(3), 265–299. https://doi.org/10.1207/S1532785XMEP0303_03 Bivona, J. M., Critelli, J. W., & Clark, M. J. (2012). 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Introduction: Bubbles and Sport The ephemeral materiality of bubbles – beautiful, spectacular, and distracting but ultimately fragile – when applied to protect or conserve in the interests of sport-media profit, creates conditions that exacerbate existing inequalities in sport and society. Bubbles are usually something to watch, admire, and chase after in their brief yet shiny lives. There is supposed to be, technically, nothing inside them other than one or more gasses, and yet we constantly refer to people and objects being inside bubbles. The metaphor of the bubble has been used to describe the life of celebrities, politicians in purpose-built capital cities like Canberra, and even leftist, environmentally activist urban dwellers. The metaphorical and material qualities of bubbles are aligned—they cannot be easily captured and are liable to change at any time. In this article we address the metaphorical sporting bubble, which is often evoked in describing life in professional sport. This is a vernacular term used to capture and condemn the conditions of life of elite sportspeople (usually men), most commonly after there has been a sport-related scandal, especially of a sexual nature (Rowe). It is frequently paired with connotatively loaded adjectives like pampered and indulged. The sporting bubble is rarely interrogated in academic literature, the concept largely being left to the media and moral entrepreneurs. It is represented as involving a highly privileged but also pressurised life for those who live inside it. A sporting bubble is a world constructed for its most prized inhabitants that enables them to be protected from insurgents and to set the terms of their encounters with others, especially sport fans and disciplinary agents of the state. The Covid-19 pandemic both reinforced and reconfigured the operational concept of the bubble, re-arranging tensions between safety (protecting athletes) and fragility (short careers, risks of injury, etc.) for those within, while safeguarding those without from bubble contagion. Privilege and Precarity Bubble-induced social isolation, critics argue, encourages a loss of perspective among those under its protection, an entitled disconnection from the usual rules and responsibilities of everyday life. For this reason, the denizens of the sporting bubble are seen as being at risk to themselves and, more troublingly, to those allowed temporarily to penetrate it, especially young women who are first exploited by and then ejected from it (Benedict). There are many well-documented cases of professional male athletes “behaving badly” and trying to rely on institutional status and various versions of the sporting bubble for shelter (Flood and Dyson; Reel and Crouch; Wade). In the age of mobile and social media, it is increasingly difficult to keep misbehaviour in-house, resulting in a slew of media stories about, for example, drunkenness and sexual misconduct, such as when then-Sydney Roosters co-captain Mitchell Pearce was suspended and fined in 2016 after being filmed trying to force an unwanted kiss on a woman and then simulating a lewd act with her dog while drunk. There is contestation between those who condemn such behaviour as aberrant and those who regard it as the conventional expression of youthful masculinity as part of the familiar “boys will be boys” dictum. The latter naturalise an inequitable gender order, frequently treating sportsmen as victims of predatory women, and ignoring asymmetries of power between men and women, especially in homosocial environments (Toffoletti). For those in the sporting bubble (predominantly elite sportsmen and highly paid executives, also mostly men, with an array of service staff of both sexes moving in and out of it), life is reflected for those being protected via an array of screens (small screens in homes and indoor places of entertainment, and even smaller screens on theirs and others’ phones, as well as huge screens at sport events). These male sport stars are paid handsomely to use their skill and strength to perform for the sporting codes, their every facial expression and bodily action watched by the media and relayed to audiences. This is often a precarious existence, the usually brief career of an athlete worker being dependent on health, luck, age, successful competition with rivals, networks, and club and coach preferences. There is a large, aspirational reserve army of athletes vying to play at the elite level, despite risks of injury and invasive, life-changing medical interventions. Responsibility for avoiding performance and image enhancing drugs (PIEDs) also weighs heavily on their shoulders (Connor). Professional sportspeople, in their more reflective moments, know that their time in the limelight will soon be up, meaning that getting a ticket to the sporting bubble, even for a short time, can make all the difference to their post-sport lives and those of their families. The most vulnerable of the small minority of participants in sport who make a good, short-term living from it are those for whom, in the absence of quality education and prior social status, it is their sole likely means of upward social mobility (Spaaij). Elite sport performers are surrounded by minders, doctors, fitness instructors, therapists, coaches, advisors and other service personnel, all supporting athletes to stay focussed on and maximise performance quality to satisfy co-present crowds, broadcasters, sponsors, sports bodies and mass media audiences. The shield offered by the sporting bubble supports the teleological win-at-all-costs mentality of professional sport. The stakes are high, with athlete and executive salaries, sponsorships and broadcasting deals entangled in a complex web of investments in keeping the “talent” pivotal to the “attention economy” (Davenport and Beck)—the players that provide the content for sale—in top form. Yet, the bubble cannot be entirely secured and poor behaviour or performance can have devastating effects, including permanent injury or disability, mental illness and loss of reputation (Rowe, “Scandals and Sport”). Given this fragile materiality of the sporting bubble, it is striking that, in response to the sudden shutdown following the economic and health crisis caused by the 2020 global pandemic, the leaders of professional sport decided to create more of them and seek to seal the metaphorical and material space with unprecedented efficiency. The outcome was a multi-sided tale of mobility, confinement, capital, labour, and the gendering of sport and society. The Covid-19 Gilded Cage Sociologists such as Zygmunt Bauman and John Urry have analysed the socio-politics of mobilities, whereby some people in the world, such as tourists, can traverse the globe at their leisure, while others remain fixed in geographical space because they lack the means to be mobile or, in contrast, are involuntarily displaced by war, so-called “ethnic cleansing”, famine, poverty or environmental degradation. The Covid-19 global pandemic re-framed these matters of mobilities (Rowe, “Subjecting Pandemic Sport”), with conventional moving around—between houses, businesses, cities, regions and countries—suddenly subjected to the imperative to be static and, in perniciously unreflective technocratic discourse, “socially distanced” (when what was actually meant was to be “physically distanced”). The late-twentieth century analysis of the “risk society” by Ulrich Beck, in which the mysterious consequences of humans’ predation on their environment are visited upon them with terrifying force, was dramatically realised with the coming of Covid-19. In another iteration of the metaphor, it burst the bubble of twenty-first century global sport. What we today call sport was formed through the process of sportisation (Maguire), whereby hyper-local, folk physical play was reconfigured as multi-spatial industrialised sport in modernity, becoming increasingly reliant on individual athletes and teams travelling across the landscape and well over the horizon. Co-present crowds were, in turn, overshadowed in the sport economy when sport events were taken to much larger, dispersed audiences via the media, especially in broadcast mode (Nicholson, Kerr, and Sherwood). This lucrative mediation of professional sport, though, came with an unforgiving obligation to generate an uninterrupted supply of spectacular live sport content. The pandemic closed down most sports events and those that did take place lacked the crucial participation of the co-present crowd to provide the requisite event atmosphere demanded by those viewers accustomed to a sense of occasion. Instead, they received a strange spectacle of sport performers operating in empty “cathedrals”, often with a “faked” crowd presence. The mediated sport spectacle under the pandemic involved cardboard cut-out and sex doll spectators, Zoom images of fans on large screens, and sampled sounds of the crowd recycled from sport video games. Confected co-presence produced simulacra of the “real” as Baudrillardian visions came to life. The sporting bubble had become even more remote. For elite sportspeople routinely isolated from the “common people”, the live sport encounter offered some sensory experience of the social – the sounds, sights and even smells of the crowd. Now the sporting bubble closed in on an already insulated and insular existence. It exposed the irony of the bubble as a sign of both privileged mobility and incarcerated athlete work, both refuge and prison. Its logic of contagion also turned a structure intended to protect those inside from those outside into, as already observed, a mechanism to manage the threat of insiders to outsiders. In Australia, as in many other countries, the populace was enjoined by governments and health authorities to help prevent the spread of Covid-19 through isolation and immobility. There were various exceptions, principally those classified as essential workers, a heterogeneous cohort ranging from supermarket shelf stackers to pharmacists. People in the cultural, leisure and sports industries, including musicians, actors, and athletes, were not counted among this crucial labour force. Indeed, the performing arts (including dance, theatre and music) were put on ice with quite devastating effects on the livelihoods and wellbeing of those involved. So, with all major sports shut down (the exception being horse racing, which received the benefit both of government subsidies and expanding online gambling revenue), sport organisations began to represent themselves as essential services that could help sustain collective mental and even spiritual wellbeing. This case was made most aggressively by Australian Rugby League Commission Chairman, Peter V’landys, in contending that “an Australia without rugby league is not Australia”. In similar vein, prominent sport and media figure Phil Gould insisted, when describing rugby league fans in Western Sydney’s Penrith, “they’re lost, because the football’s not on … . It holds their families together. People don’t understand that … . Their life begins in the second week of March, and it ends in October”. Despite misgivings about public safety and equality before the pandemic regime, sporting bubbles were allowed to form, re-form and circulate. The indefinite shutdown of the National Rugby League (NRL) on 23 March 2020 was followed after negotiation between multiple entities by its reopening on 28 May 2020. The competition included a team from another nation-state (the Warriors from Aotearoa/New Zealand) in creating an international sporting bubble on the Central Coast of New South Wales, separating them from their families and friends across the Tasman Sea. Appeals to the mental health of fans and the importance of the NRL to myths of “Australianness” notwithstanding, the league had not prudently maintained a financial reserve and so could not afford to shut down for long. Significant gambling revenue for leagues like the NRL and Australian Football League (AFL) also influenced the push to return to sport business as usual. Sport contests were needed in order to exploit the gambling opportunities – especially online and mobile – stimulated by home “confinement”. During the coronavirus lockdowns, Australians’ weekly spending on gambling went up by 142 per cent, and the NRL earned significantly more than usual from gambling revenue—potentially $10 million above forecasts for 2020. Despite the clear financial imperative at play, including heavy reliance on gambling, sporting bubble-making involved special licence. The state of Queensland, which had pursued a hard-line approach by closing its borders for most of those wishing to cross them for biographical landmark events like family funerals and even for medical treatment in border communities, became “the nation's sporting hub”. Queensland became the home of most teams of the men’s AFL (notably the women’s AFLW season having been cancelled) following a large Covid-19 second wave in Melbourne. The women’s National Netball League was based exclusively in Queensland. This state, which for the first time hosted the AFL Grand Final, deployed sport as a tool in both national sports tourism marketing and internal pre-election politics, sponsoring a documentary, The Sporting Bubble 2020, via its Tourism and Events arm. While Queensland became the larger bubble incorporating many other sporting bubbles, both the AFL and the NRL had versions of the “fly in, fly out” labour rhythms conventionally associated with the mining industry in remote and regional areas. In this instance, though, the bubble experience did not involve long stays in miners’ camps or even the one-night hotel stopovers familiar to the popular music and sport industries. Here, the bubble moved, usually by plane, to fulfil the requirements of a live sport “gig”, whereupon it was immediately returned to its more solid bubble hub or to domestic self-isolation. In the space created between disciplined expectation and deplored non-compliance, the sporting bubble inevitably became the scrutinised object and subject of scandal. Sporting Bubble Scandals While people with a very low risk of spreading Covid-19 (coming from areas with no active cases) were denied entry to Queensland for even the most serious of reasons (for example, the death of a child), images of AFL players and their families socialising and enjoying swimming at the Royal Pines Resort sporting bubble crossed our screens. Yet, despite their (players’, officials’ and families’) relative privilege and freedom of movement under the AFL Covid-Safe Plan, some players and others inside the bubble were involved in “scandals”. Most notable was the case of a drunken brawl outside a Gold Coast strip club which led to two Richmond players being “banished”, suspended for 10 matches, and the club fined $100,000. But it was not only players who breached Covid-19 bubble protocols: Collingwood coaches Nathan Buckley and Brenton Sanderson paid the $50,000 fine imposed on the club for playing tennis in Perth outside their bubble, while Richmond was fined $45,000 after Brooke Cotchin, wife of team captain Trent, posted an image to Instagram of a Gold Coast day spa that she had visited outside the “hub” (the institutionally preferred term for bubble). She was subsequently distressed after being trolled. Also of concern was the lack of physical distancing, and the range of people allowed into the sporting bubble, including babysitters, grandparents, and swimming coaches (for children). There were other cases of players being caught leaving the bubble to attend parties and sharing videos of their “antics” on social media. Biosecurity breaches of bubbles by players occurred relatively frequently, with stern words from both the AFL and NRL leaders (and their clubs) and fines accumulating in the thousands of dollars. Some people were also caught sneaking into bubbles, with Lekahni Pearce, the girlfriend of Swans player Elijah Taylor, stating that it was easy in Perth, “no security, I didn’t see a security guard” (in Barron, Stevens, and Zaczek) (a month later, outside the bubble, they had broken up and he pled guilty to unlawfully assaulting her; Ramsey). Flouting the rules, despite stern threats from government, did not lead to any bubble being popped. The sport-media machine powering sporting bubbles continued to run, the attendant emotional or health risks accepted in the name of national cultural therapy, while sponsorship, advertising and gambling revenue continued to accumulate mostly for the benefit of men. Gendering Sporting Bubbles Designed as biosecurity structures to maintain the supply of media-sport content, keep players and other vital cogs of the machine running smoothly, and to exclude Covid-19, sporting bubbles were, in their most advanced form, exclusive luxury camps that illuminated the elevated socio-cultural status of sportsmen. The ongoing inequalities between men’s and women’s sport in Australia and around the world were clearly in evidence, as well as the politics of gender whereby women are obliged to “care” and men are enabled to be “careless” – or at least to manage carefully their “duty of care”. In Australia, the only sport for women that continued during the height of the Covid-19 lockdown was netball, which operated in a bubble that was one of sacrifice rather than privilege. With minimum salaries of only $30,000 – significantly less than the lowest-paid “rookies” in the AFL – and some being mothers of small children and/or with professional jobs juggled alongside their netball careers, these elite sportswomen wanted to continue to play despite the personal inconvenience or cost (Pavlidis). Not one breach of the netballers out of the bubble was reported, indicating that they took their responsibilities with appropriate seriousness and, perhaps, were subjected to less scrutiny than the sportsmen accustomed to attracting front-page headlines. National Netball League (also known after its Queensland-based naming rights sponsor as Suncorp Super Netball) players could be regarded as fortunate to have the opportunity to be in a bubble and to participate in their competition. The NRL Women’s (NRLW) Premiership season was also completed, but only involved four teams subject to fly in, fly out and bubble arrangements, and being played in so-called curtain-raiser games for the NRL. As noted earlier, the AFLW season was truncated, despite all the prior training and sacrifice required of its players. Similarly, because of their resource advantages, the UK men’s and boy’s top six tiers of association football were allowed to continue during lockdown, compared to only two for women and girls. In the United States, inequalities between men’s and women’s sports were clearly demonstrated by the conditions afforded to those elite sportswomen inside the Women’s National Basketball Association (WNBA) sport bubble in the IMG Academy in Florida. Players shared photos of rodent traps in their rooms, insect traps under their mattresses, inedible food and blocked plumbing in their bubble accommodation. These conditions were a far cry from the luxury usually afforded elite sportsmen, including in Florida’s Walt Disney World for the men’s NBA, and is just one of the many instances of how gendered inequality was both reproduced and exacerbated by Covid-19. Bursting the Bubble As we have seen, governments and corporate leaders in sport were able to create material and metaphorical bubbles during the Covid-19 lockdown in order to transmit stadium sport contests into home spaces. The rationale was the importance of sport to national identity, belonging and the routines and rhythms of life. But for whom? Many women, who still carry the major responsibilities of “care”, found that Covid-19 intensified the affective relations and gendered inequities of “home” as a leisure site (Fullagar and Pavlidis). Rates of domestic violence surged, and many women experienced significant anxiety and depression related to the stress of home confinement and home schooling. During the pandemic, women were also more likely to experience the stress and trauma of being first responders, witnessing virus-related sickness and death as the majority of nurses and care workers. They also bore the brunt of much of the economic and employment loss during this time. Also, as noted above, livelihoods in the arts and cultural sector did not receive the benefits of the “bubble”, despite having a comparable claim to sport in contributing significantly to societal wellbeing. This sector’s workforce is substantially female, although men dominate its senior roles. Despite these inequalities, after the late March to May hiatus, many elite male sportsmen – and some sportswomen - operated in a bubble. Moving in and out of them was not easy. Life inside could be mentally stressful (especially in long stays of up to 150 days in sports like cricket), and tabloid and social media troll punishment awaited those who were caught going “over the fence”. But, life in the sporting bubble was generally preferable to the daily realities of those afflicted by the trauma arising from forced home confinement, and for whom watching moving sports images was scant compensation for compulsory immobility. The ethical foundation of the sparkly, ephemeral fantasy of the sporting bubble is questionable when it is placed in the service of a voracious “media sports cultural complex” (Rowe, Global Media Sport) that consumes sport labour power and rolls back progress in gender relations as a default response to a global pandemic. Covid-19 dramatically highlighted social inequalities in many areas of life, including medical care, work, and sport. For the small minority of people involved in sport who are elite professionals, the only thing worse than being in a sporting bubble during the pandemic was not being in one, as being outside precluded their participation. Being inside the bubble was a privilege, albeit a dubious one. But, as in wider society, not all sporting bubbles are created equal. Some are more opulent than others, and the experiences of the supporting and the supported can be very different. The surface of the sporting bubble may be impermanent, but when its interior is opened up to scrutiny, it reveals some very durable structures of inequality. Bubbles are made to burst. They are, by nature, temporary, translucent structures created as spectacles. As a form of luminosity, bubbles “allow a thing or object to exist only as a flash, sparkle or shimmer” (Deleuze, 52). In echoing Deleuze, Angela McRobbie (54) argues that luminosity “softens and disguises the regulative dynamics of neoliberal society”. The sporting bubble was designed to discharge that function for those millions rendered immobile by home confinement legislation in Australia and around the world, who were having to deal with the associated trauma, risk and disadvantage. 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Rogers, Michael. “Buckley, Sanderson to Pay Pies’ Huge Fine for COVID Breach.” AFL.com.au 1 Aug. 2020. 8 Mar. 2021 <https://www.afl.com.au/news/479118/buckley-sanderson-to-pay-pies-huge-fine-for-COVID-breach>. Richardson, David, and Richard Denniss. “Gender Experiences during the COVID-19 Lockdown: Women Lose from COVID-19, Men to Gain from Stimulus.” The Australia Institute June 2020. 8 Mar. 2021 <https://australiainstitute.org.au/report/gender-experiences-during-the-COVID-19-lockdown>. Rowe, David. “All Sport Is Global: A Hard Lesson from the Pandemic.” Open Forum 28 Mar. 2020. 8 Mar. 2021 <https://www.openforum.com.au/all-sport-is-global-a-hard-lesson-from-the-pandemic>. ———. “And the Winner Is … Television: Spectacle and Sport in a Pandemic.” Open Forum 19 Sep. 2020. 8 Mar. 2021 <https://www.openforum.com.au/and-the-winner-istelevision-spectacle-and-sport-in-a-pandemic>. ———. Global Media Sport: Flows, Forms and Futures. London: Bloomsbury, 2011. ———. “Scandals and Sport.” Routledge Companion to Media and Scandal. Eds. Howard Tumber and Silvio Waisbord. London: Routledge, 2019. 324–32. ———. “Subjecting Pandemic Sport to a Sociological Procedure.” Journal of Sociology 56.4 (2020): 704–13. Schout, David. “Cricket Prepares for Mental Health Challenges Thrown Up by Bubble Life.” The Guardian 8 Nov. 2020. 8 Mar. 2021 <https://www.theguardian.com/sport/2020/nov/08/cricket-prepares-for-mental-health-challenges-thrown-up-by-bubble-life>. Spaaij, Ramón. Sport and Social Mobility: Crossing Boundaries. London: Routledge, 2011. The Sporting Bubble. Dir. Peter Dickson. Nine Network Australia, 2020. Swanston, Tim. “With Coronavirus Limiting Interstate Movement, Queensland Is the Nation’s Sporting Hub—Is That Really Safe?” ABC News 29 Aug. 2020. 8 Mar. 2021 <https://www.abc.net.au/news/2020-08-29/coronavirus-queensland-rules-for-sports-teams-explainer/12542634>. Toffoletti, Kim. “How Is Gender-Based Violence Covered in the Sporting News? An Account of the Australian Football League Sex Scandal.” Women's Studies International Forum 30.5 (2007): 427–38. Urry, John. Mobilities. Cambridge: Polity Press, 2007. Walter, Brad. “From Shutdown to Restart: How NRL Walked Tightrope to Get Season Going Again.” NRL.com 25 May 2020. 8 Mar. 2021 <https://www.nrl.com/news/2020/05/25/from-shutdown-to-restart-how-nrl-walked-tightrope-to-get-season-going-again>. Wade, Lisa. “Rape on Campus: Athletes, Status, and the Sexual Assault Crisis.” The Conversation 7 Mar. 2017. 8 Mar. 2021 <https://theconversation.com/rape-on-campus-athletes-status-and-the-sexual-assault-crisis-72255>. Webster, Andrew. “Sydney Roosters’ Mitchell Pearce Involved in a Drunken Incident with a Dog? And Your Point Is ...?” Sydney Morning Herald 28 Jan. 2016. 8 Mar. 2021 <https://www.smh.com.au/sport/nrl/sydney-roosters-mitchell-pearce-involved-in-a-drunken-incident-with-a-dog-and-your-point-is--20160127-gmfemh.html>. Whittaker, Troy. “Three-Peat Not Driving Broncos in NRLW Grand Final.” NRL.com 24 Oct. 2020. 8 Mar. 2021 <https://www.nrl.com/news/2020/10/24/three-peat-not-driving-broncos-in-nrlw-grand-final>. Yahoo! Sport Staff. “‘Not Okay’: Uproar over ‘Disgusting’ Find inside Quarantine.” Yahoo! Sport 9 July 2020. 8 Mar. 2021 <https://au.sports.yahoo.com/wnba-disturbing-conditions-coronavirus-bubble-slammed-003557243.html>.

Abstract Disclosure: C.C. Low Wang: Research Investigator; Self; Dexcom, Virta Health. R.O. Estacio: None. S. Coronel-Mockler: None. N. Flattery: None. A. McKenzie: Employee; Self; Virta Health. Stock Owner; Self; Virta Health. D. Harrison: Employee; Self; Virta Health. Stock Owner; Self; Virta Health. M.P. Bonaca: Consulting Fee; Self; Audentes. Research Investigator; Self; Abbott Laboratories, Agios Pharmaceuticals, Alexion Pharmaceuticals, Inc., Alnylam, Amgen Inc, Angionetics, Anthos Therapeutics, ARCA Biopharma Inc, Array, AstraZeneca, Atentiv, Better Therapeutics, Bayer, Inc., Bristol-Myers Squibb, Cardiol Therapeutics, CellResearch Corp, CSL Behring, Eidos Therapeutics, EP Trading Company, Esperion Therapeutics, EveryWell, Faraday Pharmaceuticals, Fortress Biotech, HeartFlow, Insmed, Jansen Pharmaceuticals, Lexicon Pharmaceuticals, Inc., Kowa Research, Merck & Co., Moderna, Novo Nordisk, Pfizer, Inc., PhaseBio, PPD Development, Prothena Biosciences, Regeneron Pharmaceuticals, Regio Biosciences, Sanifit Therapeutics, Sanofi, Stealth Biotherapeutics, Wraser, Cambrian Biopharma, Cook Regentech, EPG Communications, Epizon Pharma, Exicon Consulting, Medtronic, Silence Therapeutics, VarmX. Stock Owner; Self; Pfizer, Inc., Medtronic. Introduction: Individuals in rural communities face challenges accessing healthcare. Innovative strategies combining local Community Health Workers (CHW) and virtual digital solutions may be beneficial for improving type 2 diabetes (T2D) care and cardiovascular (CV) risk. Hypothesis: A virtually delivered digitally based intervention will improve glycemic control in individuals with diabetes in rural communities. Methods: The Virta Intervention in CommuniTies in cOloRado (VICTOR)-Pilot Study is designed to examine whether referral to the Virta Intervention (VINT) while integrated into the CHW program Colorado Heart Healthy Solutions (CHHS), a health education program designed to improve cardiovascular risk factors, is feasible, acceptable, and improves hemoglobin A1c (HbA1c). VINT is a low-carbohydrate approach to T2D treatment which is delivered through a continuous remote care platform via a smartphone application; patients receive care from a dedicated Health Coach and Medical Provider to boost efficacy and ensure safety. Adults with T2D age 18-79 yr in rural Colorado enrolled in CHHS and taking one or more antihyperglycemic medications for at least 3 months, with BMI &gt;25 kg/m2, and HbA1c &gt;7.5% were randomized to VINT + CHHS vs CHHS alone. The primary outcome is change in HbA1c from baseline to 3 months. Secondary outcomes include change in body weight, number of diabetes medications, and patient-reported outcomes. The Intervention arm undergoes VINT + CHHS for 6 months, then CHHS alone for 3 months. The Control arm starts with CHHS alone for 3 months, then VINT + CHHS for 3 months, and finally CHHS alone for 3 months. Both groups are assessed at baseline (0), 3, 6 and 9 months. Enrollment for the trial is complete, and the study is ongoing. Results: A total of 48 individuals are enrolled from 2 rural Colorado communities, 25 in the Intervention arm and 23 in the Control arm. Of these, 65% are female, mean age 59.4 years (range 36-77, SD 10.1), 92% white, 4% Hispanic, mean body mass index (BMI) 34.3 kg/m2 (range 25-62, SD 7.0), mean HbA1c 9.0% (range 7.5-14.1%, SD 1.3), mean weight 216.6 lb (range 148-364, SD 46.9), median number of diabetes medications: 2, with 36% of participants on insulin. The primary outcome of change in HbA1c from baseline to 3 months will be assessed in March 2023 and available for reporting at the 2023 Endocrine Society meeting. Conclusion: The VICTOR-Pilot study is evaluating the effect on HbA1c, medication burden, feasibility, and acceptability of a virtual digital dietary intervention to improve glycemic control and risk factor management in patients with type 2 diabetes living in rural communities. The trial has fully enrolled, and the primary end point as well as other key secondary endpoints will be reported. Presentation: Thursday, June 15, 2023

Pornography is a fictional media genre that depicts sexual fantasies and explicitly presents naked bodies and sexual activities for the purpose of sexual arousal (Williams, 1989; McKee et al., 2020). Regarding media ethics and media effects, pornography has traditionally been viewed as highly problematic. Pornographic material has been accused of portraying sexuality in unhealthy, morally questionable and often sexist ways, thereby harming performers, audiences, and society at large. In the age of the Internet, pornography has become more diverse, accessible, and widespread than ever (Döring, 2009; Miller et al., 2020). Consequently, the depiction of sexuality in pornography is the focus of a growing number of content analyses of both mass media (e.g., erotic and pornographic novels and movies) and social media (e.g., erotic and pornographic stories, photos and videos shared via online platforms). Typically, pornography’s portrayals of sexuality are examined by measuring the prevalence and frequency of sexual practices or relational dynamics and related gender roles via quantitative content analysis (for research reviews see Carrotte et al., 2020; Miller & McBain, 2022). This entry focuses on the representation of degradation as one of eight important dimensions of the portrayals of sexuality in pornography. Field of application/theoretical foundation: In the field of pornographic media content research, different theories are used, mainly 1) general media effects theories, 2) sexual media effects theories, 3) gender role, feminist and queer theories, 4) sexual fantasy and desire theories, and different 5) mold theories versus mirror theories. The DOCA entry “Conceptual Overview (Portrayals of Sexuality in Pornography)” introduces all these theories and explains their application to pornography. The respective theories are applicable to the analysis of the depiction of degradation as one dimension of the portrayals of sexuality in pornography. References/combination with other methods of data collection: Manual quantitative content analyses of pornographic material can be combined with qualitative (e.g., Keft-Kennedy, 2008) as well as computational (e.g., Seehuus et al., 2019) content analyses. Furthermore, content analyses can be complemented with qualitative interviews and quantitative surveys to investigate perceptions and evaluations of the portrayals of sexuality in pornography among pornography’s creators and performers (e.g., West, 2019) and audiences (e.g., Cowan & Dunn, 1994; Hardy et al., 2022; Paasoonen, 2021; Shor, 2022). Additionally, experimental studies are helpful to measure directly how different dimensions of pornographic portrayals of sexuality are perceived and evaluated by recipients, and if and how these portrayals can affect audiences’ sexuality-related thoughts, feelings, and behaviors (e.g., Kohut & Fisher, 2013; Miller et al., 2019). Example studies for manual quantitative content analyses: A common research hypothesis states that pornography often depicts sexuality which is degrading towards women (by men). (Conversely, an indicator against degradation is the depiction of sexual agency of women, i.e., representations of women actively initiating and guiding sexual encounters, and enjoying self-determined and reciprocal sex acts.) To test such hypotheses and code pornographic material accordingly, it is necessary to clarify the concept of “degradation” and use valid and reliable measures of different types of degradation. In addition, it is necessary to code the sex/gender of the person depicted as the source and/or the target of the respective degrading act. It is important to note that in the context of pornographic content research, researchers conceptualize degradation differently. Also, it should be noted, that there is some overlap between the variable degradation and the variable violence in the context of pornographic portrayals of sexuality. For example, the depiction of “name calling” in a pornographic scene can be understood as an indicator of “violence” (namely verbal aggression) or of “degradation”. Name calling is covered as verbal aggression (following Fritz et al., 2020; see DOCA entry “Violence (Portrayals of Sexuality in Pornography)”), hence, it is not covered here again as degradation, even though some authors do so (such as Gorman et al., 2010). In general, one can argue that all violent acts – apart from being potentially painful and harmful – have a component of degradation because they put the target of violence in a subordinate role. However, not all degrading acts are violent (e.g., degradation by systematic lack of sexual reciprocity does not entail overt aggression). Coding Material Measure Operationalization (excerpt) Reliability Source Degradation: Degradation in the context of pornography is defined as a depiction of sexuality that is not characterized by mutuality, respect and equal power but instead is characterized by non-reciprocity, inequality, dominance, objectification and dehumanization, usually with men in the superior role and women in the subordinate role (Cowan & Dunn, 1994). Several variables indicating degradation during sex have been developed and are measured together with the sex/gender of persons involved, such as unreciprocated sex (e.g., female performer gives oral sex but does not receive it; male performer orgasms but female performer does not), status inequality (e.g., male performer depicted as older, better educated, more affluent than female performer), expressions of dominance (e.g., male performer ties female performer up or orders her around), objectification (e.g., male performer ejaculates on female performer’s body or face; gaping of the vagina or anus; double penetration of vagina or anus of the female performer) and dehumanization (e.g., male performer urinates on female performer’s body). While consensus can be reached between some researchers and media users that respective sex acts appear degrading to them (Cowan & Dunn, 1994), others disagree and either do not find these acts inherently degrading or recognize that they may be part of sexual fantasies and role play of degradation (Miller & McBain, 2022). Apart from issues of performer health protection, degrading acts are also regarded as relevant in terms of modelling behaviors for audiences. N=45 pornographic videos from 15 different adult websites (3 videos per website) Display of body Being degraded: Actor displayed showing a higher level of nudity in comparison to co-actor(s). Binary coding (1: yes; 2: no). Percentage agreement 100% for all degradation variables in codebook Gorman et al. (2010) Domination Degrading another: Actor displayed showing control and being in the dominating position, i.e. directing the co-actor(s) and the sexual acts. Binary coding (1: yes; 2: no). Submission Being degraded: Actor displayed in the submissive role, i.e. following demands, allowing to be moved in any position. Binary coding (1: yes; 2: no). Ejaculation onto the face Being degraded: Actor’s face or mouth displayed as being ejaculated on. Binary coding (1: yes; 2: no). Exploitation Degrading another: Actor displayed as using another with less power (e.g., due to age, social status, social role) as sexual object. Binary coding (1: yes; 2: no). Lack of reciprocity Degrading another: Actor displayed as disregarding mutuality and reciprocity during sexual acts and focusing only on their own satisfaction. Binary coding (1: yes; 2: no). References Carrotte, E. R., Davis, A. C., & Lim, M. S. (2020). Sexual behaviors and violence in pornography: Systematic review and narrative synthesis of video content analyses. Journal of Medical Internet Research, 22(5), Article e16702. https://doi.org/10.2196/16702 Cowan, G., & Dunn, K. F. (1994). What themes in pornography lead to perceptions of the degradation of women? Journal of Sex Research, 31(1), 11–21. https://doi.org/10.1080/00224499409551726 Döring, N. (2009). The Internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25(5), 1089–1101. https://doi.org/10.1016/j.chb.2009.04.003 Fritz, N., Malic, V. [Vinny], Paul, B., & Zhou, Y. (2020). A descriptive analysis of the types, targets, and relative frequency of aggression in mainstream pornography. Archives of Sexual Behavior, 49(8), 3041–3053. https://doi.org/10.1007/s10508-020-01773-0 Gorman, S., Monk-Turner, E., & Fish, J. N. (2010). Free adult internet web sites: How prevalent are degrading acts? Gender Issues, 27(3-4), 131–145. https://doi.org/10.1007/s12147-010-9095-7 Hardy, J., Kukkonen, T., & Milhausen, R. (2022). Examining sexually explicit material use in adults over the age of 65 years. The Canadian Journal of Human Sexuality, 31(1), 117–129. https://doi.org/10.3138/cjhs.2021-0047 Keft-Kennedy, V. (2008). Fantasising masculinity in Buffyverse slash fiction: Sexuality, violence, and the vampire. Nordic Journal of English Studies, 7(1), 49–80. Kohut, T., & Fisher, W. A. (2013). The impact of brief exposure to sexually explicit video clips on partnered female clitoral self-stimulation, orgasm and sexual satisfaction. The Canadian Journal of Human Sexuality, 22(1), 40–50. https://doi.org/10.3138/cjhs.935 McKee, A., Byron, P., Litsou, K., & Ingham, R. (2020). An interdisciplinary definition of pornography: Results from a global Delphi panel. Archives of Sexual Behavior, 49(3), 1085–1091. https://doi.org/10.1007/s10508-019-01554-4 Miller, D. J., & McBain, K. A. (2022). The content of contemporary, mainstream pornography: A literature review of content analytic studies. American Journal of Sexuality Education, 17(2), 219–256. https://doi.org/10.1080/15546128.2021.2019648 Miller, D. J., McBain, K. A., & Raggatt, P. T. F. (2019). An experimental investigation into pornography’s effect on men’s perceptions of the likelihood of women engaging in porn-like sex. Psychology of Popular Media Culture, 8(4), 365–375. https://doi.org/10.1037/ppm0000202 Miller, D. J., Raggatt, P. T. F., & McBain, K. (2020). A literature review of studies into the prevalence and frequency of men’s pornography use. American Journal of Sexuality Education, 15(4), 502–529. https://doi.org/10.1080/15546128.2020.1831676 Paasonen, S. (2021). “We watch porn for the fucking, not for romantic tiptoeing”: Extremity, fantasy and women’s porn use. Porn Studies, 1–14. https://doi.org/10.1080/23268743.2021.1956366 Seehuus, M., Stanton, A. M., & Handy, A. B. (2019). On the content of "real-world" sexual fantasy: Results from an analysis of 250,000+ anonymous text-based erotic fantasies. Archives of Sexual Behavior, 48(3), 725–737. https://doi.org/10.1007/s10508-018-1334-0 Shor, E. (2022). Who seeks aggression in pornography? Findings from interviews with viewers. Archives of Sexual Behavior, 51(2), 1237–1255. https://doi.org/10.1007/s10508-021-02053-1 West, C. (2019). Pornography and ethics: An interview with porn performer Blath. Porn Studies, 6(2), 264–267. https://doi.org/10.1080/23268743.2018.1505540 Williams, L. (1989). Hard Core: Power, pleasure, and the frenzy of the visible. University of California Press.

Photo by Sharon McCutcheon on Unsplash ABSTRACT COVID-19 highlighted a disproportionate impact upon marginalized communities that needs to be addressed. Specifically, a focus on equity rather than equality would better address and prevent the disparities seen in COVID-19. A distributive justice framework can provide this great benefit but will succeed only if the medical community engages in outreach, anti-racism measures, and listens to communities in need. INTRODUCTION COVID-19 disproportionately impacted communities of color and lower socioeconomic status, sparking political discussion about existing inequities in the US.[1] Some states amended their guidelines for allocating resources, including vaccines, to provide care for marginalized communities experiencing these inequities, but there has been no clear consensus on which guidelines states should amend or how they should be ethically grounded. In part, this is because traditional justice theories do not acknowledge the deep-seated institutional and interpersonal discrimination embedded in our medical system. Therefore, a revamped distributive justice approach that accounts for these shortcomings is needed to guide healthcare decision-making now and into the post-COVID era. BACKGROUND Three terms – health disparity, health inequities, and health equity – help frame the issue. A health disparity is defined as any difference between populations in terms of disease incidence or adverse health events, such as morbidity or mortality. In contrast, health inequities are health disparities due to avoidable systematic structures rooted in racial, social, and economic injustice.[2] For example, current data demonstrate that Black, Latino, Indigenous Americans, and those living in poverty suffer higher morbidity and mortality rates from COVID-19.[3] Finally, health equity is the opportunity for anyone to attain his or her full health potential without interference from systematic structures and factors that generate health inequities, including race, socioeconomic status, gender, ethnicity, religion, sexual orientation, or geography.[4] ANALYSIS Health inequities for people of color with COVID-19 have led to critiques of states that do not account for race in their resource allocation guidelines.[5] For example, the Massachusetts Department of Public Health revised its COVID-19 guidelines regarding resource allocation to patients with the best chance of short-term survival.[6] Critics have argued that this change addresses neither preexisting structural inequities nor provider bias that may have led to comorbidities and increased vulnerability to COVID-19. By failing to address race specifically, they argue the policy will perpetuate poorer outcomes in already marginalized groups. As the inequities in COVID-19 outcomes continue to be uncovered and the data continue to prove that marginalized communities suffered disproportionately, we, as healthcare providers, must reconsider our role in addressing the injustices. Our actions must be ethically grounded in the concept of justice. l. Primary Theories of Justice The principle of justice in medical ethics relates to how we ought to treat people and allocate resources. Multiple theories have emerged to explain how justice should be implemented, with three of the most prominent being egalitarianism, utilitarianism, and distributive. This paper argues that distributive justice is the best framework for remedying past actions and enacting systemic changes that may persistently prevent injustices. An egalitarian approach to justice states all individuals are equal and, therefore, should have identical access to resources. In the allocation of resources, an egalitarian approach would support a strict distribution of equal value regardless of one’s attributes or characteristics. Putting this theory into practice would place a premium on guidelines based upon first-come, first-served basis or random selection.[7] However, the egalitarian approach taken in the UK continues to worsen health inequities due to institutional and structural discrimination.[8] A utilitarian approach to justice emphasizes maximizing overall benefits and achieving the greatest good for the greatest number of people. When resources are limited, the utilitarian principle historically guides decision-making. In contrast to the egalitarian focus on equal distribution, utilitarianism focuses on managing distributions to maximize numerical outcomes. During the COVID-19 pandemic, guidelines for allocating resources had utilitarian goals like saving the most lives, which may prioritize the youthful and those deemed productive in society, followed by the elderly and the very ill. It is important to reconsider using utilitarian approaches as the default in the post-COVID healthcare community. These approaches fail to address past inequity, sacrificing the marginalized in their emphasis on the greatest amount of good rather than the type of good. Finally, a distributive approach to justice mandates resources should be allocated in a manner that does not infringe individual liberties to those with the greatest need. Proposed by John Rawls in a Theory of Justice, this approach requires accounting for societal inequality, a factor absent from egalitarianism and utilitarianism.[9] Naomi Zack elaborates how distributive justice can be applied to healthcare, outlining why racism is a social determinant of health that must be acknowledged and addressed.[10] Until there are parallel health opportunities and better alignment of outcomes among different social and racial groups, the underlying systemic social and economic variables that are driving the disparities must be fixed. As a society and as healthcare providers, we should be striving to address the factors that perpetuate health inequities. While genetics and other variables influence health, the data show proportionately more exposure, more cases, and more deaths in the Black American and Hispanic populations. Preexisting conditions and general health disparities are signs of health inequity that increased vulnerability. Distributive justice as a theoretical and applied framework can be applied to preventable conditions that increase vulnerability and can justify systemic changes to prevent further bias in the medical community. During a pandemic, egalitarian and utilitarian approaches to justice are prioritized by policymakers and health systems. Yet, as COVID-19 has demonstrated, they further perpetuate the death and morbidity of populations that face discrimination. These outcomes are due to policies and guidelines that overall benefit white communities over communities of color. Historically, US policy that looks to distribute resources equally (focusing on equal access instead of outcomes), in a color-blind manner, has further perpetuated poor outcomes for marginalized communities.[11] ll. Historical and Ongoing Disparities Across socio-demographic groups, the medical system exacerbates historical and current inequities. Members of marginalized races,[12] women,[13] LGBTQ people,[14] and poor people[15] experience trauma caused by discrimination, marginalization, and failure to access high-quality public and private goods. Through the unequal treatment of marginalized communities, these historic traumas continue. In the US, people of color do not receive equal and fair medical treatment. A meta-analysis found that Hispanics and Black Americans were significantly undertreated for pain compared to their white counterparts over the last 20 years.[16] This is partly due to provider bias. Through interviewing medical trainees, a study by the National Academy of Science found that half of medical students and residents harbored racist beliefs such as “Black people’s nerve endings are less sensitive than white people’s” or “Black people’s skin is thicker than white people’s skin.”[17] More than 3,000 Indigenous American women were coerced, threatened, and deliberately misinformed to ensure cooperation in forced sterilization.[18] Hispanic people have less support in seeking medical care, in receiving culturally appropriate care, and they suffer from the medical community’s lack of resources to address language barriers.[19] In the US, patients of different sexes do not receive the same quality of healthcare. Despite having greater health needs, middle-aged and older women are more likely to have fewer hospital stays and fewer physician visits compared to men of similar demographics and health risk profiles.[20] In the field of critical care, women are less likely to be admitted to the ICU, less likely to receive interventions such as mechanical ventilation, and more likely to die compared to their male ICU counterparts.[21] In the US, patients of different socioeconomic statuses do not receive the same quality of healthcare. Low-income patients are more likely to have higher rates of infant mortality, chronic disease, and a shorter life span.[22] This is partly due to the insurance-based discrimination in the medical community.[23] One in three deaths of those experiencing homelessness could have been prevented by timely and effective medical care. An individual experiencing homelessness has a life expectancy that is decades shorter than that of the average American.[24] lll. Action Needed: Policy Reform While steps need to be taken to provide equitable care in the current pandemic, including the allocation of vaccines, they may not address the historical failures of health policy, hospital policy, and clinical care to eliminate bias and ensure equal treatment of patients. According to an applied distributive justice framework, inequities must be corrected. Rather than focusing primarily on fair resource allocation, medicine must be actively anti-racist, anti-sexist, anti-transphobic, and anti-discriminatory. Evidence has shown that the health inequities caused by COVID-19 are smaller in regions that have addressed racial wealth gaps through forms of reparations.[25] Distributive justice calls for making up for the past using tools of allocation as well as tools to remedy persistent problems. For example, Brigham and Women’s Hospital in Boston, MA, began “Healing ARC,” a pilot initiative that involves acknowledgement, redress, and closure on an institutional level.[26] Acknowledgement entails informing patients about disparities at the hospital, claiming responsibility, and incorporating community ideas for redress. Redress involves a preferential admission option for Black and Hispanic patients to specialty services, especially cardiovascular services, rather than general medicine. Closure requires that community and patient stakeholders work together to ensure that a new system is in place that will continue to prioritize equity. Of note, redress could take the form of cash transfers, discounted or free care, taxes on nonprofit hospitals that exclude patients of color,[27] or race-explicit protocol changes (such as those being instituted by Brigham and Women’s Hospital that admit patients historically denied access to certain forms of medical care). In New York, for instance, the New York State Bar Association drafted the COVID-19 resolutions to ensure that emergency regulations and guidelines do not discriminate against communities of color, and even mandate that diverse patient populations be included in clinical trials.[28] Also, physicians must listen to individuals from marginalized communities to identify needs and ensure that community members take part in decision-making. The solution is not to simply build new health centers in communities of color, as this may lead to tiers of care. Rather, local communities should have a chance to impact existing hospital policy and should also use their political participation to further their healthcare interests. Distributive justice does not seek to disenfranchise groups that hold power in the system. It aims to transform the system so that those in power do not continue to obtain unfair benefits at the expense of others. The framework accounts for unjust historical oppression and current injustices in our system to provide equitable outcomes to all who access the system. In this vein, we can begin to address the flagrant disparities between communities that have always – and continue to – exist in healthcare today.[29] CONCLUSION As equality focuses on access, it currently fails to do justice. Instead of outcomes, it is time to focus on equity. A focus on equity rather than equality would better address and prevent the disparities seen in COVID-19. A distributive justice framework can gain traction in clinical decision-making guidelines and system-level reallocation of resources but will succeed only if the medical community engages in outreach, anti-racism measures, and listens to communities in need. There should be an emphasis on implementing a distributive justice framework that treats all patients equitably, accounts for historical harm, and focuses on transparency in allocation and public health decision-making. [1] APM Research Lab Staff. 2020. “The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S.” APM Research Lab. https://www.apmresearchlab.org/covid/deaths-by-race. [2] Bharmal, N., K. P. Derose, M. Felician, and M. M. Weden. 2015. “Understanding the Upstream Social Determinants of Health.” California: RAND Corporation 1-18. https://www.rand.org/pubs/working_papers/WR1096.html. [3] Yancy, C. W. 2020. “COVID-19 and African Americans.” JAMA. 323 (19): 1891-2. https://doi.org/10.1001/jama.2020.6548; Centers for Disease Control and Prevention. 2020. “COVID-19 in Racial and Ethnic Health Disparities.” Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html. [4] Braveman, P., E. Arkin, T. Orleans, D. Proctor, and A. Plough. 2017. “What is Health Equity?” Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html. [5] Bedinger, M. 2020 Apr 22. “After Uproar, Mass. Revises Guidelines on Who Gets an ICU Bed or Ventilator Amid COVID-19 Surge.” Wbur. https://www.wbur.org/commonhealth/2020/04/20/mass-guidelines-ventilator-covid-coronavirus; Wigglesworth, A. 2020 May 11. “Institutional Racism, Inequity Fuel High Minority Death Toll from Coronavirus, L.A. Officials Say.” Los Angeles Times. https://www.latimes.com/california/story/2020-05-11/institutional-racism-inequity-high-minority-death-toll-coronavirus. [6] Executive Office of Health and Human Services Department of Public Health. 2020 Oct 20. “Crises Standards of Care Planning and Guidance for the COVID-19 Pandemic.” Commonwealth of Massachusetts. https://www.mass.gov/doc/crisis-standards-of-care-planning-guidance-for-the-covid-19-pandemic. [7] Emanuel, E. J., G. Persad, R. Upshur, et al. 2020. “Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine 382: 2049-55. https://doi.org/10.1056/NEJMsb2005114. [8] Salway, S., G. Mir, D. Turner, G. T. Ellison, L. Carter, and K. Gerrish. 2016. “Obstacles to "Race Equality" in the English National Health Service: Insights from the Healthcare Commissioning Arena.” Social Science and Medicine 152: 102-110. https://doi.org/10.1016/j.socscimed.2016.01.031. [9] Rawls, J. A Theory of Justice (Revised Edition) (Cambridge, MA: Belknap Press of Harvard University Press, 1999). [10] Zack, N. Applicative Justice: A Pragmatic Empirical Approach to Racial Injustice (New York: The Rowman & Littlefield Publishing Group, 2016). [11] Charatz-Litt, C. 1992. “A Chronicle of Racism: The Effects of the White Medical Community on Black Health.” Journal of the National Medical Association 84 (8): 717-25. http://hdl.handle.net/10822/857182. [12] Washington, H. A. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006). [13] d'Oliveira, A. F., S. G. Diniz, and L. B. Schraiber. 2002. “Violence Against Women in Health-care Institutions: An Emerging Problem.” Lancet. 359 (9318): 1681-5. https://doi.org/10.1016/S0140-6736(02)08592-6. [14] Hafeez, H., M. Zeshan, M. A. Tahir, N. Jahan, and S. Naveed. 2017. “Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus 9 (4): e1184. https://doi.org/10.7759/cureus.1184; Drescher, J., A. Schwartz, F. Casoy, et al. 2016. “The Growing Regulation of Conversion Therapy.” Journal of Medical Regulation 102 (2): 7-12. https://doi.org/10.30770/2572-1852-102.2.7; Stroumsa, D. 2014. “The State of Transgender Health Care: Policy, Law, and Medical Frameworks.” American Journal of Public Health. 104 (3): e31-8. https://doi.org/10.2105/AJPH.2013.301789. [15] Stepanikova, I., and G. R. Oates. 2017. “Perceived Discrimination and Privilege in Health Care: The Role of Socioeconomic Status and Race.” American Journal of Preventative Medicine. 52 (1s1): S86-s94. https://doi.org/10.1016/j.amepre.2016.09.024; Swartz, K. “Health Care for the Poor: For Whom, What Care, and Whose Responsibility?” In Cancian, M., and S. Danziger (Eds.). Changing Poverty, Changing Policies (New York: Russell Sage Foundation Press, 2009), 69-74. [16] Meghani, S. H., E. Byun, and R. M. Gallagher. 2012. “Time to Take Stock: A Meta-analysis and Systematic Review of Analgesic Treatment Disparities for Pain in the United States.” Pain Medicine 13 (2): 150-74. https://doi.org/10.1111/j.1526-4637.2011.01310.x; Williams, D. R., and T. D. Rucker. 2000. “Understanding and Addressing Racial Disparities in Health Care.” Health Care Financing Review 21 (4): 75-90. https://scholar.harvard.edu/davidrwilliams/dwilliam/publications/understanding-and-addressing-racial-disparities-health. [17] Hoffman, K. M., S. Trawalter, J. R. Axt, and M. N. Oliver. 2016. “Racial Bias in Pain assessment and treatment recommendations, and false beliefs about biological Differences Between Blacks and Whites.” PNAS 113 (16): 4296-4301. https://doi.org/10.1073/pnas.1516047113. [18] Pacheco, C. M., S. M. Daley, T. Brown, M. Filipp, K. A. Greiner, and C. M. Daley. 2013. “Moving Forward: Breaking the Cycle of Mistrust Between American Indians and Researchers.” American Journal of Public Health. 103 (12): 2152-9. https://doi.org/10.2105/AJPH.2013.301480. [19] Velasco-Mondragon, E., A. Jimenez, A. G. Palladino-Davis, D. Davis, and J. A. Escamilla-Cejudo. 2016. “Hispanic Health in the USA: A Scoping Review of the Literature.” Public Health Reviews 37:31. https://doi.org/10.1186/s40985-016-0043-2. [20] Cameron, K. A., J. Song, L. M. Manheim, and D. D. Dunlop. 2010. “Gender Disparities in Health and Healthcare Use Among Older Adults.” Journal of Women’s Health (Larchmt) 19 (9): 1643-50. https://doi.org/10.1089/jwh.2009.1701. [21] Bierman, A. S. 2007. “Sex Matters: Gender Disparities in Quality and Outcomes of Care. Canadian Medical Association Journal 177 (12): 1520-1. https://doi.org/10.1503/cmaj.071541; Fowler, R. A., S. Sabur, P. Li, et al. 2007. “Sex-and Age-based Differences in the Delivery and Outcomes of Critical Care. Canadian Medical Association Journal 177 (12): 1513-9. https://doi.org/10.1503/cmaj.071112. [22] McLaughlin, D. K., and C. S. Stokes. 2002. “Income Inequality and Mortality in US Counties: Does Minority Racial Concentration Matter?” American Journal of Public Health 92 (1): 99-104. https://doi.org/.10.2105/ajph.92.1.99; Shea, S., J. Lima, A. Diez-Roux, N. W. Jorgensen, and R. L. McClelland. 2016. “Socioeconomic Status and Poor Health Outcome at 10 years of Follow-up in the Multi-ethnic Study of Atherosclerosis.” PLoS One 11 (11): e0165651. https://doi.org/10.1371/journal.pone.0165651. [23] Han, X., K. T. Call, J. K. Pintor, G. Alarcon-Espinoza, and A. B. Simon. 2015. “Reports of Insurance-based Discrimination in Health care and its Association with Access to Care.” American Journal of Public Health 105 Suppl 3 (Suppl 3): S517-25. https://doi.org/10.2105/AJPH.2015.302668. [24] Aldridge, R. W., D. Menezes, D. Lewer, et al. 2019. “Causes of Death Among Homeless People: A Population-based Cross-sectional Study of Linked Hospitalization and Mortality Data in England.” Wellcome Open Research 4:49. https://doi.org/10.12688/wellcomeopenres.15151.1. [25] Richardson, E. T., M. M. Malik, W. A. Darity Jr., et al. 2021. “Reparations for Black American Descendants of Persons Enslaved in the U.S. and their Potential Impact on SARS-CoV-2 Transmission.” Social Science and Medicine 276: 113741. https://doi.org/10.1016/j.socscimed.2021.113741. [26] Wispelwey, B., and M. Morse. 2021. “An Antiracist Agenda for Medicine.” Boston Review. http://bostonreview.net/science-nature-race/bram-wispelwey-michelle-morse-antiracist-agenda-medicine. [27] Johnson, S. F., A. Ojo, and H. J. Warraich. 2021. “Academic Health Centers’ Antiracism Strategies Must Extend to their Business Practices.” Annals of Internal Medicine 174 (2): 254-5. https://doi.org/10.7326/M20-6203; Golub, M., N. Calman, C. Ruddock, et al. 2011. “A Community Mobilizes to End Medical Apartheid.” Progress in Community Health Partnerships: Research, Education, and Action 5 (3): 317-25. https://doi.org/10.1353/cpr.2011.0041. [28] New York State Bar Association. 2020. “New York State Bar Association House of Delegates: Revised COVID-19 Resolutions.” https://nysba.org/app/uploads/2020/10/Final-Health-Law-Section-COVID-19-Resolutions_10-8-20-1-1.pdf. [29] Egede, L. E. 2006. “Race, Ethnicity, Culture, and Disparities in Health Care.” Journal of General Internal Medicine 21 (6): 667-669. https://doi.org/10.1111%2Fj.1525-1497.2006.0512.x

Pornography is a fictional media genre that depicts sexual fantasies and explicitly presents naked bodies and sexual activities for the purpose of sexual arousal (Williams, 1989; McKee et al., 2020). Regarding media ethics and media effects, pornography has traditionally been viewed as highly problematic. Pornographic material has been accused of portraying sexuality in unhealthy, morally questionable and often sexist ways, thereby harming performers, audiences, and society at large. In the age of the Internet, pornography has become more diverse, accessible, and widespread than ever (Döring, 2009; Miller et al., 2020). Consequently, the depiction of sexuality in pornography is the focus of a growing number of content analyses of both mass media (e.g., erotic and pornographic novels and movies) and social media (e.g., erotic and pornographic stories, photos and videos shared via online platforms). Typically, pornography’s portrayals of sexuality are examined by measuring the prevalence and frequency of sexual practices or relational dynamics and related gender roles via quantitative content analysis (for research reviews see Carrotte et al., 2020; Miller & McBain, 2022). This entry focuses on the representation of sex acts as one of eight important dimensions of the portrayals of sexuality in pornography. Field of application/theoretical foundation: In the field of pornographic media content research, different theories are used, mainly 1) general media effects theories, 2) sexual media effects theories, 3) gender role, feminist and queer theories, 4) sexual fantasy and desire theories, and different 5) mold theories versus mirror theories. The DOCA entry “Conceptual Overview (Portrayals of Sexuality in Pornography)” introduces all these theories and explains their application to pornography. The respective theories are applicable to the analysis of the depiction of sex acts as one dimension of portrayals of sexuality in pornography. References/combination with other methods of data collection: Manual quantitative content analyses of pornographic material can be combined with qualitative (e.g., Keft-Kennedy, 2008) as well as computational (e.g., Seehuus et al., 2019) content analyses. Furthermore, content analyses can be complemented with qualitative interviews and quantitative surveys to investigate perceptions and evaluations of the portrayals of sexuality in pornography among pornography’s creators and performers (e.g., West, 2019) and audiences (e.g., Cowan & Dunn, 1994; Hardy et al., 2022; Paasoonen, 2021; Shor, 2022). Additionally, experimental studies are helpful to measure directly how different dimensions of pornographic portrayals of sexuality are perceived and evaluated by recipients, and if and how these portrayals can affect audiences’ sexuality-related thoughts, feelings, and behaviors (e.g., Kohut & Fisher, 2013; Miller et al., 2019). Example studies for manual quantitative content analyses: Common research hypotheses state that pornography depicts sexuality as exaggerated regarding the variety of depicted sex acts, including commonly depicting statistically uncommon acts. More specifically, it is hypothesized, that the typical heterosexual porn script (which often includes oral, vaginal, and anal intercourse altogether in one scene) might normalize, or even prescribe, engagement in oral and anal intercourse in everyday heterosexual encounters. To test such hypotheses and code pornographic material accordingly, it is necessary to clarify the concept of “sex acts” and use valid and reliable measures for different types of sex acts. In addition, it is necessary to code the sex/gender of the person depicted as involved in the respective sex acts in different roles (e.g., giving or receiving oral sex). It is important to note that in the context of pornographic content research, researchers conceptualize sex acts differently. In particular, some researchers categorize some sex acts as violence or degradation, while other researchers cover them as more or less common sexual practices (e.g., “hair pulling” can be understood and coded as violence or as an element of consensual rough sex practices; “name calling” can be understood as verbal aggression or degradation or as an element of consensual dirty talk practices; see DOCA entries “Violence (Portrayals of Sexuality in Pornography)” and “Degradation (Portrayals of Sexuality in Pornography)”). Coding Material Measure Operationalization (excerpt) Reliability Source Sex Acts: Various types of sex acts can be differentiated such as oral sex, spanking or ejaculating on the body (Carrotte et al., 2020). Usually, in pornography research, sex acts related to rough sex and some types of BDSM are categorized as “Violence” (see DOCA entry “Violence (Portrayals of Sexuality in Pornography)”) and sex acts related to paraphilias such as fetishes, kinks and some types of BDSM are categorized as “Degradation” (see DOCA entry “Degradation (Portrayals of Sexuality in Pornography)”). Respective categorizations are based on some observers’ moral evaluations and disregard consent and the pleasure of participants (or that of other observers). Hence, depending on the researcher’s perspective, the full spectrum of consensual sexual activities can be subsumed under “sex acts” or only a sub-set of sexual activities that are regarded as normative and normophilic (Miller & McBain, 2022; Zhou et al., 2019). N=3,053 pornographic videos randomly selected from Xvideos.com Kissing Percentage agreement average across all variables in codebook: 98% Zhou et al. (2019) - Light kissing Light kissing between actors on mouth. Binary coding (1: present; 2: not present). - Deep kissing Deep kissing between actors on mouth. Binary coding (1: present; 2: not present). - Kissing and sucking on body Light and/or deep kissing between actors on mouth and sucking on the other actor’s body. Binary coding (1: present; 2: not present). Manual / digital sexual stimulation - Manual stimulation of penis (type of manual/digital stimulation) Manual stimulation of penis. Binary coding (1: present; 2: not present). - Manual stimulation of vulva and/or vagina (type of manual/digital stimulation) Manual stimulation of vulva and/or vagina. Binary coding (1: present; 2: not present). - Manual stimulation of anus (type of manual/digital stimulation) Manual stimulation of anus. Binary coding (1: present; 2: not present). Oral Sex - Fellatio (type of oral sex) Oral-penile contact between actors. Binary coding (1: present; 2: not present). - Cunnilingus (type of oral sex) Oral-vulva or oral-vaginal contact between actors. Binary coding (1: present; 2: not present). - Anilingus (type of oral sex) Oral-anal contact (a.k.a. rimming) between actors. Binary coding (1: present; 2: not present). Intercourse - Vaginal intercourse (type of intercourse) Penetration of one actor’s vagina by another actor’s penis. Binary coding (1: present; 2: not present). - Anal intercourse (type of intercourse) Penetration of one actor’s anus by another actor’s penis. Binary coding (1: present; 2: not present). N=50 popular pornographic videos from PornHub.com Orgasm - Female orgasm Overt orgasm of female performer, as indicated by the presence of “squirting” or other verbal and nonverbal cues (e.g., facial contortions, moaning, verbal statements communicating orgasm). Binary coding (1: present; 2: not present). Percentage agreement: 92% Séguin et al. (2018) - Male orgasm Overt orgasm of male performer, as indicated by the presence of ejaculate or other verbal and nonverbal cues (e.g., facial contortions, moaning, verbal statements communicating orgasm). Binary coding (1: present; 2: not present). Percentage agreement: 100% The selected sex act variables can be complemented with further variables that go into more detail. For example, for many sex act variables it makes sense to differentiate between the passive/receiving and active/giving role of the performers involved (e.g., receiving oral sex or giving oral sex). Furthermore, in addition to the act of vaginal or anal intercourse different intercourse positions (e.g., lying, sitting, standing positions; woman on top or bottom during intercourse) could be coded. For a discussion of measurement problems and best practice regarding coding female orgasms see Lebedíková (2022).ReferencesCarrotte, E. R., Davis, A. C., & Lim, M. S. (2020). Sexual behaviors and violence in pornography: Systematic review and narrative synthesis of video content analyses. Journal of Medical Internet Research, 22(5), Article e16702. https://doi.org/10.2196/16702Cowan, G., & Dunn, K. F. (1994). What themes in pornography lead to perceptions of the degradation of women? Journal of Sex Research, 31(1), 11–21. https://doi.org/10.1080/00224499409551726Döring, N. (2009). The Internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25(5), 1089–1101. https://doi.org/10.1016/j.chb.2009.04.003Hardy, J., Kukkonen, T., & Milhausen, R. (2022). Examining sexually explicit material use in adults over the age of 65 years. The Canadian Journal of Human Sexuality, 31(1), 117–129. https://doi.org/10.3138/cjhs.2021-0047Keft-Kennedy, V. (2008). Fantasising masculinity in Buffyverse slash fiction: Sexuality, violence, and the vampire. Nordic Journal of English Studies, 7(1), 49–80.Kohut, T., & Fisher, W. A. (2013). The impact of brief exposure to sexually explicit video clips on partnered female clitoral self-stimulation, orgasm and sexual satisfaction. The Canadian Journal of Human Sexuality, 22(1), 40–50. https://doi.org/10.3138/cjhs.935Lebedíková, M. (2022). How much screaming is an orgasm: The problem with coding female climax. Porn Studies, 9(2), 208–223. https://doi.org/10.1080/23268743.2022.2034523McKee, A., Byron, P., Litsou, K., & Ingham, R. (2020). An interdisciplinary definition of pornography: Results from a global Delphi panel. Archives of Sexual Behavior, 49(3), 1085–1091. https://doi.org/10.1007/s10508-019-01554-4Miller, D. J., & McBain, K. A. (2022). The content of contemporary, mainstream pornography: A literature review of content analytic studies. American Journal of Sexuality Education, 17(2), 219–256. https://doi.org/10.1080/15546128.2021.2019648Miller, D. J., McBain, K. A., & Raggatt, P. T. F. (2019). An experimental investigation into pornography’s effect on men’s perceptions of the likelihood of women engaging in porn-like sex. Psychology of Popular Media Culture, 8(4), 365–375. https://doi.org/10.1037/ppm0000202Miller, D. J., Raggatt, P. T. F., & McBain, K. (2020). A literature review of studies into the prevalence and frequency of men’s pornography use. American Journal of Sexuality Education, 15(4), 502–529. https://doi.org/10.1080/15546128.2020.1831676Paasonen, S. (2021). “We watch porn for the fucking, not for romantic tiptoeing”: Extremity, fantasy and women’s porn use. Porn Studies, 1–14. https://doi.org/10.1080/23268743.2021.1956366Seehuus, M., Stanton, A. M., & Handy, A. B. (2019). On the content of "real-world" sexual fantasy: Results from an analysis of 250,000+ anonymous text-based erotic fantasies. Archives of Sexual Behavior, 48(3), 725–737. https://doi.org/10.1007/s10508-018-1334-0Séguin, L. J., Rodrigue, C., & Lavigne, J. (2018). Consuming ecstasy: Representations of male and female orgasm in mainstream pornography. Journal of Sex Research, 55(3), 348-356. https://doi.org/10.1080/00224499.2017.1332152Shor, E. (2022). Who seeks aggression in pornography? Findings from interviews with viewers. Archives of Sexual Behavior, 51(2), 1237–1255. https://doi.org/10.1007/s10508-021-02053-1West, C. (2019). Pornography and ethics: An interview with porn performer Blath. Porn Studies, 6(2), 264–267. https://doi.org/10.1080/23268743.2018.1505540Williams, L. (1989). Hard Core: Power, pleasure, and the frenzy of the visible. University of California Press.Zhou, Y., Paul, B., Malic, V. [Vincent], & Yu, J. (2019). Sexual behavior patterns in online sexually explicit materials: A network analysis. Quality & Quantity, 53(4), 2253–2271. https://doi.org/10.1007/s11135-019-00869-7

Pornography is a fictional media genre that depicts sexual fantasies and explicitly presents naked bodies and sexual activities for the purpose of sexual arousal (Williams, 1989; McKee et al., 2020). Regarding media ethics and media effects, pornography has traditionally been viewed as highly problematic. Pornographic material has been accused of portraying sexuality in unhealthy, morally questionable and often sexist ways, thereby harming performers, audiences, and society at large. In the age of the Internet, pornography has become more diverse, accessible, and widespread than ever (Döring, 2009; Miller et al., 2020). Consequently, the depiction of sexuality in pornography is the focus of a growing number of content analyses of both mass media (e.g., erotic and pornographic novels and movies) and social media (e.g., erotic and pornographic stories, photos and videos shared via online platforms). Typically, pornography’s portrayals of sexuality are examined by measuring the prevalence and frequency of sexual practices or relational dynamics and related gender roles via quantitative content analysis (for research reviews see Carrotte et al., 2020; Miller & McBain, 2022). This entry focuses on the representation of performer bodily appearance as one of eight important dimensions of the portrayals of sexuality in pornography. Field of application/theoretical foundation: In the field of pornographic media content research, different theories are used, mainly 1) general media effects theories, 2) sexual media effects theories, 3) gender role, feminist and queer theories, 4) sexual fantasy and desire theories, and different 5) mold theories versus mirror theories. The DOCA entry “Conceptual Overview (Portrayals of Sexuality in Pornography)” introduces all these theories and explains their application to pornography. The respective theories are applicable to the analysis of the depiction of performer bodily appearance as one dimension of the portrayals of sexuality in pornography. References/combination with other methods of data collection: Manual quantitative content analyses of pornographic material can be combined with qualitative (e.g., Keft-Kennedy, 2008) as well as computational (e.g., Seehuus et al., 2019) content analyses. Furthermore, content analyses can be complemented with qualitative interviews and quantitative surveys to investigate perceptions and evaluations of the portrayals of sexuality in pornography among pornography’s creators and performers (e.g., West, 2019) and audiences (e.g., Cowan & Dunn, 1994; Hardy et al., 2022; Paasoonen, 2021; Shor, 2022). Additionally, experimental studies are helpful to measure directly how different dimensions of pornographic portrayals of sexuality are perceived and evaluated by recipients, and if and how these portrayals can affect audiences’ sexuality-related thoughts, feelings, and behaviors (e.g., Kohut & Fisher, 2013; Miller et al., 2019). Example studies for manual quantitative content analyses: Common research hypotheses state that performers in pornography are mainly selected and presented to conform to gendered norms of sexual attractiveness but also potentially unhealthy beauty standards or current beauty trends. To test such hypotheses and code pornographic material accordingly, it is necessary to clarify the concept of “performer bodily appearance” and use valid and reliable measures for different aspects of appearance. In addition, it is necessary to code the sex/gender of the persons depicted. Two different approaches to coding are available: Direct coding based on the performer’s appearance (e.g., breast size) versus indirect coding based on meta-information about the material, such as the sub-genre pornography category the material belongs to (e.g., the “big tits”, “BBW” [big beautiful women], “tattoed women” categories on PornHub) or statistics provided as part of performer profiles published on online platforms (e.g., height, weight, bra or penis size). Coding Material Measure Operationalization (excerpt) Reliability Source Performer Bodily Appearance: Among the many aspects of performer appearance, those conventionally related to sexual attractiveness are measured most often in the context of pornography research. Researchers may also measure variables related to general beauty trends in society (e.g., shaving of pubic and body hair) or assess aspects of performer appearance which could be consider to promote unhealthy/unrealistic beauty standards (e.g., performers being unhealthily underweight or extremely muscular). Apart from issues of performer health protection, unhealthy standards of beauty and sexual attractiveness are also regarded as relevant in terms of modelling behaviors for audiences. N=50 best-selling pornographic videos and DVDs in Australia in 2003 with 838 sexual scenes Performer body type Performer body type. Polytomous coding (1: unhealthy underweight; 2: slim / undertoned; 3: average (untoned); 4: average (toned); 5: bulked up / very muscular; 6: overweight). Not available McKee et al. (2008) Performer breast size Performer breast size. Polytomous coding (1: smaller than average breasts; 2: average-sized breasts; 3: larger than average breasts). Performer breast surgery Performer breast surgery is obvious. Polytomous coding (1: yes; 2: no; 3: unsure). Performer penis size Performer penis size. Polytomous coding (1: smaller than average penis; 2: average-sized penis; 3: larger than average penis). N > 6,900 performer profiles from 10 gay male adult websites Performer penis size Performer penis size (as listed in performer profile). Polytomous coding (1: 5–6.5 inches; 2: 7–8 inches, 3: 8.5–10 inches, 4: 10.5–13 inches) Not available Brennan (2018) N=50 MILF [“Mother I’d like to fuck” sub-genre category] and 50 “Teen” pornographic videos randomly selected from 10 different adult websites (10 videos per website) Performer pubic hair Performer pubic hair. Polytomous coding (1: none; 2. groomed; 3: natural). Percentage agreement across all variables in codebook: 90.3% Vannier et al. (2014) References Brennan, J. (2018). Size matters: Penis size and sexual position in gay porn profiles. Journal of Homosexuality, 65(7), 912-933. https://doi.org/10.1080/00918369.2017.1364568 Carrotte, E. R., Davis, A. C., & Lim, M. S. (2020). Sexual behaviors and violence in pornography: Systematic review and narrative synthesis of video content analyses. Journal of Medical Internet Research, 22(5), Article e16702. https://doi.org/10.2196/16702 Cowan, G., & Dunn, K. F. (1994). What themes in pornography lead to perceptions of the degradation of women? Journal of Sex Research, 31(1), 11–21. https://doi.org/10.1080/00224499409551726 Döring, N. (2009). The Internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25(5), 1089–1101. https://doi.org/10.1016/j.chb.2009.04.003 Hardy, J., Kukkonen, T., & Milhausen, R. (2022). Examining sexually explicit material use in adults over the age of 65 years. The Canadian Journal of Human Sexuality, 31(1), 117–129. https://doi.org/10.3138/cjhs.2021-0047 Keft-Kennedy, V. (2008). Fantasising masculinity in Buffyverse slash fiction: Sexuality, violence, and the vampire. Nordic Journal of English Studies, 7(1), 49–80. Kohut, T., & Fisher, W. A. (2013). The impact of brief exposure to sexually explicit video clips on partnered female clitoral self-stimulation, orgasm and sexual satisfaction. The Canadian Journal of Human Sexuality, 22(1), 40–50. https://doi.org/10.3138/cjhs.935 McKee, A., Albury, K., & Lumby, C. (2008). The porn report. Melbourne University Press. McKee, A., Byron, P., Litsou, K., & Ingham, R. (2020). An interdisciplinary definition of pornography: Results from a global Delphi panel. Archives of Sexual Behavior, 49(3), 1085–1091. https://doi.org/10.1007/s10508-019-01554-4 Miller, D. J., & McBain, K. A. (2022). The content of contemporary, mainstream pornography: A literature review of content analytic studies. American Journal of Sexuality Education, 17(2), 219–256. https://doi.org/10.1080/15546128.2021.2019648 Miller, D. J., McBain, K. A., & Raggatt, P. T. F. (2019). An experimental investigation into pornography’s effect on men’s perceptions of the likelihood of women engaging in porn-like sex. Psychology of Popular Media Culture, 8(4), 365–375. https://doi.org/10.1037/ppm0000202 Miller, D. J., Raggatt, P. T. F., & McBain, K. (2020). A literature review of studies into the prevalence and frequency of men’s pornography use. American Journal of Sexuality Education, 15(4), 502–529. https://doi.org/10.1080/15546128.2020.1831676 Paasonen, S. (2021). “We watch porn for the fucking, not for romantic tiptoeing”: Extremity, fantasy and women’s porn use. Porn Studies, 1–14. https://doi.org/10.1080/23268743.2021.1956366 Seehuus, M., Stanton, A. M., & Handy, A. B. (2019). On the content of "real-world" sexual fantasy: Results from an analysis of 250,000+ anonymous text-based erotic fantasies. Archives of Sexual Behavior, 48(3), 725–737. https://doi.org/10.1007/s10508-018-1334-0 Shor, E. (2022). Who seeks aggression in pornography? Findings from interviews with viewers. Archives of Sexual Behavior, 51(2), 1237–1255. https://doi.org/10.1007/s10508-021-02053-1 Vannier, S. A., Currie, A. B., & O'Sullivan, L. F. (2014). Schoolgirls and soccer moms: A content analysis of free “teen” and “MILF” online pornography. Journal of Sex Research, 51(3), 253-264. https://doi.org/10.1080/00224499.2013.829795 West, C. (2019). Pornography and ethics: An interview with porn performer Blath. Porn Studies, 6(2), 264–267. https://doi.org/10.1080/23268743.2018.1505540 Williams, L. (1989). Hard Core: Power, pleasure, and the frenzy of the visible. University of California Press.

Pornography is a fictional media genre that depicts sexual fantasies and explicitly presents naked bodies and sexual activities for the purpose of sexual arousal (Williams, 1989; McKee et al., 2020). Regarding media ethics and media effects, pornography has traditionally been viewed as highly problematic. Pornographic material has been accused of portraying sexuality in unhealthy, morally questionable and often sexist ways, thereby harming performers, audiences, and society at large. In the age of the Internet, pornography has become more diverse, accessible, and widespread than ever (Döring, 2009; Miller et al., 2020). Consequently, the depiction of sexuality in pornography is the focus of a growing number of content analyses of both mass media (e.g., erotic and pornographic novels and movies) and social media (e.g., erotic and pornographic stories, photos and videos shared via online platforms). Typically, pornography’s portrayals of sexuality are examined by measuring the prevalence and frequency of sexual practices or relational dynamics and related gender roles via quantitative content analysis (for research reviews see Carrotte et al., 2020; Miller & McBain, 2022). This entry focuses on the representation of performer demographics (such as sex/gender, age, and race/ethnicity) as one of eight important dimensions of the portrayals of sexuality in pornography. Field of application/theoretical foundation: In the field of pornographic media content research, different theories are used, mainly 1) general media effects theories, 2) sexual media effects theories, 3) gender role, feminist and queer theories, 4) sexual fantasy and desire theories, and different 5) mold theories versus mirror theories. The DOCA entry “Conceptual Overview (Portrayals of Sexuality in Pornography)” introduces all these theories and explains their application to pornography. The respective theories are applicable to the analysis of the depiction of performer demographics as one dimension of portrayals of sexuality in pornography. References/combination with other methods of data collection: Manual quantitative content analyses of pornographic material can be combined with qualitative (e.g., Keft-Kennedy, 2008) as well as computational (e.g., Seehuus et al., 2019) content analyses. Furthermore, content analyses can be complemented with qualitative interviews and quantitative surveys to investigate perceptions and evaluations of the portrayals of sexuality in pornography among pornography’s creators and performers (e.g., West, 2019) and audiences (e.g., Cowan & Dunn, 1994; Hardy et al., 2022; Paasoonen, 2021; Shor, 2022). Additionally, experimental studies are helpful to measure directly how different dimensions of pornographic portrayals of sexuality are perceived and evaluated by recipients, and if and how these portrayals can affect audiences’ sexuality-related thoughts, feelings, and behaviors (e.g., Kohut & Fisher, 2013; Miller et al., 2019). Example studies for manual quantitative content analyses: Common research hypotheses in relation to performer demographics state that pornography portrays sexuality in a sexist manner entailing violence towards and degradation of women, usually perpetrated by men. In addition, it is hypothesized that pornographic portrayals of sexuality are asymmetric in terms of showing men in superior and dominating, and women in subordinate and submissive, positions. This sex/gender asymmetry can be reflected in demographic variables such as social status (difference) or age (difference). Furthermore, mainstream pornography is critized for its racist portrayal of sexuality. This means that non-White performers are underrepresented and if they are represented are often depicted according to racial/ethnic stereotypes. To test such hypotheses and code pornographic material accordingly, it is necessary to clarify demographic concepts such as sex/gender, age, and race/ethnicity and use valid and reliable measures. It is important to note that in the context of pornographic content research, researchers conceptualize demographic characteristics differently and that two different approaches to coding are available: Direct coding based on the person’s appearance (e.g., apparent sex/gender, age or skin color) versus indirect coding based on meta-information about the material, such as the sub-genre category the material belongs to (e.g., pornography category “Asian” displaying Asian-looking performers or “Teen” displaying adult performers who look very young). If applying an intersectional theoretical framework (see DOCA entry “Conceptual Overview (Portrayals of Sexuality in Pornography)”) the researcher would need to code each performer in terms of multiple demographic variables. Coding Material Measure Operationalization (excerpt) Reliability Source Sex/gender: Most analyses of the way sexuality is portrayed in pornography hypothesize (or, at least, acknowledge the possibility) that men and women are depicted differently (e.g., that men are more likely to be depicted as the perpetrators of violent behaviors and that women are more likely to be depicted as recipients of violent behaviors). Accordingly, coding the sex/gender of performers is often essential to addressing research questions in this area. The term gender is often preferred when referring to people as groups, as gender reflects a social categorization, whereas sex reflects a biological categorization (American Psychological Association, 2020). While many content analyses of pornography address sex/gender differences they do not present any standardized measures for the demographic variable of sex/gender. The measure presented below is one of the rare exceptions, but it remains vague in its coding instructions and the meanings of the value “other”. N=50 segments (length 20 min. each) from a random sample of 50 bestselling pornographic films (1 segment per film) depicting a total of 1,109 sexual behaviors Sex/gender (based on performer appearance) “Coder’s perception of character’s sex based on primary and secondary sex characteristics.” Polytomous coding (1: male; 2: female; 3: other). Cohen’s Kappa: 1.0 Willis et al. (2020) Age: Performer age may be a variable of interest in its own right (e.g., if investigating whether pornography has a bias toward depicting performers in their early 20s). Alternatively, performer age may be recorded to investigate differential depictions by age group (e.g., investigating whether younger female performers are more likely to be depicted as submissive than older female performers). It should be noted that a performer’s age may be different to their character’s age (as is often the case in the legal pornography category “Teen”, where young characters are played by adult performers; Willis et al, 2020). It should be noted that reliable coding of age (of the performer or of the performed character) is difficult as tools such as make-up, costume, lighting, filters can greatly bias impressions. This problem is reflected in the available measures that cannot ensure sufficient reliability. N=50 best-selling pornographic videos and DVDs in Australia in 2003 with 838 sexual scenes Age of performer (based on performer appearance) Performer age. Polytomous coding (1: 18-30 years; 2: 31-40 years; 3: 41-50 years; 4: 51+ years). Not available McKee et al. (2008) N=50 segments (length 20 min. each) from a random sample of 50 bestselling pornographic films (1 segment per film) depicting a total of 1,109 sexual behaviors Age of character (based on character appearance) “Coder’s perception of character’s age—not the actor’s—based on physical appearance.” Note: some characters were clearly intended to be under 18 years of age, but their actors were likely older. Polytomous coding (1: <18; 2: 18-20; 3: 21-30; 4: 31-40; 5: 41-50; 6: >50 years). Cohen’s Kappa: .47 Willis et al. (2020) Race/Ethnicity: Critical analyses of racism in pornography address the mere visibility of different races/ethnicities as well as racial/ethnic stereotypes, such as Black men being depicted as sexually aggressive and well-endowed or Asian women being depicted as petite, submissive and docile (Miller & McBain, 2022). N=269 popular pornographic videos from different PornHub.com sub-genre categories Race/ethnicity (based on pornographic sub-genre category) Videos selected/coded according to race/ethnicity-related sub-genre categories on PornHub. Polytomous coding (1: “Asian/Japanese” PornHub categeory; 2: “Interracial” PornHub category; 3: “Ebony” PornHub category; 4: “Latina” PornHub category). Not applicable Shor & Seida (2019) N=45 pornographic videos from 15 different adult websites (3 videos per website) Race/ethnicity (based on performer appearance) Performers coded according to physical appearance. Binary coding (1: White; 2: non-White/other race). Not available Gorman et al. (2010) N=50 segments (length 20 min. each) from a random sample of 50 bestselling pornographic films (1 segment per film) depicting a total of 1,109 sexual behaviors Race/ethnicity (based on performer appearance) “Coder’s perception of character’s race based on physical appearance.” Polytomous coding (1: White; 2: Black; 3: Asian; 4: Latina/o; 5: Native American; 6: other). Cohen’s Kappa: .94 Willis et al. (2020) ReferencesAmerican Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.).Carrotte, E. R., Davis, A. C., & Lim, M. S. (2020). Sexual behaviors and violence in pornography: Systematic review and narrative synthesis of video content analyses. Journal of Medical Internet Research, 22(5), Article e16702. https://doi.org/10.2196/16702Cowan, G., & Dunn, K. F. (1994). What themes in pornography lead to perceptions of the degradation of women? Journal of Sex Research, 31(1), 11–21. https://doi.org/10.1080/00224499409551726Döring, N. (2009). The Internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25(5), 1089–1101. https://doi.org/10.1016/j.chb.2009.04.003Gorman, S., Monk-Turner, E., & Fish, J. N. (2010). Free adult internet web sites: How prevalent are degrading acts? Gender Issues, 27(3-4), 131–145. https://doi.org/10.1007/s12147-010-9095-7Hardy, J., Kukkonen, T., & Milhausen, R. (2022). Examining sexually explicit material use in adults over the age of 65 years. The Canadian Journal of Human Sexuality, 31(1), 117–129. https://doi.org/10.3138/cjhs.2021-0047Keft-Kennedy, V. (2008). Fantasising masculinity in Buffyverse slash fiction: Sexuality, violence, and the vampire. Nordic Journal of English Studies, 7(1), 49–80.Kohut, T., & Fisher, W. A. (2013). The impact of brief exposure to sexually explicit video clips on partnered female clitoral self-stimulation, orgasm and sexual satisfaction. The Canadian Journal of Human Sexuality, 22(1), 40–50. https://doi.org/10.3138/cjhs.935McKee, A. (2015). Methodological issues in defining aggression for content analyses of sexually explicit material. Archives of Sexual Behavior, 44(1), 81–87. https://doi.org/10.1007/s10508-013-0253-3McKee, A., Byron, P., Litsou, K., & Ingham, R. (2020). An interdisciplinary definition of pornography: Results from a global Delphi panel. Archives of Sexual Behavior, 49(3), 1085–1091. https://doi.org/10.1007/s10508-019-01554-4Miller, D. J., & McBain, K. A. (2022). The content of contemporary, mainstream pornography: A literature review of content analytic studies. American Journal of Sexuality Education, 17(2), 219–256. https://doi.org/10.1080/15546128.2021.2019648Miller, D. J., McBain, K. A., & Raggatt, P. T. F. (2019). An experimental investigation into pornography’s effect on men’s perceptions of the likelihood of women engaging in porn-like sex. Psychology of Popular Media Culture, 8(4), 365–375. https://doi.org/10.1037/ppm0000202Miller, D. J., Raggatt, P. T. F., & McBain, K. (2020). A literature review of studies into the prevalence and frequency of men’s pornography use. American Journal of Sexuality Education, 15(4), 502–529. https://doi.org/10.1080/15546128.2020.1831676Paasonen, S. (2021). “We watch porn for the fucking, not for romantic tiptoeing”: Extremity, fantasy and women’s porn use. Porn Studies, 1–14. https://doi.org/10.1080/23268743.2021.1956366Seehuus, M., Stanton, A. M., & Handy, A. B. (2019). On the content of "real-world" sexual fantasy: Results from an analysis of 250,000+ anonymous text-based erotic fantasies. Archives of Sexual Behavior, 48(3), 725–737. https://doi.org/10.1007/s10508-018-1334-0Shor, E. (2022). Who seeks aggression in pornography? Findings from interviews with viewers. Archives of Sexual Behavior, 51(2), 1237–1255. https://doi.org/10.1007/s10508-021-02053-1Shor, E., & Seida, K. (2019). "Harder and harder"? Is mainstream pornography becoming increasingly violent and do viewers prefer violent content? Journal of Sex Research, 56(1), 16–28. https://doi.org/10.1080/00224499.2018.1451476West, C. (2019). Pornography and ethics: An interview with porn performer Blath. Porn Studies, 6(2), 264–267. https://doi.org/10.1080/23268743.2018.1505540Williams, L. (1989). Hard Core: Power, pleasure, and the frenzy of the visible. University of California Press.Willis, M., Canan, S. N., Jozkowski, K. N., & Bridges, A. J. (2020). Sexual consent communication in best-selling pornography films: A content analysis. Journal of Sex Research, 57(1), 52–63. https://doi.org/10.1080/00224499.2019.1655522

Pornography is a fictional media genre that depicts sexual fantasies and explicitly presents naked bodies and sexual activities for the purpose of sexual arousal (Williams, 1989; McKee et al., 2020). Regarding media ethics and media effects, pornography has traditionally been viewed as highly problematic. Pornographic material has been accused of portraying sexuality in unhealthy, morally questionable and often sexist ways, thereby harming performers, audiences, and society at large. In the age of the Internet, pornography has become more diverse, accessible, and widespread than ever (Döring, 2009; Miller et al., 2020). Consequently, the depiction of sexuality in pornography is the focus of a growing number of content analyses of both mass media (e.g., erotic and pornographic novels and movies) and social media (e.g., erotic and pornographic stories, photos and videos shared via online platforms). Typically, pornography’s portrayals of sexuality are examined by measuring the prevalence and frequency of sexual practices and related gender roles via quantitative content analysis (for research reviews see Carrotte et al., 2020; Miller & McBain, 2022). This DOCA entry focuses on the representation of violence as one of eight important dimensions of the portrayals of sexuality in pornography. Field of application/theoretical foundation: In the field of pornographic media content research, different theories are used, mainly 1) general media effects theories, 2) sexual media effects theories, 3) gender role, feminist and queer theories, 4) sexual fantasy and desire theories, and different 5) mold theories versus mirror theories. The DOCA entry “Conceptual Overview (Portrayals of Sexuality in Pornography)” introduces all these theories and explains their application to pornography. The respective theories are applicable to the analysis of the depiction of violence as one dimension of the portrayals of sexuality in pornography. References/combination with other methods of data collection: Manual quantitative content analyses of pornographic material can be combined with qualitative (e.g., Keft-Kennedy, 2008) as well as computational (e.g., Seehuus et al., 2019) content analyses. Furthermore, content analyses can be complemented with qualitative interviews and quantitative surveys to investigate perceptions and evaluations of the portrayals of sexuality in pornography among pornography’s creators and performers (e.g., West, 2019) and audiences (e.g., Cowan & Dunn, 1994; Hardy et al., 2022; Paasoonen, 2021; Shor, 2022). Additionally, experimental studies are helpful to measure directly how different dimensions of pornographic portrayals of sexuality are perceived and evaluated by recipients, and if and how these portrayals can affect audiences’ sexuality-related thoughts, feelings, and behaviors (e.g., Kohut & Fisher, 2013; Miller et al., 2019). Example studies for manual quantitative content analyses: Common research hypotheses state that pornography depicts sexuality as violent and shows violent acts such as verbal aggression, physical aggression or image-based abuse being predominately perpetrated by men targeting women. To test such hypotheses and code pornographic material accordingly, it is necessary to clarify the concept of “violence” and use valid and reliable measures for different types of violence. In addition, it is necessary to code the sex/gender of the person depicted as the source and/or the target of the respective violent act (e.g., in the context of verbal sexual aggression, the target of verbal aggression is coded as female or male and the source of verbal aggression is coded as female or male). It is important to note that in the context of pornographic content research, researchers conceptualize violence differently. Also, it should be noted, that there is some overlap between the variable violence and the variable degradation in the context of pornographic portrayals of sexuality. For example, the depiction of “name calling” in a pornographic scene can be understood as an indicator of “violence” (namely verbal aggression) or of “degradation”. Name calling is covered here as verbal aggression (following Fritz et al., 2020), hence, it is not covered again as degradation, even though some authors do so (such as Gorman et al., 2010; see DOCA entry “Degradation (Portrayals of Sexuality in Pornography)”). In general, one can argue that all violent acts – apart from being potentially painful and harmful – have a component of degradation because they put the target of violence in a subordinate role. However, not all degrading acts are violent (e.g., degradation by systematic lack of sexual reciprocity does not entail overt aggression). Coding Material Measure Operationalization (excerpt) Reliability Source Violence: Usually, violence is defined as behavior directed toward the goal of harm or injury of another living being, who is motivated to avoid such treatment (McKee, 2015). However, in content analyses of pornography, violent behavior is often coded regardless of intention to harm or actual harm done. Instead, violence is coded with reference to the presence of prespecified behaviors (e.g., spanking, slapping, choking), even if these behaviors are presented as consensual and sexually arousing (Miller & McBain, 2022). Technology-facilitated sexual violence (image-based sexual abuse) addresses the illegal recording and dissemination of intimate imagery without consent, such as revenge porn, upskirting or spy cams (Henry & Powell, 2018). Mainstream pornography platforms partly disseminate illegal material and partly market some of their legal commercial pornography under these respective labels, hence pretending to provide non-consensual pornography (Vera-Gray et al., 2021). Apart from issues of performer health protection, violent acts are also regarded as relevant in terms of modelling behaviors for audiences. N=4,009 heterosexual scenes from 3,767 pornographic videos sampled from PornHub.com (574 scenes) and and Xvideos. com (3,435 scenes) Verbal aggression “An action that clearly does or could reasonably be expected to cause psychological harm to oneself or another person through name calling or insulting”. Binary coding (1: present; 2: not present). Percentage Agreement: 97.5% (PornHub) / 88.9% (Xvideos) Fritz et al. (2020) Physical aggression “Any action that clearly did or could reasonably be expected to cause physical harm to oneself or another person, regardless of the perpetrator’s intent and the target’s response”. Binary coding (1: present; 2: not present). Percentage Agreement: 98.8% (Pornhub) / 97.6% (Xvideos) - Spanking (type of physical aggression) “Striking on the buttocks with an open hand”. Binary coding (1: present; 2: not present). Percentage Agreement: 94.2% (Pornhub) / 96.9% (Xvideos) - Slapping (type of physical aggression) “Striking oneself or another with an entirely unclosed hand, group of fingers, or palm”. Binary coding (1: present; 2: not present). Percentage Agreement: 99.2% (Pornhub) / 98.1% (Xvideos) - Gagging (type of physical aggression) “Any instance in which an object (including the genitals) is inserted into a person’s mouth, such that it appears to cut off their ability to breathe freely and/or causes them to experience a throat spasm”. Binary coding (1: present; 2: not present). Percentage Agreement: 99.2% (Pornhub) / 96.7% (Xvideos) - Pulling hair (type of physical aggression) “Any instance where the hair on a person’s head is grasped or pulled on, such that the person’s head is pulled (even slightly) in a particular direction”. Binary coding (1: present; 2: not present). Percentage Agreement: 100.0% (Pornhub) / 98.9% (Xvideos) - Choking (type of physical aggression) “To cause another to stop breathing, if only for a moment, by grabbing the throat”. Binary coding (1: present; 2: not present). Percentage Agreement: 98.3% (Pornhub) / 98.8% (Xvideos) - Pushing (type of physical aggression) ‘‘Use of one’s hands, arms, or other body parts to force another person’s body or part of their body to move in a particular manner or direction”. Binary coding (1: present; 2: not present). Percentage Agreement: 95.0% (Pornhub) / 97.9% (Xvideos) N=131,738 titles of pornographic videos presented on the landing pages of the three leading mainstream pornography video platforms in the UK: PornHub.com, Xhamster.com, Xvideos.com Image-based sexual abuse Pornographic video title includes keywords indicating image-based sexual abuse such as “spy”, “hidden”, “upskirting”, “leak” or “revenge”. Binary coding (1: present; 2: not present). Not available Vera-Gray et al. (2021) At the same time, porn platforms may disseminate material without the consent of the depicted persons in such violence-indicating categories, but also in regular sub-genre categories (such as "Threesome", "Handjob"), making it impossible for coders to reliably detect all image-based violence. References Carrotte, E. R., Davis, A. C., & Lim, M. S. (2020). Sexual behaviors and violence in pornography: Systematic review and narrative synthesis of video content analyses. Journal of Medical Internet Research, 22(5), Article e16702. https://doi.org/10.2196/16702 Cowan, G., & Dunn, K. F. (1994). What themes in pornography lead to perceptions of the degradation of women? Journal of Sex Research, 31(1), 11–21. https://doi.org/10.1080/00224499409551726 Döring, N. (2009). The Internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25(5), 1089–1101. https://doi.org/10.1016/j.chb.2009.04.003 Fritz, N., Malic, V. [Vinny], Paul, B., & Zhou, Y. (2020). A descriptive analysis of the types, targets, and relative frequency of aggression in mainstream pornography. Archives of Sexual Behavior, 49(8), 3041–3053. https://doi.org/10.1007/s10508-020-01773-0 Gorman, S., Monk-Turner, E., & Fish, J. N. (2010). Free adult internet web sites: How prevalent are degrading acts? Gender Issues, 27(3-4), 131–145. https://doi.org/10.1007/s12147-010-9095-7 Hardy, J., Kukkonen, T., & Milhausen, R. (2022). Examining sexually explicit material use in adults over the age of 65 years. The Canadian Journal of Human Sexuality, 31(1), 117–129. https://doi.org/10.3138/cjhs.2021-0047 Henry, N., & Powell, A. (2018). Technology-facilitated sexual violence: A literature review of empirical research. Trauma, Violence & Abuse, 19(2), 195–208. https://doi.org/10.1177/1524838016650189 Keft-Kennedy, V. (2008). Fantasising masculinity in Buffyverse slash fiction: Sexuality, violence, and the vampire. Nordic Journal of English Studies, 7(1), 49–80. Kohut, T., & Fisher, W. A. (2013). The impact of brief exposure to sexually explicit video clips on partnered female clitoral self-stimulation, orgasm and sexual satisfaction. The Canadian Journal of Human Sexuality, 22(1), 40–50. https://doi.org/10.3138/cjhs.935 McKee, A. (2015). Methodological issues in defining aggression for content analyses of sexually explicit material. Archives of Sexual Behavior, 44(1), 81–87. https://doi.org/10.1007/s10508-013-0253-3 McKee, A., Byron, P., Litsou, K., & Ingham, R. (2020). An interdisciplinary definition of pornography: Results from a global Delphi panel. Archives of Sexual Behavior, 49(3), 1085–1091. https://doi.org/10.1007/s10508-019-01554-4 Miller, D. J., & McBain, K. A. (2022). The content of contemporary, mainstream pornography: A literature review of content analytic studies. American Journal of Sexuality Education, 17(2), 219–256. https://doi.org/10.1080/15546128.2021.2019648 Miller, D. J., McBain, K. A., & Raggatt, P. T. F. (2019). An experimental investigation into pornography’s effect on men’s perceptions of the likelihood of women engaging in porn-like sex. Psychology of Popular Media Culture, 8(4), 365–375. https://doi.org/10.1037/ppm0000202 Miller, D. J., Raggatt, P. T. F., & McBain, K. (2020). A literature review of studies into the prevalence and frequency of men’s pornography use. American Journal of Sexuality Education, 15(4), 502–529. https://doi.org/10.1080/15546128.2020.1831676 Paasonen, S. (2021). “We watch porn for the fucking, not for romantic tiptoeing”: Extremity, fantasy and women’s porn use. Porn Studies, 1–14. https://doi.org/10.1080/23268743.2021.1956366 Seehuus, M., Stanton, A. M., & Handy, A. B. (2019). On the content of "real-world" sexual fantasy: Results from an analysis of 250,000+ anonymous text-based erotic fantasies. Archives of Sexual Behavior, 48(3), 725–737. https://doi.org/10.1007/s10508-018-1334-0 Shor, E. (2022). Who seeks aggression in pornography? Findings from interviews with viewers. Archives of Sexual Behavior, 51(2), 1237–1255. https://doi.org/10.1007/s10508-021-02053-1 Vera-Gray, F., McGlynn, C., Kureshi, I., & Butterby, K. (2021). Sexual violence as a sexual script in mainstream online pornography. The British Journal of Criminology, 61(5), 1243–1260. https://doi.org/10.1093/bjc/azab035 West, C. (2019). Pornography and ethics: An interview with porn performer Blath. Porn Studies, 6(2), 264–267. https://doi.org/10.1080/23268743.2018.1505540 Williams, L. (1989). Hard Core: Power, pleasure, and the frenzy of the visible. University of California Press.

Introduction It is now commonplace for babies to begin their lives inhabiting media environments characterised by the presence, distribution, and mobility of digital devices and screens. Such arrangements can be traced, in part, to the birth of a new regime of mobile and touchscreen media beginning with the release of the iPhone in 2007 and the iPad in 2010, which stimulated a surge in household media consumption, underpinned by broadband and wireless Internet infrastructures. Research into these conditions of ambient mediation at the beginnings of life, however, is currently dominated by medical and educational literature, largely removed from media studies approaches that seek to understand the everyday contexts of babies using media. Putting aside discourses of promise or peril familiar to researchers of children’s media (Buckingham; Postman), this paper draws on ongoing research in both domestic and social media settings exploring infants’ everyday encounters and entanglements with mobile media and communication technologies. The paper identifies the ways infants’ mobile communication is assembled and distributed through touchscreen interfaces, proxy parent users, and commercial software sorting. It argues that within these interfacial, intermediary, and interactive contexts, we can conceptualise infants’ communicative agency through an emerging repertoire of techniques: accidental, assisted and automated. This assemblage of infant communication recognises that children no longer live with but in media (Deuze), which underscores the impossibility of a path of media resistance found in medical discourses of ‘exposure’ and restriction, and instead points to the need for critical and ethical responses to these immanent conditions of infant media life. Background and Approach Infants, understandably, have largely been excluded from analyses of mobile mediality given their historically limited engagement with or capacity to use mobile media. Yet, this situation is undergoing change as mobile devices become increasingly prominent in children’s homes (OfCom; Rideout), and as touchscreen interfaces lower thresholds of usability (Buckleitner; Hourcade et al.). The dominant frameworks within research addressing infants and media continue to resonate with long running and widely circulated debates in the study of children and mass media (Wartella and Robb), responding in contradictory ways to what is seen as an ever-increasing ‘technologization of childhood’ (McPake, Plowman and Stephen). Education research centres on digital literacy, emphasising the potential of mobile computing for these future digital learners, labourers, and citizens (McPake, Plowman and Stephen). Alternatively, health research largely positions mobile media within the rubric of ‘screen time’ inherited from older broadcast models, with paediatric groups continuing to caution parents about the dangers of infants’ ‘exposure’ to electronic screens (Strasburger and Hogan), without differentiating between screen types or activities. In turn, a range of digital media channels seek to propel or profit from infant media culture, with a number of review sites, YouTube channels and tech blogs promoting or surveying the latest gadgets and apps for babies. Within media studies, research is beginning to analyse the practices, conceptions and implications of digital interfaces and content for younger children. Studies are, for example, quantifying the devices, activities, and time spent by young children with mobile devices (Ofcom; Rideout), reviewing the design and marketing of children’s mobile application software products (e.g. Shuler), analysing digital content shared about babies on social media platforms (Kumar & Schoenebeck; Morris), and exploring emerging interactive spaces and technologies shaping young children’s ‘postdigital’ play (Giddings; Jayemanne, Nansen and Apperley). This paper extends this growing area of research by focusing specifically on infants’ early encounters, contexts, and configurations of mobile mediality, offering some preliminary analysis of an emerging repertoire of mobile communication techniques: accidental, assisted, and automated. That is, through infants playing with devices and accidentally activating them; through others such as parents assisting use; and through software features in applications that help to automate interaction. This analysis draws from an ongoing research project exploring young children’s mobile and interactive media use in domestic settings, which is employing ethnographic techniques including household technology tours and interviews, as well as participant observation and demonstrations of infant media interaction. To date 19 families, with 31 children aged between 0 and 5, located in Melbourne, Australia have participated. These participating families are largely homogeneous and privileged; though are a sample of relatively early and heavy adopters that reveal emerging qualities about young children’s changing media environments and encounters. This approach builds on established traditions of media and ethnographic research on technology consumption and use within domestic spaces (e.g. Mackay and Ivey; Silverstone and Hirsch), but turns to the digital media encountered by infants, the geographies and routines of these encounters, and how families mediate these encounters within the contexts of home life. This paper offers some preliminary findings from this research, drawing mostly from discussions with parents about their babies’ use of digital, mobile, and touchscreen media. In this larger project, the domestic and family research is accompanied by the collection of online data focused on the cultural context of, and content shared about, infants’ mobile media use. In this paper I report on social media analysis of publicly shared images tagged with #babyselfie queried from Instagram’s API. I viewed all publicly shared images on Instagram tagged with #babyselfie, and collected the associated captions, comments, hashtags, and metadata, over a period of 48 hours in October 2014, resulting in a dataset of 324 posts. Clearly, using this data for research purposes raises ethical issues about privacy and consent given the posts are being used in an unintended context from which they were originally shared; something that is further complicated by the research focus on young children. These issues, in which the ease of extracting online data using digital methods research (Rogers), needs to be both minimised and balanced against the value of the research aims and outcomes (Highfield and Leaver). To minimise risks, captions and comments cited in this paper have been de-identified; whist the value of this data lies in complementing and contextualising the more ethnographically informed research, despite perceptions of incompatibility, through analysis of the wider cultural and mediated networks in which babies’ digital lives are now shared and represented. This field of cultural production also includes analysis of examples of children’s software products from mobile app stores that support baby image capture and sharing, and in particular in this paper discussion of the My Baby Selfie app from the iTunes App Store and the Baby Selfie app from the Google Play store. The rationale for drawing on these multiple sources of data within the larger project is to locate young children’s digital entanglements within the diverse places, platforms and politics in which they unfold. This research scope is limited by the constraints of this short paper, however different sources of data are drawn upon here in order to identify, compare, and contextualise the emerging themes of accidental, assisted, and automated. Accidental Media Use The domestication and aggregation of mobile media in the home, principally laptops, mobile phones and tablet computers has established polymediated environments in which infants are increasingly surrounded by mobile media; in which they often observe their parents using mobile devices; and in which the flashing of screens unsurprisingly draws their attention. Living within these ambient media environments, then, infants often observe, find and reach for mobile devices: on the iPad or whatever, then what's actually happening in front of them, then naturally they'll gravitate towards it. These media encounters are animated by touchscreens interfaces that are responsive to the gestural actions of infants. Conversely, touchscreen interfaces drive attempts to swipe legacy media screens. Underscoring the nomenclature of ‘natural user interfaces’ within the design and manufacturer communities, screens lighting up through touch prompts interest, interaction, and even habituation through gestural interaction, especially swiping: It's funny because when she was younger she would go up the T.V. and she would try swiping to turn the channel.They can grab it and start playing with it. It just shows that it's so much part of their world … to swipe something. Despite demonstrable capacities of infants to interact with mobile screens, discussions with parents revealed that accidental forms of media engagement were a more regular consequence of these ambient contexts, interfacial affordances and early encounters with mobile media. It was not uncommon for infants to accidentally swipe and activate applications, to temporarily lock the screen, or even to dial contacts: He didn't know the password, and he just kept locking it … find it disabled for 15 minutes.If I've got that on YouTube, they can quite quickly get on to some you know [video] … by pressing … and they don't do it on purpose, they're just pushing random buttons.He does Skype calls! I think he recognizes their image, the icon. Then just taps it and … Similarly, in the analysis of publicly shared images on Instagram tagged with #babyselfie, there were instances in which it appeared infants had accidentally taken photos with the cameraphone based on the image content, photo framing or descriptions in the caption. Many of these photos showed a baby with an arm in view reaching towards the phone in a classic trope of a selfie image; others were poorly framed shots showing parts of baby faces too close to the camera lens suggesting they accidentally took the photograph; whilst most definitive was many instances in which the caption of the image posted by parents directly attributed the photographic production to an infant: Isabella's first #babyselfie She actually pushed the button herself! My little man loves taking selfies lol Whilst, then, the research identified many instances in which infants accidentally engaged in mobile media use, sometimes managing to communicate with an unsuspecting interlocutor, it is important to acknowledge such encounters could not have emerged without the enabling infrastructure of ambient media contexts and touchscreen interfaces, nor observed without studying this infrastructure utilising materially-oriented ethnographic perspectives (Star). Significantly, too, was the intermediary role played by parents. With parents acting as intermediaries in household environments or as proxy users in posting content on their behalf, multiple forms of assisted infant communication were identified. Assisted Media Use Assisted communication emerged from discussions with parents about the ways, routines, and rationale for making mobile media available to their children. These sometimes revolved around keeping their child engaged whilst they were travelling as a family – part of what has been described as the pass-back effect – but were more frequently discussed in terms of sharing and showing digital content, especially family photographs, and in facilitating infant mediated communication with relatives abroad: they love scrolling through my photos on my iPhone …We quite often just have them [on Skype] … have the computers in there while we're having dinner … the laptop will be there, opened up at one end of the table with the family here and there will be my sister having breakfast with her family in Ireland … These forms of parental mediated communication did not, however, simply situate or construct infants as passive recipients of their parents’ desires to make media content available or their efforts to establish communication with extended family members. Instead, the research revealed that infants were often active participants in these processes, pushing for access to devices, digital content, and mediated communication. These distributed relations of agency were expressed through infants verbal requests and gestural urging; through the ways parents initiated use by, for example, unlocking a device, preparing software, or loading an application, but then handed them over to infants to play, explore or communicate; and through wider networks of relations in which others including siblings, acted as proxies or had a say in the kinds of media infants used: she can do it, once I've unlocked … even, even with iView, once I'm on iView she can pick her own show and then go to the channel she wants to go to.We had my son’s birthday and there were some photos, some footage of us singing happy birthday and the little one just wants to watch it over and over again. She thinks it's fantastic watching herself.He [sibling] becomes like a proxy user … with the second one … they don't even need the agency because of their sibling. Similarly, the assisted communication emerging from the analysis of #babyselfie images on Instagram revealed that parents were not simply determining infant media use, but often acting as proxies on their behalf. #Selfie obsessed baby. Seriously though. He won't stop. Insists on pressing the button and everything. He sees my phone and points and says "Pic? Pic?" I've created a monster lol. In sharing this digital content on social networks, parents were acting as intermediaries in the communication of their children’s digital images. Clearly they were determining the platforms and networks where these images were published online, yet the production of these images was more uncertain, with accidental self-portraits taken by infants suggesting they played a key role in the circuits of digital photography distribution (van Dijck). Automated Media Use The production, archiving, circulation and reception of these images speaks to larger assemblages of media in which software protocols and algorithms are increasingly embedded in and help to configure everyday life (e.g. Chun; Gillespie), including young children’s media lives (Ito). Here, software automates process of sorting and shaping information, and in doing so both empowers and governs forms of infant media conduct. The final theme emerging from the research, then, is the identification of automated forms of infant mobile media use enabled through software applications and algorithmic operations. Automated techniques of interaction emerged as part of the repertoire of infant mobile mediality and communication through observations and discussions during the family research, and through surveying commercial software applications. Within family discussions, parents spoke about the ways digital databases and applications facilitated infant exploration and navigation. These included photo galleries stored on mobile devices, as well as children’s Internet television services such as the Australian Broadcasting Corporation’s catch-up online TV service, iView, which are visually organised and easily scrollable. In addition, algorithmic functions for sorting, recommending and autoplay on the video-sharing platform YouTube meant that infants were often automatically delivered an ongoing stream of content: They just keep watching it [YouTube]. So it leads on form the other thing. Which is pretty amazing, that's pretty interactive.Yeah, but the kids like, like if they've watched a YouTube clip now, they'll know to look down the next column to see what they want to play next … you get suggestions there so. Forms of automated communication specifically addressing infants was also located in examples of children’s software products from mobile app stores: the My Baby Selfie app from the iTunes App Store and the Baby Selfie app from the Google Play store. These applications are designed to support baby image capture and sharing, promising to “allow your baby to take a photo of him himself [sic]” (Giudicelli), based on automated software features that use sounds and images to capture a babies attention and touch sensors to activate image capture and storage. In one sense, these applications may appear to empower infants to participate in the production of digital content, namely selfies, yet they also clearly distribute this agency with and through mobile media and digital software. Moreover, they imply forms of conduct, expectations and imperatives around the possibilities of infant presence in a participatory digital culture. Immanent Ethic and Critique Digital participation typically assumes a degree of individual agency in deciding what to share, post, or communicate that is not typically available to infants. The emerging communicative practices of infants detailed above suggests that infants are increasingly connecting, however this communicative agency is distributed amongst a network of ambient devices, user-friendly interfaces, proxy users, and software sorting. Such distributions reflect conditions Deuze has noted, that we do not live with but in media. He argues this ubiquity, habituation, and embodiment of media and communication technologies pervade and constitute our lives becoming effectively invisible, negating the possibility of an outside from which resistance can be mounted. Whilst, resistance remains a solution promoted in medical discourses and paediatric advice proposing no ‘screen time’ for children aged below two (Strasburger and Hogan), Deuze’s thesis suggests this is ontologically futile and instead we should strive for a more immanent relation that seeks to modulate choices and actions from within our media life: finding “creative ways to wield the awesome communication power of media both ethically and aesthetically” ("Unseen" 367). An immanent ethics and a critical aesthetics of infant mediated life can be located in examples of cultural production and everyday parental practice addressing the arrangements of infant mobile media and communication discussed above. For example, an article in the Guardian, ‘Toddlers pose a serious risk to smartphones and tablets’ parodies moral panics around children’s exposure to media by noting that media devices are at greater risk of physical damage from children handling them, whilst a design project from the Eindhoven Academy – called New Born Fame – built from soft toys shaped like social media logos, motion and touch sensors that activate image capture (much like babyselfie apps), but with automated social media sharing, critically interrogates the ways infants are increasingly bound-up with the networked and algorithmic regimes of our computational culture. Finally, parents in this research revealed that they carefully considered the ethics of media in their children’s lives by organising everyday media practices that balanced dwelling with new, old, and non media forms, and by curating their digitally mediated interactions and archives with an awareness they were custodians of their children’s digital memories (Garde-Hansen et al.). I suggest these examples work from an immanent ethical and critical position in order to make visible and operate from within the conditions of infant media life. Rather than seeking to deny or avoid the diversity of encounters infants have with and through mobile media in their everyday lives, this analysis has explored the ways infants are increasingly configured as users of mobile media and communication technologies, identifying an emerging repertoire of infant mobile communication techniques. The emerging practices of infant mobile communication outlined here are intertwined with contemporary household media environments, and assembled through accidental, assisted, and automated relations of living with mobile media. Moreover, such entanglements of use are both represented and discursively reconfigured through multiple channels, contexts, and networks of public mediation. Together, these diverse contexts and forms of conduct have implications for both studying and understanding the ways babies are emerging as active participants and interpellated subjects within a continually expanding digital culture. Acknowledgments This research was supported with funding from the Australian Research Council (ARC) Discovery Early Career Researcher Award (DE130100735). I would like to express my appreciation to the children and families involved in this study for their generous contribution of time and experiences. References Buckingham, David. After the Death of Childhood: Growing Up in the Age of Electronic Media. Polity Press: Oxford, 2000. Buckleitner, Warren. “A Taxonomy of Multi-Touch Interaction Styles, by Stage.” Children's Technology Review 18.11 (2011): 10-11. Chun, Wendy. Programmed Visions: Software and Memory. Cambridge: MIT Press, 2011. Deuze, Mark. “Media Life.” Media, Culture and Society 33.1 (2011): 137-148. Deuze, Mark. “The Unseen Disappearance of Invisible Media: A Response to Sebastian Kubitschko and Daniel Knapp.” Media, Culture and Society 34.3 (2012): 365-368. Garde-Hansen, Joanne, Andrew Hoskins and Anna Reading. Save as … Digital Memories. Hampshire: Palgrave Macmillan, 2009. Giddings, Seth. Gameworlds: Virtual Media and Children’s Everyday Play. New York: Bloomsbury, 2014. Gillespie, Tarleton. “The Relevance of Algorithms.” Media Technologies: Essays on Communication, Materiality, and Society. Eds. Tarelton Gillespie, Pablo Boczkowski and Kirsten Foot. Cambridge: MIT Press, 2014. Giudicelli, Patrick. "My Baby Selfie." iTunes App Store. Apple Inc., 2015. Highfield, Tim, and Tama Leaver. “A Methodology for Mapping Instagram Hashtags.” First Monday 20.1 (2015). Hourcade, Juan Pablo, Sarah Mascher, David Wu, and Luiza Pantoja. “Look, My Baby Is Using an iPad! An Analysis of Youtube Videos of Infants and Toddlers Using Tablets.” Proceedings of CHI 15. New York: ACM Press, 2015. 1915–1924. Ito, Mizuko. Engineering Play: A Cultural History of Children’s Software. Cambridge: MIT Press, 2009. Jayemanne, Darshana, Bjorn Nansen and Thomas Apperley. “Post-Digital Play and the Aesthetics of Recruitment.” Proceedings of Digital Games Research Association (DiGRA) 2015. Lüneburg, 14-17 May 2015. Kumar, Priya, and Sarita Schoenebeck. “The Modern Day Baby Book: Enacting Good Mothering and Stewarding Privacy on Facebook.” Proceedings of CSCW 2015. Vancouver, 14-18 March 2015. Mackay, Hugh, and Darren Ivey. Modern Media in the Home: An Ethnographic Study. Rome: John Libbey, 2004. Morris, Meredith. “Social Networking Site Use by Mothers of Young Children.” Proceedings of CSCW 2014. 1272-1282. OfCom. Children and Parents: Media Use and Attitudes Report. London: OfCom, 2013. McPake, Joanna, Lydia Plowman and Christine Stephen. "The Technologisation of Childhood? Young Children and Technology in The Home.” Children and Society 24.1 (2010): 63–74. Postman, Neil. Technopoly: The Surrender of Culture to Technology. New York: Vintage, 1993. Rideout, Victoria. Zero to Eight: Children’s Media Use in America 2013. Common Sense Media, 2013. Rogers, Richard. Digital Methods. Boston. MIT Press, 2013. Silverstone, Roger, and Eric Hirsch (eds). Consuming Technologies: Media and Information in Domestic Spaces. London: Routledge, 1992. Shuler, Carly. iLearn: A Content Analysis of the iTunes App Store’s Education Section. New York: The Joan Ganz Cooney Center at Sesame Workshop, 2009. Star, Susan Leigh. “The Ethnography of Infrastructure.” American Behavioral Scientist 43.3 (1999): 377–391. Strasburger, Victor, and Marjorie Hogan. “Policy Statement from the American Academy of Pediatrics: Children, Adolescents, and the Media.” Pediatrics 132 (2013): 958-961. Van Dijck, José. “Digital Photography: Digital Photography: Communication, Identity, Memory.” Visual Communication 7.1 (2008): 57-76. Wartella, Ellen, and Michael Robb. “Historical and Recurring Concerns about Children’s Use of the Mass Media.” The Handbook of Children, Media, and Development. Eds. Sandra Calvert and Barbara Wilson. Malden: Blackwell, 2008.

Pornography is a fictional media genre that depicts sexual fantasies and explicitly presents naked bodies and sexual activities for the purpose of sexual arousal (Williams, 1989; McKee et al., 2020). Regarding media ethics and media effects, pornography has traditionally been viewed as highly problematic. Pornographic material has been accused of portraying sexuality in unhealthy, morally questionable and often sexist ways, thereby harming performers, audiences, and society at large. In the age of the Internet, pornography has become more diverse, accessible, and widespread than ever (Döring, 2009; Miller et al., 2020). Consequently, the depiction of sexuality in pornography is the focus of a growing number of content analyses of both mass media (e.g., erotic and pornographic novels and movies) and social media (e.g., erotic and pornographic stories, photos and videos shared via online platforms). Typically, pornography’s portrayals of sexuality are examined by measuring the prevalence and frequency of sexual practices or relational dynamics and related gender roles via quantitative content analysis (for research reviews see Carrotte et al., 2020; Miller & McBain, 2022). This entry focuses on the representation of consent communication as one of eight important dimensions of the portrayals of sexuality in pornography. Field of application/theoretical foundation: In the field of pornographic media content research, different theories are used, mainly 1) general media effects theories, 2) sexual media effects theories, 3) gender role, feminist and queer theories, 4) sexual fantasy and desire theories, and different 5) mold theories versus mirror theories. The DOCA entry “Conceptual Overview (Portrayals of Sexuality in Pornography)” introduces all these theories and explains their application to pornography. The respective theories are applicable to the analysis of the depiction of consent communication as one dimension of the portrayals of sexuality in pornography. References/combination with other methods of data collection: Manual quantitative content analyses of pornographic material can be combined with qualitative (e.g., Keft-Kennedy, 2008) as well as computational (e.g., Seehuus et al., 2019) content analyses. Furthermore, content analyses can be complemented with qualitative interviews and quantitative surveys to investigate perceptions and evaluations of the portrayals of sexuality in pornography among pornography’s creators and performers (e.g., West, 2019) and audiences (e.g., Cowan & Dunn, 1994; Hardy et al., 2022; Paasoonen, 2021; Shor, 2022). Additionally, experimental studies are helpful to measure directly how different dimensions of pornographic portrayals of sexuality are perceived and evaluated by recipients, and if and how these portrayals can affect audiences’ sexuality-related thoughts, feelings, and behaviors (e.g., Kohut & Fisher, 2013; Miller et al., 2019). Example studies for manual quantitative content analyses: A common research hypothesis states that pornography depicts sex mostly without consent communication, especially explicit verbal communication. To test this hypothesis and code pornographic material accordingly, it is necessary to clarify the concept of “consent communication” and use valid and reliable measures for different types of consent communication. Here it is important to conceptually differentiate between consent communication between characters in the fictional world of the porn scene and consent communication between performers on set (or consent of performers to have their image be recorded and disseminated as pornography). This distinction becomes murky with regard to amateur pornography, which ostensibly is meant to depict “authentic” sex (although this sex may still be performative), and also professional pornography in which a performer is playing “themselves” as opposed to a character. Some production studios (especially those specializing in BDSM content) embed interviews with performers into their videos, in which performers indicate that they consented to the activities presented. Coding Material Measure Operationalization (excerpt) Reliability Source Consent Communication: Whenever in the sequence of sexual activities depicted in pornography a new activity is started, the question arises if all participants have consented to the new behavior. Sexual consent between characters can be communicated verbally and nonverbally (Willis et al., 2020). Further, verbal or nonverbal communication may be explicit or implicit (Willis et al., 2020). Apart from issues of performer health protection, explicit consent communication on camera is also regarded as relevant in terms of modelling behaviors for audiences. N=50 segments (length 20 min. each) from a random sample of 50 bestselling pornographic films (1 segment per film) depicting a total of 1,109 sexual behaviors Explicit verbal sexual consent “Straightforward statements, questions, or responses expressing agreement to engage in sexual behavior stated using words for actual sexual behavior or a very close synonym”. Binary coding (1: present; 2: not present). Cohen’s Kappa: .72 Willis et al. (2020) Implicit verbal sexual consent “Verbally initiating sexual behavior or communicating agreement to engage in sexual behavior without explicitly using the word sex or other close synonyms. The content of the words may not be sexual in nature, but the connotation or tone of voice used by the characters implies sex or is sexual in nature”. Binary coding (1: present; 2: not present). Cohen’s Kappa: .63 Explicit nonverbal sexual consent “Behaviors or actions that are sexually explicit including bodily touching in a sexual way”. Binary coding (1: present; 2: not present). Cohen’s Kappa: .76 Implicit nonverbal sexual consent “Behaviors or actions that imply interest in engagement in sexual behavior”. Binary coding (1: present; 2: not present). Cohen’s Kappa: .65 No response “Characters do not say anything, do not resist, or let the sexual activity happen without much action. The person is a passive participant in sexual behavior, but not uncomfortable, distressed, or showing signs of disinterest”. Binary coding (1: present; 2: not present). Cohen’s Kappa: .72 No sexual consent shown “Scene begins or video cuts away and comes back with characters engaging in sexual behavior without any preceding actions to assess consent”. Binary coding (1: present; 2: not present). Cohen’s Kappa: .95 For more nuanced analyses of consent communication, the sex/gender of the persons involved in consent communication can be coded (see DOCA entry “Performer Demographics (Portrayals of Sexuality in Pornography)”) and the respective sex acts that are to be consented to (see DOCA entry “Sex Acts (Portrayals of Sexuality in Pornography)”). Furthermore, relationship status between characters might play an important role for consent communication (Willis et al., 2020): Characters in established relationships might be more likely to communicate sexual consent nonverbally than those in casual encounters (see DOCA entry "Relational Context of Sex (Portrayals of Sexuality in Pornography"). References Carrotte, E. R., Davis, A. C., & Lim, M. S. (2020). Sexual behaviors and violence in pornography: Systematic review and narrative synthesis of video content analyses. Journal of Medical Internet Research, 22(5), Article e16702. https://doi.org/10.2196/16702 Cowan, G., & Dunn, K. F. (1994). What themes in pornography lead to perceptions of the degradation of women? Journal of Sex Research, 31(1), 11–21. https://doi.org/10.1080/00224499409551726 Döring, N. (2009). The Internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25(5), 1089–1101. https://doi.org/10.1016/j.chb.2009.04.003 Hardy, J., Kukkonen, T., & Milhausen, R. (2022). Examining sexually explicit material use in adults over the age of 65 years. The Canadian Journal of Human Sexuality, 31(1), 117–129. https://doi.org/10.3138/cjhs.2021-0047 Keft-Kennedy, V. (2008). Fantasising masculinity in Buffyverse slash fiction: Sexuality, violence, and the vampire. Nordic Journal of English Studies, 7(1), 49–80. Kohut, T., & Fisher, W. A. (2013). The impact of brief exposure to sexually explicit video clips on partnered female clitoral self-stimulation, orgasm and sexual satisfaction. The Canadian Journal of Human Sexuality, 22(1), 40–50. https://doi.org/10.3138/cjhs.935 McKee, A., Byron, P., Litsou, K., & Ingham, R. (2020). An interdisciplinary definition of pornography: Results from a global Delphi panel. Archives of Sexual Behavior, 49(3), 1085–1091. https://doi.org/10.1007/s10508-019-01554-4 Miller, D. J., & McBain, K. A. (2022). The content of contemporary, mainstream pornography: A literature review of content analytic studies. American Journal of Sexuality Education, 17(2), 219–256. https://doi.org/10.1080/15546128.2021.2019648 Miller, D. J., McBain, K. A., & Raggatt, P. T. F. (2019). An experimental investigation into pornography’s effect on men’s perceptions of the likelihood of women engaging in porn-like sex. Psychology of Popular Media Culture, 8(4), 365–375. https://doi.org/10.1037/ppm0000202 Miller, D. J., Raggatt, P. T. F., & McBain, K. (2020). A literature review of studies into the prevalence and frequency of men’s pornography use. American Journal of Sexuality Education, 15(4), 502–529. https://doi.org/10.1080/15546128.2020.1831676 Paasonen, S. (2021). “We watch porn for the fucking, not for romantic tiptoeing”: Extremity, fantasy and women’s porn use. Porn Studies, 1–14. https://doi.org/10.1080/23268743.2021.1956366 Seehuus, M., Stanton, A. M., & Handy, A. B. (2019). On the content of "real-world" sexual fantasy: Results from an analysis of 250,000+ anonymous text-based erotic fantasies. Archives of Sexual Behavior, 48(3), 725–737. https://doi.org/10.1007/s10508-018-1334-0 Shor, E. (2022). Who seeks aggression in pornography? Findings from interviews with viewers. Archives of Sexual Behavior, 51(2), 1237–1255. https://doi.org/10.1007/s10508-021-02053-1 West, C. (2019). Pornography and ethics: An interview with porn performer Blath. Porn Studies, 6(2), 264–267. https://doi.org/10.1080/23268743.2018.1505540 Williams, L. (1989). Hard Core: Power, pleasure, and the frenzy of the visible. University of California Press. Willis, M., Canan, S. N., Jozkowski, K. N., & Bridges, A. J. (2020). Sexual consent communication in best-selling pornography films: A content analysis. Journal of Sex Research, 57(1), 52–63. https://doi.org/10.1080/00224499.2019.1655522

Pornography is a fictional media genre that depicts sexual fantasies and explicitly presents naked bodies and sexual activities for the purpose of sexual arousal (Williams, 1989; McKee et al., 2020). Regarding media ethics and media effects, pornography has traditionally been viewed as highly problematic. Pornographic material has been accused of portraying sexuality in unhealthy, morally questionable and often sexist ways, thereby harming performers, audiences, and society at large. In the age of the Internet, pornography has become more diverse, accessible, and widespread than ever (Döring, 2009; Miller et al., 2020). Consequently, the depiction of sexuality in pornography is the focus of a growing number of content analyses of both mass media (e.g., erotic and pornographic novels and movies) and social media (e.g., erotic and pornographic stories, photos and videos shared via online platforms). Typically, pornography’s portrayals of sexuality are examined by measuring the prevalence and frequency of sexual practices or relational dynamics and related gender roles via quantitative content analysis (for research reviews see Carrotte et al., 2020; Miller & McBain, 2022). This entry focuses on the representation of safer sex practices as one of eight important dimensions of the portrayals of sexuality in pornography. Field of application/theoretical foundation: In the field of pornographic media content research, different theories are used, mainly 1) general media effects theories, 2) sexual media effects theories, 3) gender role, feminist and queer theories, 4) sexual fantasy and desire theories, and different 5) mold theories versus mirror theories. The DOCA entry “Conceptual Overview (Portrayals of Sexuality in Pornography)” introduces all these theories and explains their application to pornography. The respective theories are applicable to the analysis of the depiction of safer sex practices as one dimension of the portrayals of sexuality in pornography. References/combination with other methods of data collection: Manual quantitative content analyses of pornographic material can be combined with qualitative (e.g., Keft-Kennedy, 2008) as well as computational (e.g., Seehuus et al., 2019) content analyses. Furthermore, content analyses can be complemented with qualitative interviews and quantitative surveys to investigate perceptions and evaluations of the portrayals of sexuality in pornography among pornography’s creators and performers (e.g., West, 2019) and audiences (e.g., Cowan & Dunn, 1994; Hardy et al., 2022; Paasoonen, 2021; Shor, 2022). Additionally, experimental studies are helpful to measure directly how different dimensions of pornographic portrayals of sexuality are perceived and evaluated by recipients, and if and how these portrayals can affect audiences’ sexuality-related thoughts, feelings, and behaviors (e.g., Kohut & Fisher, 2013; Miller et al., 2019). Example studies for manual quantitative content analyses: A common research hypothesis states that pornography displays sexuality – and even high-risk sex acts, such as penetrative sex – predominately without condoms. To test such hypotheses and code pornographic material accordingly, it is necessary to clarify the concept of “safer sex” and use valid and reliable measures for different types of safer sex practices. It is important to note that safer sex practices could be assessed at the sexual encounter level (e.g., Is a condom used during the sexual encounter?) or at the level of specific sexual acts (e.g., Is a condom used during anal sex?). It is also possible that a scene depicts a condom being used, but only for the purpose of it being removed (e.g., to highlight the unrestricted nature of the sex being shown or as part of an impregnation roleplay). Given that such scenarios would depict condom use while simultaneously presenting sex with a condom as being less pleasurable, researchers may need to consider these contextual factors when developing their coding schemes. In gay male pornography “barebacking” (deliberately forgoing condom use during anal sex) is its own sub-genre (Tollini, 2019), thus there is a possibility for indirect coding based on meta-information about whether material sits within this sub-genre. Coding Material Measure Operationalization (excerpt) Reliability Source Safer Sex Practices: Condom use during penetrative sex with a penis provides a high degree of protection against pregnancies and several types of STIs (Sexually Transmitted Infections) including HIV (Human Immunodeficiency Virus). While condom use is recommended for private sexual encounters (and demanded by some legislatures for porn performers), condoms can increase pain, risk of injury and risk of STI/HIV transmission among performers (particularly those engaging in receptive penetrative practices) because professional performances are typically much longer and more demanding than the average private sexual encounters. For this reason, some porn performers have challenged the idea that legal obligations for condom use on set effectively protect them (Shachner, 2015). Alternative protection measures are often preferred by professional performers (e.g., long acting contraception methods, regular STI/HIV testing, HIV-Pre-Exposure Prophylaxis). The availability of HIV-Pre-Exposure Prophylaxis has resulted in a trend toward condomless anal sex (“barebacking”) in gay male pornography (Tollini, 2019). Apart from issues of performer health protection, safer sex practices in pornography are also regarded as relevant in terms of modelling behaviors for audiences. N=50 scenes from 50 best-selling heterosexual adult films (1 scene per film) and N=50 scenes from 50 bestselling male homosexual films (1 scene per film) Condom use - Condom use during penile-oral contact (type of condom use) Penile-oral contact is shown and a condom is used at least some of the time during this act. Binary coding (1: yes; 2: no). Cohen’s Kappa across all four variables: .78 Grudzen et al. (2009) - Condom use during penile-vaginal contact (type of condom use) Penile-vaginal contact is shown and a condom is used at least some of the time during this act. Binary coding (1: yes; 2: no). - Condom use during penile-anal contact (type of condom use) Penile-anal contact is shown and a condom is used at least some of the time during this act. Binary coding (1: yes; 2: no). - Condom use during anal-to-oral penile insertion Anal-to-oral penile insertion (penile-oral insertion immediately following penile-anal insertion) is shown and a condom is used at least some of the time during this act. Binary coding (1: yes; 2: no). Apart from condom use, further safer sex practices can be measured (e.g., visible use of lube to prevent pain or injuries during penetrative sex; observable communication between characters about sexual health status, STI testing, or use of contraception). References Carrotte, E. R., Davis, A. C., & Lim, M. S. (2020). Sexual behaviors and violence in pornography: Systematic review and narrative synthesis of video content analyses. Journal of Medical Internet Research, 22(5), Article e16702. https://doi.org/10.2196/16702 Cowan, G., & Dunn, K. F. (1994). What themes in pornography lead to perceptions of the degradation of women? Journal of Sex Research, 31(1), 11–21. https://doi.org/10.1080/00224499409551726 Döring, N. (2009). The Internet’s impact on sexuality: A critical review of 15 years of research. Computers in Human Behavior, 25(5), 1089–1101. https://doi.org/10.1016/j.chb.2009.04.003 Grudzen, C. R., Elliott, M. N., Kerndt, P. R., Schuster, M. A., Brook, R. H., & Gelberg, L. (2009). Condom use and high-risk sexual acts in adult films: A comparison of heterosexual and homosexual films. American Journal of Public Health, 99(S1), S152-156. https://doi.org/10.2105/AJPH.2007.127035 Hardy, J., Kukkonen, T., & Milhausen, R. (2022). Examining sexually explicit material use in adults over the age of 65 years. The Canadian Journal of Human Sexuality, 31(1), 117–129. https://doi.org/10.3138/cjhs.2021-0047 Keft-Kennedy, V. (2008). Fantasising masculinity in Buffyverse slash fiction: Sexuality, violence, and the vampire. Nordic Journal of English Studies, 7(1), 49–80. Kohut, T., & Fisher, W. A. (2013). The impact of brief exposure to sexually explicit video clips on partnered female clitoral self-stimulation, orgasm and sexual satisfaction. The Canadian Journal of Human Sexuality, 22(1), 40–50. https://doi.org/10.3138/cjhs.935 McKee, A., Byron, P., Litsou, K., & Ingham, R. (2020). An interdisciplinary definition of pornography: Results from a global Delphi panel. Archives of Sexual Behavior, 49(3), 1085–1091. https://doi.org/10.1007/s10508-019-01554-4 Miller, D. J., & McBain, K. A. (2022). The content of contemporary, mainstream pornography: A literature review of content analytic studies. American Journal of Sexuality Education, 17(2), 219–256. https://doi.org/10.1080/15546128.2021.2019648 Miller, D. J., McBain, K. A., & Raggatt, P. T. F. (2019). An experimental investigation into pornography’s effect on men’s perceptions of the likelihood of women engaging in porn-like sex. Psychology of Popular Media Culture, 8(4), 365–375. https://doi.org/10.1037/ppm0000202 Miller, D. J., Raggatt, P. T. F., & McBain, K. (2020). A literature review of studies into the prevalence and frequency of men’s pornography use. American Journal of Sexuality Education, 15(4), 502–529. https://doi.org/10.1080/15546128.2020.1831676 Paasonen, S. (2021). “We watch porn for the fucking, not for romantic tiptoeing”: Extremity, fantasy and women’s porn use. Porn Studies, 1–14. https://doi.org/10.1080/23268743.2021.1956366 Shachner, J. (2015). Unwrapped: How the Los Angeles County Safer Sex in the Adult Film Industry Act's condom mandate hurts performers & violates the First Amendment. Health Matrix: The Journal of Law Medicine, 24(1), 345–375. Seehuus, M., Stanton, A. M., & Handy, A. B. (2019). On the content of "real-world" sexual fantasy: Results from an analysis of 250,000+ anonymous text-based erotic fantasies. Archives of Sexual Behavior, 48(3), 725–737. https://doi.org/10.1007/s10508-018-1334-0 Shor, E. (2022). Who seeks aggression in pornography? Findings from interviews with viewers. Archives of Sexual Behavior, 51(2), 1237–1255. https://doi.org/10.1007/s10508-021-02053-1 Tollini, C. (2019). How two holdouts went bareback: CockyBoys and Men. com's initial transition to producing videos without condoms. Porn Studies, 6(3), 282-300. https://doi.org/10.1080/23268743.2019.1602958 West, C. (2019). Pornography and ethics: An interview with porn performer Blath. Porn Studies, 6(2), 264–267. https://doi.org/10.1080/23268743.2018.1505540 Williams, L. (1989). Hard Core: Power, pleasure, and the frenzy of the visible. University of California Press.

Introduction From the annual ‘Pink Test’ cricket match in Australia to Mother’s Day fun runs, there has been a proliferation of ‘pink’ uniformed charity events. This article analyses the pink uniform of the 2020 Cancer Council Tasmania’s Women’s first virtual 5K walk/run (W5K). The Women’s 5K event took take place virtually in September 2020 due to COVID-19 restrictions. The annual event, which runs through the CBD of Launceston, a regional city in Tasmania, typically attracts around 2,000 participants and is Cancer Council Tasmania’s major annual fundraiser. Cancer Council received 798 registrations for the 2020 virtual event and raised over $120,000. Locating the W5K pink uniform within the emergence of “embodied philanthropy” (Robert), this article analyses how pink uniforms were used by virtual walkers and runners to recreate the mass affective and community spectacle of the usually in-person event. Drawing upon Vilnai-Yavert and Rafaeli’s artifacts framework, the article extends the concept of “embodied philanthropy” to outline the instrumental, symbolic and aesthetic dimensions of the pink sports charity uniform. While acknowledging the risks of “pinkwashing” in reproducing narrow gender ideals and bright-siding cancer, the article argues the pink uniform was vital in staging a meaningful and impactful virtual event. Sports Uniforms Uniforms are central to the formation and expression of collective and organisational identities (Craik; Timmons and East; Joseph and Alex). The classic sociological articulation of uniforms is that they function to define boundaries, ensure conformity, and suppress individuality. Sport provides a key space to analyse how uniforms discipline individuals and bodies but also challenge and reject rules and bodily regulations. Sport is a window to examine how uniforms involve a tension between both tradition and innovation and regulation and experimentation (Craik 139). While research has examined sport fans and team uniforms there is little research on the sport charity uniform. Much of the sociological literature on sporting uniforms focusses on male football fans. Back et al. point out that “the notion of “wearing the shirt” summons the “deepest level of symbolic identity and commitment” (82). For dedicated fans, wearing their team’s apparel is a potent and embodied “emblem of locality and identity” (82). More recent research has focussed on the ways in which sporting uniforms can be used in social movements and political protest. These include the inclusion of LGBTQI ‘rainbow’ tops in basketball (Bagley and Liao) and the ways in which Serena Williams’s clothing choices were used to challenge traditional race, class and gender assumptions in tennis (Allen). Redressing the skewed focus on uniforms among male sports fans, Sveinson, Hoeber, and Toffoletti argue that pink merchandise and clothing are cultural artifacts worn and conceptualised by female fans as representing different aspects of their identity. Their findings show that women who follow professional sports teams tend to reject “pink and pretty” offerings, as they reproduce a traditional view of femininity that delegitimatises their fan identity. This laden symbolism is critical to understanding the pink uniform of the W5K. Pinkification of Cancer One of the most well-known aspects of the pink uniform is the “pink ribbon” campaign. Ribbon wearers acknowledge that they are connected to cancer in some way; as a survivor, a friend or relative, or as advocates committed to the medical research needed to find a cure for breast (and other) cancers. Moore’s ‘ribbon culture’ identifies four main symbolic uses of the ribbon: show solidarity with a cause or group; tool for community campaigns; a token of mourning; or to display ‘self-awareness’ in the wearer. The emergence of the pink uniform in sports charity can be linked to the Susan G Komen foundation, one of the early pioneers of cause-related marketing and the founder of the Race for the Cure, the earliest of sports charity events (Palmer). King suggests the colour pink was chosen for race merchandise as it conveyed traditional notions of femininity and was part of the Foundation’s strategy of normalising discussion of breast cancer. The associations between pink, breast cancer, and identity categories of women (mother, sister, daughter, etc.) have been key to the fundraising success of Komen, largely because they were implicitly positioned in opposition to other health promotion campaigns (e.g., AIDS) also competing for market attention in the 1980s and 1990s. While AIDS was associated with “deviant” identities of gay men, drug users, and sex workers, breast cancer was made visible “through straight, White, married, young to middle aged women” (King 107). Since this time many men’s sporting leagues and events globally have partnered with breast cancer and other “pink” initiatives. In Australia, the annual ‘Pink Test’ cricket match raises money for breast cancer care nurses, while in the US NFL players wear pink socks and gloves. The proliferation of pink events and associated merchandise has led to criticisms of “pinkwashing” (Lyon and Montgomery 223), whereby corporations exploit pink branding to promote products which contribute very little – if anything at all – to cancer research, education, and advocacy efforts (Carter; Devlin and Sheehan). Sociologists like Ehrenreich and Moore have been critical of this “pinkification”, suggesting that it “bright-sides” breast cancer – by relentlessly emphasising a positive resolve – while simultaneously amplifying concerns about the illness. Rather than “awareness raising”, Moore suggests the close association of pink ribbon culture with consumer beauty and fitness products (e.g., Estee Lauder; LessBounce sports bras) reinforces narrow ideals of femininity, but also adds to the pervasive dread of breast cancer in relation to these same ideals (for example, via chemotherapy-induced hair loss and mastectomies). The following section introduces the theoretical framework. Embodied Philanthropy and Material Artifacts Julie Robert’s “embodied philanthropy” provides a useful theoretical starting point for analysing the pink uniform of sports charity. Robert (1) describes embodied philanthropy as part of a cultural movement where people "pledge their bodies to raise funds for and awareness of a variety of causes". Embodied philanthropy often relies on the body to publicly display altruism and one’s own ‘will to health’. Embodied philanthropy thus offers a highly visible means of modeling “good citizenship”, particularly in practicing both care of the self and civic minded entrepreneurialism (Wade et al.). While embodied philanthropy draws attention to the body and its emerging role in charitable endeavours, it overlooks how material “things” such as clothes, costumes, and uniforms are integral to the embodied performances characteristic of sports charity events. Vilnai-Yavetz and Rafaeli’s interdisciplinary organisational artifacts framework provides a useful way to extend Robert’s focus on the body in philanthropy to include embodied artifacts such as uniforms and clothing. For this article, artifacts are conceptualised as material objects such as pink t-shirts, ribbons, and hats purposely worn for W5K participation and fundraising. Vilnai-Yavetz and Rafaeli posit three dimensions through which organisational artifacts produce meaning: 1) instrumentality: the “impact of an artifact on the tasks or goals of people, groups, or organisations” (12); 2) aesthetics: the “sensory experience an artifact elicits” (12); and 3) symbolism: the “meanings and associations an artifact elicits” (14). Vilnai-Yavetz and Rafaeli’s model offers a way of conceptualising the embodied role of uniform for understanding more short-term or ephemeral types of sporting community, such as the “neo-tribes” (Maffesoli) that form around fitness philanthropy events (e.g. annual fun runs). How then do people understand the role of the pink uniform when participating in sports charity events? What role does the pink uniform play instrumentally, aesthetically, and symbolically? Do cancer charities need to rethink their use of pink considering concerns about pinkwashing, bright-siding cancer, and reproducing constrictive gender ideals? The following section uses the findings from a wider qualitative interview-based study on motivations and experiences of participating and fundraising in the 2020 virtual W5 to help answer these questions. The interview sample comprised 12 women and one man with an age range of 32 to 75. Transcribed interviews were thematically analysed, guided by the theoretical framework. Recreating the ‘Sea of Pink’: Instrumental, Symbolic, and Aesthetic Dimensions of the Pink Sports Charity Uniform Most participants framed their virtual participation in terms of missing the in-person spectacle of the “sea of pink running through the streets” (Emily). In the context of this mass “absence” of pink, wearing and displaying artifacts such as pink T-shirts, ribbons, bandanas, hats, face paint, and dyed hair were assembled as an “informal” sports charity uniform. The following participants capture this creative use of the pink uniform: I had the pink shirt and then we had pink hats and my neighbour who’s had cancer came and she had pink on. (Grace) I decked myself out in pink and all the number and whatever else and yeah, I had a great time by myself. I had music going and yeah … I think I might have even had pink hair at the time. (Leah) These descriptions evoke Robert’s claim that embodied philanthropy leans heavily on the “showiness of the body for philanthropic ends” (4). However, rather than moralised displays of suffering or neoliberal models of self-responsibility, the pink uniform plays out as part of a rejection of more ‘elite’ forms of embodied philanthropy with the emphasis on ‘fun’, ‘play’, and ‘enjoyment’. The pink uniform figures as a rejection of martyr-like displays and expectations commonly observed in other forms of embodied philanthropy, with participants not expected to suffer for the cause but rather to gather, play, remember, and celebrate. Building on uniform as a feature of embodied philanthropy, the following section uses Vilnai-Yavetz and Rafaeli’s framework to analyse the instrumental, symbolic, and aesthetic dimensions of the W5K pink uniform. Instrumental Dimensions Instrumentality relates to how artifacts serve to achieve individual and organisational goals (Vilnai-Yavetz and Rafeili). Three key instrumental functions of the pink uniform can be identified in the participants’ stories. First, wearing and displaying artifacts such as pink T-shirts and hair-dye enabled participants to become producers of their own sports charity events. As Elizabeth said: “I would happily wear my t-shirt and do my own fun run”. Displaying the pink uniform enabled participants to stage their own “micro” fitness philanthropy event in the absence of the “sea of pink”. The pink uniform was central to participants and organisers being able to produce and stage individualised embodied philanthropy events without the corporeal ‘mass’ of the mass-participation event. Second, the pink uniform helped participants simulate the affective spectacle, ritual, and “neo-tribal” warmth (Maffesoli) of the face-to-face event. The pink uniform was key to producing a sense of ritualised ‘atmosphere’ and generating feelings of connection and solidarity. The shift to a virtual format meant greater reliance on participants producing imagery of their participation to generate a sense of online community and affective spectacle. Social media affordances, including the use of the #doitforher hashtag, were vital to creating this collective affect. Without sharing and circulating imagery of the pink uniform through social media, organisers would have struggled to host a meaningful and viable event. Chloe commented how “I felt the presence with the online kind of sharing of other people’s experiences, quite motivating and really wonderful … just being out and seeing other people in a sea of pink and doing their version of the event was quite special”. Third, participants used their own creative labour to craft and display pink uniforms that expressed their connection to the cause (fighting cancer) and organisation (Cancer Council). In Robert’s terms, the pink uniform transformed the body into a charitable “billboard” and “income generator”. For example, Penelope discussed how their running club made their own t-shirts for their event – complete with individual nicknames –, while Elizabeth described how they designed a stamp that featured a picture of herself wearing a Cancer Council t-Shirt to publicise the event. This echoes aforementioned claims that ‘wearing the shirt’ establishes symbolic identity and commitment. However, rather than generating feelings of allegiance to a club, the pink shirt expressed connection with the cause or organisation while also serving advocacy purposes. As Chloe said: “just getting out there in the pink top is raising awareness”. The t-shirt also operated as a communicator of “good citizenship”, implicitly enjoining others to support the cause (Palmer). Elizabeth, for instance, described wearing her pink Cancer Council T-shirt to an aged care facility where she volunteers to solicit “a couple of extra donations”, while Katie and Sandra explained how they wore pink shirts during their walk/runs as a way of gaining recognition and showing others “you’re doing that good work”. Symbolic Dimensions The pink charity uniform had powerful symbolic functions for participants. Participants discussed how wearing pink was linked to honouring loved ones who had died from cancer. Leah discussed how she ran her event wearing the same pink ribbon she wore at the funeral of her friend’s mother, who died from breast cancer. This aligns with Moore’s research, where ribbon wearing to signify mourning proves one of the key symbolic uses of ribbon culture. Zoe similarly expressed the links between wearing pink and rituals of reminiscence: “we both made sure we had some pink on … as we walked, we talked about [their friend] and her battle and why we were doing it … we were thinking of who we were walking for”. Pink was also worn by survivors of breast cancer such as Sandra who walked with her mum (also a breast cancer survivor) and friends: “we all had pink stuff. We painted pink on our faces. Walked the main road when we knew there was going to be a lot of traffic … so people could see us dressed in pink”. Sandra described “walking the streets with pink love hearts on our faces” as her most memorable moment of the event. While “pink ribbon culture” and the wider “pinkification” of cancer has been critiqued as “brightsiding” cancer and reinforcing narrow ideals of femininity (Ehrenreich; Moore), it is hard to deny the symbolic power of pink for these participants as a means to mourn, remember, and celebrate survivorship. The meaning of pink clothing as a gendered marker was also important in this research. While Sveinson et al. highlight problems that female sports fans have with pink merchandising, this was not an issue for the charity participants. There was a congruence between wearing pink and participants’ charitable identities. Despite pink being a close signifier of breast cancer fundraising (King), participants reflected on the importance of the W5K in supporting all cancers, particularly as breast cancer attracts “more donations” (Sandra) and “gets a lot of attention in the media” (Maureen). However, W5K’s pink branding did lead some participants, like Greg, to mistakenly believe the event is a “breast cancer race”, despite the target audience being all Tasmanians impacted upon by cancer. The feminine associations of pink – coupled with the event name – also meant some participants were unclear whether men could participate. Katie said “I love that they have the pink colouring” but it “wasn’t obvious to me that both men and women could do the walk”. Katie showed how there can be an incongruence between masculine identities and the “pink run” uniform. She commented: “my Dad was a bit reticent about wearing pink ...but he was willing to take it for the team for the day”. While Greg said he was a “metrosexual man” and “didn’t mind wearing a bit of pink”, he agreed the pink uniform created a strong impression the W5K was a “women’s only race”. Both Katie and Greg suggested that organisers should look to include more men wearing pink as part of promotional materials. Unlike Sveinson et al., who showed a tension between pink clothing and women’s fan identities, in the W5K men and women were generally comfortable wearing pink due to its higher-order symbolism as part of “fighting” cancer and “doing something good”. More widely, these findings highlight the unstable gendered meanings of pink and that rather than the pinkification of cancer simply reinforcing narrow gender ideals, it may also open possibilities, particularly for men, to express inclusive and ‘caring’ masculinities (Elliott). Aesthetic Dimensions The Cancer Council actively encourages fun and creativity in costumes for the W5K event. Images of this irreverent costuming and effervescent spectacle are re-circulated via social media to promote future participation. This is illustrated in the image below from Cancer Council’s Instagram account: Fig. 1: Instagram post by the Cancer Council While pink clothing is encouraged by the Cancer Council, individual comfort and expression is emphasised in efforts to make the event as inclusive as possible. Hence, some participants – especially ‘serious’ runners – dress in purely utilitarian modes, opting for pink running singlets, shorts, tights etc., while others embrace comically non-utilitarian styles, such as wearing tutus, feather boas, fairy wings, colourful wigs, face paint, or dyed hair. Unlike comparable events – like Nike’s women’s-only ‘She Runs the Night’ event, where all participants were required to wear identical Nike-branded pink singlets or t-shirts – the Cancer Council’s W5K encourages individual expression and creativity in clothing and adornments. In short, a kind of non-uniformity of uniform is actively promoted, so long as these displays can still be captured and circulated as signifiers of support for the cause. While the aesthetics of the ‘sea of pink’ inevitability reproduce narrow gendered tropes, it also resists others, including the ‘tailored modesty, neatness, demureness’ (Craik 13) expected of women in uniform, along with burdensome cultural ideals around the ‘fit’ and ‘feminine’ body. The lighthearted, intentionally comical pinkification – while introducing ambiguities about whether the W5K is a women’s only event – does potentially make it easier for men to participate, enabling them to shake off any stereotypical assumptions related to wearing ‘unmasculine’ colours and clothing. Greg said that ‘while I don’t think I wore pink on the day … I would’ve been happy to put some pompons on, and really jazz it up!’ Conclusion Using Cancer Council Tasmania’s first virtual 5k walk-run as an empirical case-study, the article discusses creative pink adornments as a unique sports charity uniform. Locating the pink uniform within the rise of global “pink events” and initiatives, the article suggests that the pink uniform provides a new lens to examine the material role of uniforms beyond existing research in the sociology of sport and leisure. Theoretically the article positions the emergence of the pink charity uniform as part of Robert’s “embodied philanthropy”. A key theoretical argument is that while Robert’s framework helps grasp the push toward the body-as-signifier in mass participation fundraising events, it downplays the role material artifacts such as clothing play in embodied sporting performances. It is suggested that Vilnai-Yavetz and Rafaeli’s organisational artifacts model provides a useful way to attend to the extra-corporeal aspects of “embodied philanthropy”, underlining the instrumental, symbolic, and aesthetic dimensions of uniforms as artifacts. Empirically the article highlights three key instrumental uses of the pink uniform for W5K participants. First, the uniform enabled participants to produce their own charity event; second, it helped recreate the affective spectacle and “neo-tribal” (Maffesoli) warmth of the physical event; and third, the uniform expressed connection to the cause or organisation and turned the body into a “charitable billboard” (Robert). Symbolically, the uniform, via practices such as wearing pink ribbons, helped foster rituals of mourning and remembrance. Notwithstanding persuasive critiques of pinkwashing, participants celebrated the use of pink, though some felt it sent an ambiguous message about whether men were welcome. Nonetheless, there was little identity incongruence between wearing pink and expressing sports charity identities. These findings highlight how the gendered meaning of pink artefacts are fluid and thus challenge ideas that the pinkification of cancer simply reinforces narrow gender ideals. For example, the men interviewed show how pink artefacts may work to symbolically and materially challenge traditional gendered orthodoxies and even help men express more progressive gendered identities. Aesthetically a “non-uniformity of uniform” was promoted, with the pink uniform working as a loosely aggregated symbolic system accommodating both utilitarian and non-utilitarian styles. While many theorists have raised concerns about the pinkification of cancer – both in its insistent positivity discourses and reproducing narrow gendered ideals – the aesthetics of the pink uniform in the W5K were overwhelmingly celebrated and embraced as light-hearted and fun: as material artifacts key to a joyously inclusive and community-building spectacle. References Back, Les, Tim Crabbe, and John Solomos. The Changing Face of Football: Racism, Identity and Multiculture in the English Game. Berg, 2001. Bagley, Meredith M., and Judy Liao. "Blocked Out: Athletic Voices and WNBA Uniform Politics." Sportswomen’s Apparel in the United States. Cham: Palgrave Macmillan, 2021. 57-74. Carter, Meg. "Backlash against 'Pinkwashing' of Breast Cancer Awareness Campaigns." BMJ: British Medical Journal 351 (2015). Craik, Jennifer. Uniforms Exposed: From Conformity to Transgression. Berg, 2005. Crawford, Garry. "The Career of the Sport Supporter: The Case of the Manchester Storm." Sociology 37.2 (2003): 219-237. Devlin, Michael, and Kim Sheehan. "A 'Crucial Catch': Examining Responses to NFL teams’ Corporate Social Responsibility Messaging on Facebook." Communication & Sport 6.4 (2018): 477-498. Ehrenreich, Barbara. Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. Metropolitan Books, 2009. Fawbert, J. "Replica Football Shirts: A Case of Incorporation of Popular Dissent?" Social Science Teacher 27 (1997): 9-13. Joseph, Nathan, and Nicholas Alex. "The Uniform: A Sociological Perspective." American Journal of Sociology 77.4 (1972): 719-730. King, Samantha. "Pink Ribbons Inc.: The Emergence of Cause-Related Marketing and the Corporatization of the Breast Cancer Movement." Governing the Female Body: Gender, Health, and Networks of Power (2010): 85-111. Lyon, Thomas P., and A. Wren Montgomery. "The Means and End of Greenwash." Organization & Environment 28.2 (2015): 223-249. Moore, Sarah E.H. 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The depiction of alcohol is the focus of a growing number of content analyses in the field of social media research. Typically, the occurrence and nature of alcohol representations are coded to measure the prevalence, normalization, or even glorification of alcohol and its consumption on different social media platforms (Moreno et al., 2016; Westgate & Holliday, 2016) and smartphone apps (Ghassemlou et al., 2020). But social media platforms and smartphone apps also play a role in the prevention of alcohol abuse when they disseminate messages about alcohol risks and foster harm reduction, abstinence, and sobriety (Davey, 2021; Döring & Holz, 2021; Tamersoy et al., 2015; Westgate & Holliday, 2016). Field of application/theoretical foundation: Social Cognitive Theory (SCT; Bandura 1986, 2009) as the dominant media effects theory in communication science, is applicable and widely applied to social media representations of alcohol: According to SCT, positive media portayals of alcohol and attractive role models consuming alcohol can influence the audience’s relation to alcohol. That’s why positive alcohol portayals in the media are considered a public health threat as they can foster increased and risky alcohol consumption among media users in general and young people in particular. The negative health impact predicted by SCT depends on different aspects of alcohol portrayals on social media that have been traditionally coded in manual content analyses (Beullens & Schepers, 2013; Mayrhofer & Naderer, 2019; Moreno et al., 2010) and most recently by studies relying on computational methods for content analysis (e.g. Ricard & Hassanpour, 2021). Core aspects of alcohol representations on social media are: a) the type of communicator / creator of alcohol-related social media content, b) the overall valence of the alcohol portrayal, c) the people consuming alcohol, d) the alcohol consumption behaviors, e) the social contexts of alcohol consumption, f) the types and brands of consumed alcohol, g) the consequences of alcohol consumption, and h) alcohol-related consumer protection messages in alcohol marketing (Moreno et al., 2016; Westgate & Holliday, 2016). For example, a normalizing portrayal shows alcohol consumption as a regular and normal behavior of diverse people in different contexts, while a glorifying portrayal shows alcohol consumption as a behavior that is strongly related to positive effects such as having fun, enjoying social community, feeling sexy, happy, and carefree (Griffiths & Casswell, 2011). While criticism of glorifying alcohol portrayals in entertainment media (e.g., music videos; Cranwell et al., 2015), television (e.g., Barker et al., 2021), and advertising (e.g., Curtis et al., 2018; Stautz et al., 2016) has a long tradition, the concern about alcohol representations on social media is relatively new and entails the phenomenon of alcohol brands and social media influencers marketing alcohol (Critchlow & Moodie, 2022; Turnwald et al., 2022) as well as ordinary social media users providing alcohol-related self-presentations (e.g., showing themselves partying and drinking; Boyle et al., 2016). Such alcohol-related self-presentations might elicit even stronger identification and imitation effects among social media audiences compared to regular advertising (Griffiths & Casswell, 2011). Because of its psychological and health impact, alcohol-related social media content – and alcohol marketing in particular – is also an issue of legal regulation. The World Health Organization states that “Europe is the heaviest-drinking region in the world” and strongly advocates for bans or at least stricter regulations of alcohol marketing both offline and online (WHO, 2020, p. 1). At the same time, the WHO points to the problem of clearly differentiating between alcohol marketing and other types of alcohol representations on social media. Apart from normalizing and glorifying alcohol portayals, there are also anti-alcohol posts and comments on social media. They usually point to the health risks of alcohol consumption and the dangers of alcohol addiction and, hence, try to foster harm reduction, abstincence and sobriety. While such negative alcohol portayals populate different social media platforms, an in-depth investigation of the spread, scope and content of anti-alcohol messages on social media is largely missing (Davey, 2021; Döring & Holz, 2021; Tamersoy et al., 2015). References/combination with other methods of data collection: Manual and computational content analyses of alcohol representations on social media platforms can be complemented by qualitative interview and quantitative survey data addressing alcohol-related beliefs and behaviors collected from social media users who a) create and publish alcohol-related social media content and/or b) are exposed to or actively search for and follow alcohol-related social media content (e.g., Ricard & Hassanpour, 2021; Strowger & Braitman, 2022). Furthermore, experimental studies are helpful to directly measure how different alcohol-related social media posts and comments are perceived and evaluated by recipients and if and how they can affect their alcohol-related thoughts, feelings, and behaviors (Noel, 2021). Such social media experiments can build on respective mass media experiments (e.g., Mayrhofer & Naderer, 2019). Insights from content analyses help to select or create appropriate stimuli for such experiments. Last but not least, to evaluate the effectiveness of alcohol marketing regulations, social media content analyses conducted within a longitudinal or trend study design (including measurements before and after new regulations came into effect) should be preferred over cross-sectional studies (e.g., Chapoton et al., 2020). Example Studies for Manual Content Analyses: Coding Material Measure Operationalization (excerpt) Reliability Source a) Creators of alcohol-related social media content Extensive explorations on Facebook, Instagram and TikTok Creators of alcohol-related social media content on Facebook, Instagram and TikTok Polytomous variable “Type of content creator” (1: alcohol industry; 2: media organization/media professional; 3: health organization/health professional; 4: social media influencer; 5: ordinary social media user; 6: other) Not available Döring & Tröger (2018) Döring & Holz (2021) b) Valence of alcohol-related social media content N = 3 015 Facebook comments N = 100 TikTok videos Valence of alcohol-related social media content (posts or comments) Binary variable “Valence of alcohol-related social media content” (1: positive/pro-alcohol sentiment; 2: negative/anti-alcohol sentiment) Cohen’s Kappa average of .72 for all alcohol-related variables in codebook* Döring & Holz (2021) *Russell et al. (2021) c) People consuming alcohol N = 160 Facebook profiles (profile pictures, personal photos, and text) Portrayal of people consuming alcohol on Facebook profiles Binary variable “Number of persons on picture” (1: alone; 2: with others) Cohen’s Kappa > .90 Beullens & Schepers (2013) d) Alcohol consumption behaviors N = 160 Facebook profiles (profile pictures, personal photos, and text) Type of depicted alcohol use/consumption Polytomous variable “Type of depicted alcohol use/consumption” (1: explicit use such as depiction of person drinking alcohol; 2: implicit use such as depiction of alcohol bottle on table; 3: alcohol logo only) Cohen’s Kappa = .89 Beullens & Schepers (2013) N = 100 TikTok videos Multiple alcoholic drinks consumed per person Binary variable “Multiple alcoholic drinks consumed per person” as opposed to having only one drink or no drink per person (1: present; 2: not present) Cohen’s Kappa average of .72 for all alcohol-related variables in codebook Russell et al. (2021) N = 100 TikTok videos Alcohol intoxication Binary variable “Alcohol intoxication” (1: present; 2: not present) Cohen’s Kappa average of .72 for all alcohol-related variables in codebook Russell et al. (2021) N = 4 800 alcohol-related Tweets Alcohol mentioned in combination with other substance use Binary variable “Alcohol mentioned in combination with tobacco, marijuana, or other drugs” (1: yes; 2: no) Cohen’s Kappa median of .73 for all pro-drinking variables in codebook Cavazos-Rehg et al. (2015) e) Social contexts of alcohol consumption N = 192 Facebook and Instagram profiles (profile pictures, personal photos, and text) Portrayal of social evaluative contexts of alcohol consumption on Facebook and Instagram profiles Polytomous variable “Social evaluative context” (1: negative context such as someone looking disapprovingly at a drunk person; 2: neutral context such as no explicit judgment or emotion is shown; 3: positive context such as people laughing and toasting with alcoholic drinks) Cohen’s Kappa ranging from .68 to .91 for all variables in codebook Hendriks et al. (2018), based on previous work by Beullens & Schepers (2013) N = 51 episodes with a total of N = 1 895 scenes of the American adolescent drama series “The OC” Portrayal of situational contexts of alcohol consumption in scenes of a TV series Polytomous variable “Setting of alcohol consumption” (1: at home; 2: at adult / youth party; 3: in a bar; 4: at work; 5: at other public place) Polytomous variable “Reason of alcohol consumption” (1: celebrating/partying; 2: habit; 3: stress relief; 4: social facilitation) Cohen’s Kappa for setting of alcohol consumption .90 Cohen’s Kappa for reason of alcohol consumption .71 Van den Bulck et al. (2008) f) Types and brands of consumed alcohol N = 17 800 posts of Instagram influencers and related comments Portrayal of different alcohol types and alcohol brands in Instagram posts Polytomous variable “Alcohol type” (1: wine; 2: beer; 3: cocktails; 4: spirits; 5: non-alcoholic drinks/0% alcohol) Binary variable “Alcohol brand visibility” (1: present if full brand name, recognizable logo, or brand name in header or tag are visible; 2: non-present) String variable “Alcohol brand name” (open text coding) Krippendorff’s Alpha ranging from .69 to 1.00 for all variables in codebook Hendriks et al. (2019) g) Consequences of alcohol consumption N = 400 randomly selected public MySpace profiles Portayal of consequences of alcohol consumption on MySpace profiles Five individually coded binary variables for different consequences associated with alcohol use (1: present; 2: not present): a) “Positive emotional consequence highlighting positive mood, feeling or emotion associated with alcohol use” b) “Negative emotional consequence highlighting negative mood, feeling or emotion associated with alcohol use” c) “Positive social consequences highlighting perceived social gain associated with alcohol use” d) “Negative social consequences highlighting perceived poor social outcomes associated with alcohol use” e) “Negative physical consequences describing adverse physical consequences or outcomes associated with alcohol use” Cohen’s Kappa ranging from 0.76 to 0.82 for alcohol references and alcohol use Moreno et al. (2010) h) Alcohol-related consumer protection messages in alcohol marketing N = 554 Tweets collected from 13 Twitter accounts of alcohol companies in Ireland Alcohol-related consumer protection messages in alcohol marketing (covers both mandatory and voluntary messages depending on national legislation) Four individually coded binary variables for different alcohol-related consumer protection messages in alcohol marketing (1: present; 2: not present): a) “Warning about the risks/danger of alcohol consumption” b) “Warning about the risks/danger of alcohol consumption when pregnant” c) “Warning about the link between alcohol consumption and fatal cancers” d) “Link/reference to website with public health information about alcohol” Not available Critchlow & Moodie (2022) The presented measures were developed for specific social media platforms, but are so generic that they can be used across different social media platforms and even across mass media channels such as TV, cinema, and advertisement. The presented measures cover different aspects of media portrayals of alcohol and can be used individually or in combination. Depending on the research aim, more detailed measures can be developed and added: for example, regarding the media portrayal of people consuming alcohol, additional measures can code people’s age, gender, ethnicity and further characteristics relevant to the respective research question. In the course of a growing body of content analyses addressing alcohol-related prevention messages on social media, respective measures can be added as well. References Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall. Bandura, A. (2009). Social cognitive theory of mass communication. In J. Bryant & M. B. Oliver (Eds.), Communication series. Media effects: Advances in theory and research (3rd ed., pp. 94–124). Routledge. Barker, A. B., Britton, J., Thomson, E., & Murray, R. L. (2021). 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Picture me drinking: Alcohol-related posts by Instagram influencers popular among adolescents and young adults. Frontiers in Psychology, 10, 2991. https://doi.org/10.3389/fpsyg.2019.02991 Mayrhofer, M., & Naderer, B. (2019). Mass media as alcohol educator for everyone? Effects of portrayed alcohol consequences and the influence of viewers’ characteristics. Media Psychology, 22(2), 217–243. https://doi.org/10.1080/15213269.2017.1378112 Moreno, M. A., Briner, L. R., Williams, A., Brockman, L., Walker, L., & Christakis, D. A. (2010). A content analysis of displayed alcohol references on a social networking web site. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 47(2), 168–175. https://doi.org/10.1016/j.jadohealth.2010.01.001 Moreno, M. A., D’Angelo, J., & Whitehill, J. (2016). Social media and alcohol: Summary of research, intervention ideas and future study directions. 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Photo by Hédi Benyounes on Unsplash ABSTRACT The current incarceration facilities for the growing number of women are depriving expecting mothers of adequate care crucial for the child’s mental and physical development. Programs need to be established to counteract this. INTRODUCTION Currently, Diana Sanchez was eight months pregnant when she was arrested for identity theft and put in a prison cell in Denver. At five a.m., two weeks after being incarcerated, she announced to a deputy outside her cell that she was going into labor. Footage from a camera in her cell shows her pacing anxiously or writhing in her bed for the five hours preceding the arrival of her son. She banged on the door and begged for help. All she received was an absorbent pad. She gave birth alone in her prison cell on July 31, 2015, around 10:45 am. At 11:00 am, a prison nurse walked in to cut the umbilical cord and take Sanchez’s newborn baby without offering postnatal care. Sanchez was later sent to a hospital, and her baby was separated from her until she was put on probation. In 2018, on behalf of her three-year-old son, Sanchez sued Denver Health and Denver Sheriff Department and won a $480,000 settlement.[1] Though many more men are incarcerated than women, the rate of growth of female incarceration has exceeded that of male incarceration for decades. One study estimated that 231,000 women are currently incarcerated in the US,[2] 80 percent of whom are mothers, and 150,000 pregnant.[3] Another recent study of 1,396 incarcerated pregnant women found that 92 percent had live births, 6.5 percent had stillbirths or miscarriages, and 4 percent terminated the pregnancy. The authors found that there is no system of reporting pregnancy outcomes in US prisons. There is a noteworthy ethical lapse in mental, emotional, and medical care that threatens the well-being of pregnant women in prison. According to Carolyn Sufrin, “Pregnant incarcerated people are one of the most marginalized and forgotten groups in our country… and women who don't get counted don't count.” [4] Poor documentation, visibility, and transparency contribute to the systemic abuse of incarcerated women. Studies document women giving birth alone in cells and shackles in solitary confinement. Their complaints regarding contractions, bleeding, and other pains of labor are often ignored.[5] l. Prenatal Care in American Prisons Diana Sanchez was not offered any prenatal care after she was incarcerated. And neither she nor her son received appropriate postnatal care.[6] Sanchez was on medication for opioid withdrawal while pregnant, which could have been detrimental to her baby’s health.[7] There is an unacceptable absence of pre- and postnatal care in most US prisons. A lack of regulation makes the availability of perinatal care unpredictable and unreliable. Several studies confirmed that there is not a standard for prenatal care for women incarcerated during pregnancy. [8] Knowledge of the appropriate mental and physical care pregnant women require, addiction support, and support for maternal-infant bonding all exists outside the prison system and ought to be used as a benchmark. At the very least, pregnant women, birthing women, and new mothers should not be placed in solitary confinement or shackled.[9] In the prenatal arena, depriving an individual of adequate healthcare is not appropriate and could be cruel and unusual. Only 18 percent of funding in prisons goes to health care for the prisoners. That is roughly $5.7 thousand per prisoner, according to an NIH study done in 2015.[10] There should be an adequate amount of funding for the health needs of incarcerated pregnant women. By depriving pregnant women of healthcare, the prisons are depriving the fetus of adequate care. ll. Respect for Autonomy During Incarceration Women maintain healthcare autonomy even when incarcerated. The purpose of a prison sentence is retribution for crimes and rehabilitation to prevent reoffending.[11] The separation of a mother and newborn causes significant developmental and psychological harm to the child and the parent. Parent-child separation does not serve the purpose of retribution or rehabilitation and is authorized only due to prisons’ limited space and resources that make it difficult to accommodate children, as well as a state interest in children’s best interests or the custody rights of the other parent. When it is possible to keep a family together, prisons should make every effort to do so for the health of the mother-child relationship. Incarcerated people may become a burden to family or society due to prison medical neglect. For example, diabetes and hypertension, which can occur during pregnancy, can worsen without treatment. The inability to access the care they would otherwise want and need endangers women and poses a burden to the healthcare system after incarceration, Depersonalizing individuals convicted of crimes must be placed in the context of historical eugenics practices. State-sanctioned sterilization and efforts to prevent women from reproducing were widespread during the early 20th century.[12] Cases of coerced and nonconsensual sterilization of incarcerated women and men evidence the history of eugenics.[13]Abortions are offered to some incarcerated women.[14] However, many incarcerated women are denied the right to see healthcare providers to thoroughly discuss abortion or other options.[15] Although the abortions are consensual, the quality of consent is questionable. lll. Prison Nursery Programs, “I need something to live for…” Indiana Women’s Prison (IWP), a max security female prison, has a program called Wee Ones that enables women convicted of nonviolent crimes to spend 30 months bonding with their newborn child. It is one of eight programs in the country that allows pregnant mothers to spend the last few months of their sentence with their children. It is a voluntary program that allows pregnant offenders a private room in a housing unit. It offers parent education, resources that are accessible after release, and career education. The program application process and the rules to which women must adhere to remain in the program are stringent. The programs generally have a zero-tolerance policy. Even simply sleeping in the same bed as the child or arguing with other mothers can result in termination from the program. Kara, a pregnant woman incarcerated for drug possession, had a history of abuse in her family and tended to act out in anger against her peers in the program. She was learning how to have healthy reactions to anger when handling her child, but her temper ultimately led to her removal from the program. Her son was placed in foster care, and Kara returned to the regular cells. In an interview before her transfer, she told the camera that Charlie gave her a purpose. With tears in her eyes, she said, “Charlie was my way of life here [...] I need something to live for [,] and I screwed up.”[16] Pregnancy in prison can be a way to improve quality of life for some women. Studies demonstrate that nursery programs improve mental health of the incarcerated women.[17] The secure attachment of the infant to its primary caregiver promotes healthy development in the child and a bonded relationship with the mother.[18] The close bond between mother and child in prisons has been shown to decrease recidivism and to reduce the burden on the foster care system.[19] Women who do not qualify for these programs, or are incarcerated in prisons without them, are separated from their newborn babies and their other children. The disconnect can lead to the child rejecting the incarcerated mother once she is released.[20] Programs like Wee Ones honor women’s autonomy while they are incarcerated. During interviews, the women expressed that although raising a child in that environment is difficult, it was better than not being with their children. While rocking a baby in her lap, one inmate expressed her frustrations with Wee Ones but then paused to express gratitude and said, “After all, it’s prison. And prison ain’t supposed to be nice.”[21] The ethical issue of autonomy reflects a more difficult dilemma in the prison landscape. lV. Counter Arguments: Do the Nursery Programs Work for the Children and the Women Typically, newborns are taken from their incarcerated mothers within two to three days of birth and sent to live with a relative or placed in foster care. Many women are never reunited with their babies. There is much debate over whether the programs are beneficial to the children. One ethical issue is whether children, as innocents, are being punished either by being in the prison system or by being separated from their mothers. Skeptics, like James Dwyer, have argued against keeping innocent babies in the custody of incarcerated mothers asserting that there is little evidence demonstrating that the programs rehabilitate the women.[22] Dwyer commented on the “reckless” hopefulness the programs provide: "It might, in fact, be the babies distract them from rehabilitation they should be doing instead. […] They're so focused on childcare and have this euphoria — they think they'll be just fine when they get out of prison and they're not. We just don't know."[23] One study showed that 58 percent of incarcerated women are arrested again after release, 38 percent are reconvicted, and 30 percent return to prison within three years.[24] Dwyer uses this data to argue that the programs are not worthwhile. However, the data is not limited to the special population that had the prison nursery experience. The data applies to all incarcerated women limiting its applicability. More importantly, there is compelling evidence to support prison nursery programs.[25] The programs do decrease recidivism[26] and prison misconduct,[27] and they allow women to create stronger bonds with their children.[28] Bev Little argues that allowing mothers to bond with their babies only delays the inevitable separation and will cause trauma and have other ill effects on the baby. [29] But others feel that stronger maternal-fetal attachment is best for both parties. There is evidence that the bond, once formed, is long-lasting. Later in life, there is less drug addiction among children who stayed in the nursery rather than being separated from their mothers.[30] Another counterargument is that the policies in prison nurseries are not as useful for motherhood outside of the facility; thus, an issue with recidivism occurs because the women are less prepared for motherhood upon release from prison. Prison nursery programs establish methods and procedures for successful motherhood that are unique to operation within correctional environments. Yet, fortunately, parenting classes offered by prisons and jails emphasize sacrifice, self-restraint, and dedicated attention to the baby. These classes aptly apply to motherhood outside of prison.[31] One incarcerated mother experiencing addiction, Kima, was described as ambivalent toward her pregnancy. “It’s something about knowing but not knowing that makes me not accountable or makes me think I’m not accountable,” Kima shared.[32] After the nurse confirmed her pregnancy, she acknowledged fear and knew she would be held accountable to the baby. The occurrence of pregnancy ambivalence is common.[33] A study of a population of prisoners from Rhode Island found that 41 percent of the women expressed ambivalent attitudes about pregnancy. 70 of the women from a population in San Francisco expressed ambivalent or negative attitudes towards pregnancy.[34] But the ambivalence of some women toward pregnancy is not a reason to prevent women who feel differently from reaping the full benefits of programs that support them during pregnancy. Another counterargument is that prison is becoming a comfort that women might seek if they are homeless or housing insecure. For example, Evelyn was released from a San Francisco jail after being arrested for using cocaine. She was 26 weeks pregnant and had a four-year-old son in the custody of her aunt. Following her release, she was homeless and using drugs in the streets. She felt that her only hope of keeping her baby safe was to go back to jail. Like Kima, she had been in and out of jail from a young age. She grew accustomed to and dependent on the care provided there. While incarceration can provide a home and a nursery, there is no ethical reason to argue for making prison less comfortable by separating babies and children from incarcerated women. Instead, these facts suggest we are not doing enough for women outside prisons either. CONCLUSION Many experts stress the dearth of research and information on these women and their babies. There is no empirical data to show how big the problem is, but there is evidence that programs providing nursery care for the children of incarcerated women have many benefits. Because the research is not largescale enough, many pregnant women in the prison system are ignored. Many women give birth in unacceptable conditions, and their children are taken from them the moment the umbilical cord is cut. While the US incarcerates too many women, a movement to expand prison nurseries could help new mothers bond with their children. Strong educational programs could aid in lowering the rates of recidivism by providing therapeutic resources for mothers.[35] There is a growing problem of mass incarceration in the US as many women are placed in correctional facilities. Most of these women are convicted of possession or use of illegal substances.[36] Many women come from disadvantaged backgrounds, poverty, and have experienced addiction. Depriving an expectant mother of adequate care is cruel and irresponsible both to the mother and her innocent child. The criminal justice system is harming children both mentally and physically. Reform of the system is needed to provide the basic care those children need. Programs like IWP’s Wee Ones are necessary for physical, psychological, and social development. A program that offers a place for mothers to raise their babies in the community of other mothers would incentivize and facilitate healthy parental habits. Further programs for mothers who are released from prison would give them valuable resources to keep them from returning and encourage healthy relationships between the mother and the baby. - [1] Li, D. K. Video allegedly shows woman giving birth in Denver jail cell alone, with no assistance. Denver: NBC News, 2019. [2] Kajstura, Aleks. “Women's Mass Incarceration: The Whole Pie 2019.” Prison Policy Initiative, 29 Oct. 2019, https://www.prisonpolicy.org/reports/pie2019women.html. (“Including those in prisons, jails, and other correctional facilities.”) [3] Swavola, E, K Riley and R Subramanian. "Overlooked: Women and Jails in an Era of Reform." Vera Institute of Justice August 2016. [4] Sufrin, C. Pregnant Behind Bars: What We Do and Don't Know About Pregnancy and Incarceration Allison Chang. 21 March 2019. Transcript. [5] Sufrin, C., 2019. (Suffrin expressed that she had seen such practices firsthand working as an OB/GYN for incarcerated women.) [6] Padilla, M. “Woman Gave Birth in Denver Jail Cell Alone, Lawsuit Says,” New York Times, Sep. 1, 2019. [7] Li, D. “Video allegedly shows woman giving birth in Denver jail cell alone, with no assistance,” NBC U.S. News, Apr. 29. 2019. [8] Knittel, A. and C. Sufrin. "Maternal Health Equity and Justice for Pregnant Women Who Experience Incarceration." JAMA Network Open 3.8 (2020). A study in Ontario, Canada, coincided with a study done in Australia. [9] Sufrin, C., et al. "Pregnancy Outcomes in US Prisons, 2016–2017." p. 803-804. [10] Sridhar, S., R. Cornish and S. Fazel. "The Costs of Healthcare in Prison and Custody: Systematic Review of Current Estimates and Proposed Guidelines for Future Reporting." Frontiers in Psychiatry 9.716 (2018). [11] Kifer, M., Hemmens, C., Stohr, M. K. “The Goals of Corrections: Perspectives from the Line” Criminal Justice Review. 1 May 2003 [12] Perry, D. M. "Our Long, Troubling History of Sterilizing the Incarcerated." The Marshall Project: Sterilization of Women in Prison 26 July 2017. [13] Rachel Roth & Sara L. Ainsworth, If They Hand You a Paper, You Sign It: A Call to End the Sterilization of Women in Prison, 26 Hastings WOMEN's L.J. 7 (2015); See Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535 (1942) (procreation considered a fundamental right; fact pattern of male sterilization in prison based on type of crime.) [14] Sufrin, C., M. D. Creinin, J. C. Chang. “Incarcerated Women and Abortion Provision: A Survey of Correctional Health Providers.” Perspectives on Sexual and Reproductive Health. p. 6-11. 23 March 2009. [15] Kasdan, D. “Abortion Access for Incarcerated Women: Are Correctional Health Practices in Conflict with Constitutional Standards?” Guttmacher Institute. 26 March 2009. [16] Born Behind Bars. Season 1, Episode 5, “They Can Take Your Baby Away,” produced by Luke Ellis, Francis Gasparini, & Jen Wise, aired on 15 Nov. 2017 A&E Networks [17] Bick, J., & Dozier, M. (2008). Helping Foster Parents Change: The Role of Parental State of Mind. In H. Steele & M. Steele (Eds.), Clinical applications of the Adult Attachment Interview (pp. 452–470). New York: Guilford Press. [18]Sroufe, L. A., B. Egeland, E. A. Carlson, W. A. Collins. (2005). The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. New York: Guilford Press. [19] Goshin, L. S., & Byrne, M. W. “Converging Streams of Opportunity for Prison Nursery Programs in the United States.” Journal of Offender Rehabilitation. 15 Apr 2009. [20] Babies Behind Bars. Dirs. W. Serrill and S. O'Brien. 2015. Another IWP pregnant woman is Taylor. At the time of the show, she was pregnant and expecting twins. In interviews throughout the episode, she expressed how her pregnancies in prison had put her in a better mood and felt beneficial to her. She had tried to sign up for the nursery program for her previous pregnancy, but her sentence was too long to get it. Her child was sent to live with a caregiver, and when Taylor was on probation, Taylor’s daughter didn’t want to be around Taylor. Taylor was so distraught that she messed up and went back, this time, pregnant with twins. After she was reincarcerated, she was able to be accepted into Wee Ones. She expressed to the camera man that the program might help her feel more like a mother so that when she gets out, she will have someone to care for. Taylor, Kara, and many other women depend on their children or their pregnancy for a purpose while behind bars. They relied on their babies to be a boon for them. [21] Babies Behind Bars. Dirs. W. Serrill and S. O'Brien. 2015. [22] Corley, C. "Programs Help Incarcerated Moms Bond with Their Babies in Prison." Criminal Justice Collaborative (2018). [23] Corley, C. "Programs Help Incarcerated Moms Bond with Their Babies in Prison." Criminal Justice Collaborative (2018). [24] Owen, B. & Crow, J. “Recidivism among Female Prisoners: Secondary Analysis of the 1994 BJS Recidivism Data Set” Department of Criminology California State University (2006) p. 28 [25] Prison Nursery Programs: Literature Review and Fact Sheet for CT. Diamond Research Consulting, 2012, www.cga.ct.gov/2013/JUDdata/tmy/2013HB-06642-R000401-Sarah Diamond - Director, Diamond Research Consulting-TMY.PDF. [26] New York Department of Correction Services (NYDOCS). (1993). Profile of Participants: The Bedford and Taconic Nursery Program in 1992. Albany, NY. Department of Correction Services.Rowland, M., & Watts, A. (2007). Washington State’s effort to the generational impact on crime. Corrections Today. Retrieved September 12, 2007, from http://www. aca.org/publications/pdf/Rowland_Watts_Aug07.pdf. [27] Carlson, J. R. (2001). Prison nursery 2000: A five-year review of the prison nursery at the Nebraska Correctional Center for Women. Journal of Offender Rehabilitation, 33, 75–97. [28] Carlson, J.R. [29] Little, B. "What Happens When a Woman Gives Birth Behind Bars?" A+E Networks, 29 October 2019. <https://www.aetv.com/real-crime/what-happens-when-a-woman-gives-birth-in-jail-or-prison>. [30] Margolies, J. K., & Kraft-Stolar, T. When “Free” Means Losing Your Mother: The Collision of Child Welfare and the Incarceration of Women in New York State 1, 9 (Correctional Association of N.Y. Women in Prison Project 2006) [31] Sufrin, C. Jailcare: Finding the Safety Net for Women Behind Bars. Berkeley: University of California Press, 2017. [32] Sufrin, C. Jailcare: p. 155. [33] Peart, M. S. & Knittel, A. K. “Contraception need and available services among incarcerated women in the United States: a systematic review.” Contraception and Reproductive Medicine. 17 March 2020 [34] LaRochelle, F., C. Castro, J. Goldenson, J. P. Tulsky, D.L. Cohan, P. D. Blumenthal, et al. “Contraceptive use and barriers to access among newly arrested women.” J Correct Health Care. (2012) p. 111–119. [35] Goshin, L., & Byrne, M. (2009). “Converging streams of opportunity for prison nursery programs in the United States.” Journal of Offender Rehabilitation. 2009. p.271–295. [36] Elizabeth Swavola, Kristine Riley, Ram Subramanian. Overlooked: Women and Jails in an Era of Reform. New York: Vera Institute of Justice, 2016.

IntroductionLike other forms of embodiment, pregnancy has increasingly become subject to representation and interpretation via digital technologies. Pregnancy and the unborn entity were largely private, and few people beyond the pregnant women herself had access to the foetus growing within her (Duden). Now pregnant and foetal bodies have become open to public portrayal and display (Lupton The Social Worlds of the Unborn). A plethora of online materials – websites depicting the unborn entity from the moment of conception, amateur YouTube videos of births, social media postings of ultrasounds and self-taken photos (‘selfies’) showing changes in pregnant bellies, and so on – now ensure the documentation of pregnant and unborn bodies in extensive detail, rendering them open to other people’s scrutiny. Other recent digital technologies directed at pregnancy include mobile software applications, or ‘apps’. In this article, we draw on our study involving a critical discourse analysis of a corpus of pregnancy-related apps offered in the two major app stores. In so doing, we discuss the ways in which pregnancy-related apps portray pregnant and unborn bodies. We place a particular focus on the ludification and gamification strategies employed to position pregnancy as a playful, creative and fulfilling experience that is frequently focused on consumption. As we will demonstrate, these strategies have wider implications for concepts of pregnant and foetal embodiment and subjectivity.It is important here to make a distinction between ludification and gamification. Ludification is a broader term than gamification. It is used in the academic literature on gaming (sometimes referred to as ‘ludology’) to refer to elements of games reaching into other aspects of life beyond leisure pursuits (Frissen et al. Playful Identities: The Ludification of Digital Media Cultures; Raessens). Frissen et al. (Frissen et al. "Homo Ludens 2.0: Play, Media and Identity") for example, claim that even serious pursuits such as work, politics, education and warfare have been subjected to ludification. They note that digital technologies in general tend to incorporate ludic dimensions. Gamification has been described as ‘the use of game design elements in non-game contexts’ (Deterding et al. 9). The term originated in the digital media industry to describe the incorporation of features into digital technologies that not explicitly designed as games, such as competition, badges, rewards and fun that engaged and motivated users to make them more enjoyable to use. Gamification is now often used in literatures on marketing strategies, persuasive computing or behaviour modification. It is an important element of ‘nudge’, an approach to behaviour change that involves persuasion over coercion (Jones, Pykett and Whitehead). Gamification thus differs from ludification in that the former involves applying ludic principles for reasons other than the pleasures of enjoying the game for their own sake, often to achieve objectives set by actors and agencies other than the gamer. Indeed, this is why gamification software has been described by Bogost (Bogost) as ‘exploitationware’. Analysing Pregnancy AppsMobile apps have become an important medium in contemporary digital technology use. As of May 2015, 1.5 million apps were available to download on Google Play while 1.4 million were available in the Apple App Store (Statista). Apps related to pregnancy are a popular item in app stores, frequently appearing on the Apple App Store’s list of most-downloaded apps. Google Play’s figures show that many apps directed at pregnant women have been downloaded hundreds of thousands, or even millions, of times. For example, ‘Pregnancy +’, ‘I’m Expecting - Pregnancy App’ and ‘What to Expect - Pregnancy Tracker’ have each been downloaded between one and five million times, while ‘My Pregnancy Today’ has received between five and ten million downloads. Pregnancy games for young girls are also popular. Google Play figures show that the ‘Pregnant Emergency Doctor’ game, for example, has received between one and five million downloads. Research has found that pregnant women commonly download pregnancy-related apps and find them useful sources of information and support (Hearn, Miller and Fletcher; Rodger et al.; Kraschnewski et al.; Declercq et al.; Derbyshire and Dancey; O'Higgins et al.). We conducted a comprehensive analysis of all pregnancy-related smartphone apps in the two major app stores, Apple App Store and Google Play, in late June 2015. Android and Apple’s iOS have a combined market share of 91 percent of apps installed on mobile phones (Seneviratne et al.). A search for all pregnancy-related apps offered in these stores used key terms such as pregnancy, childbirth, conception, foetus/fetus and baby. After eliminating apps listed in these searches that were clearly not human pregnancy-related, 665 apps on Google Play and 1,141 on the Apple App Store remained for inclusion in our study. (Many of these apps were shared across the stores.)We carried out a critical discourse analysis of these apps, looking closely at the app descriptions offered in the two stores. We adopted the perspective that sees apps, like any other form of media, as sociocultural artefacts that both draw on and reproduce shared norms, ideals, knowledges and beliefs (Lupton "Quantified Sex: A Critical Analysis of Sexual and Reproductive Self-Tracking Using Apps"; Millington "Smartphone Apps and the Mobile Privatization of Health and Fitness"; Lupton "Apps as Artefacts: Towards a Critical Perspective on Mobile Health and Medical Apps"). In undertaking our analysis of the app descriptions in our corpus, attention was paid to the title of each app, the textual accounts of its content and use and the images that were employed, such as the logo of the app and the screenshots that were used to illustrate its content and style. Our focus in this article is on the apps that we considered as including elements of entertainment. Pregnancy-related game apps were by far the largest category of the apps in our corpus. These included games for young girls and expectant fathers as well as apps for ultrasound manipulation, pregnancy pranks, foetal sex prediction, choosing baby names, and quizzes. Less obviously, many other apps included in our analysis offered some elements of gamification and ludification, and these were considered in our analysis. ‘Pregnant Adventures’: App Games for GirlsOne of the major genres of apps that we identified was games directed at young girls. These apps invited users to shop for clothes, dress up, give a new hair style, ‘make-over’ and otherwise beautify a pregnant woman. These activities were directed at the goal of improving the physical attractiveness and therefore (it was suggested) the confidence of the woman, who was presented as struggling with coming to terms with changes in her body during pregnancy. Other apps for this target group involved the player assuming the role of a doctor in conducting medical treatments for injured pregnant women or assisting the birth of her baby.Many of these games represented the pregnant woman visually as looking like an archetypal Barbie doll, with a wardrobe to match. One app (‘Barbara Pregnancy Shopping’) even uses the name ‘Barbara’ and the screenshots show a woman similar in appearance to the doll. Its description urges players to use the game to ‘cheer up’ an ‘unconfident’ Barbara by taking her on a ‘shopping spree’ for new, glamorous clothes ‘to make Barbara feel beautiful throughout her pregnancy’. Players may find ‘sparkly accessories’ as well for Barbara and help her find a new hairstyle so that she ‘can be her fashionable self again’ and ‘feel prepared to welcome her baby!’. Likewise, the game ‘Pregnant Mommy Makeover Spa’ involves players selecting clothes, applying beauty treatments and makeup and adding accessories to give a makeover to ‘Pregnant Princess’ Leila. The ‘Celebrity Mommy’s Newborn Baby Doctor’ game combines the drawcard of ‘celebrity’ with ‘mommy’. Players are invited to ‘join the celebrities in their pregnancy adventure!’ and ‘take care of Celebrity Mom during her pregnancy!’.An app by the same developer of ‘Barbara Pregnancy Shopping’ also offers ‘Barbara’s Caesarean Birth’. The app description claims that: ‘Of course her poor health doesn’t allow Barbara to give birth to her baby herself.’ It is up to players to ‘make everything perfect’ for Barbara’s caesarean birth. The screenshots show Barbara’s pregnant abdomen being slit open, retracted and a rosy, totally clean infant extracted from the incision, complete with blonde hair. Players then sew up the wound. A final screenshot displays an image of a smiling Barbara standing holding her sleeping, swaddled baby, with the words ‘You win’.Similar games involve princesses, mermaids, fairies and even monster and vampire pregnant women giving birth either vaginally or by caesarean. Despite their preternatural status, the monster and vampire women conform to the same aesthetic as the other pregnant women in these games: usually with long hair and pretty, made-up faces, wearing fashionable clothing even on the operating table. Their newborn infants are similarly uniform in their appearance as they emerge from the uterus. They are white-skinned, clean and cherubic (described in ‘Mommy’s Newborn Baby Princess’ as ‘the cutest baby you probably want’), a far cry from the squalling, squashed-faced infants smeared in birth fluids produced by the real birth process.In these pregnancy games for girls, the pain and intense bodily effort of birthing and the messiness produced by the blood and other body fluids inherent to the process of labour and birth are completely missing. The fact that caesarean birth is a major abdominal surgery requiring weeks of recovery is obviated in these games. Apart from the monsters and vampires, who may have green- or blue-hued skin, nearly all other pregnant women are portrayed as white-skinned, young, wearing makeup and slim, conforming to conventional stereotypical notions of female beauty. In these apps, the labouring women remain glamorous, usually smiling, calm and unsullied by the visceral nature of birth.‘Track Your Pregnancy Day by Day’: Self-Monitoring and Gamified PregnancyElements of gamification were evident in a large number of the apps in our corpus, including many apps that invite pregnant users to engage in self-tracking of their bodies and that of their foetuses. Users are asked to customise the apps to document their changing bodies and track their foetus’ development as part of reproducing the discourse of the miraculous nature of pregnancy and promoting the pleasures of self-tracking and self-transformation from pregnant woman to mother. When using the ‘Pregnancy+’ app, for example, users can choose to construct a ‘Personal Dashboard’ that includes details of their pregnancy. They can input their photograph, first name and their expected date of delivery so that that each daily update begins with ‘Hello [name of user], you are [ ] weeks and [ ] days pregnant’ with the users’ photograph attached to the message. The woman’s weight gain over time and a foetal kick counter are also included in this app. It provides various ways for users to mark the passage of time, observe the ways in which their foetuses change and move week by week and monitor changes in their bodies. According to the app description for ‘My Pregnancy Today’, using such features allows a pregnant woman to: ‘Track your pregnancy day by day.’ Other apps encourage women to track such aspects of physical activity, vitamin and fluid intake, diet, mood and symptoms. The capacity to visually document the pregnant user’s body is also a feature of several apps. The ‘Baby Bump Pregnancy’, ‘WebMD Pregnancy’, ‘I’m Expecting’,’iPregnant’ and ‘My Pregnancy Today’ apps, for example, all offer an album feature for pregnant bump photos taken by the user of herself (described as a ‘bumpie’ in the blurb for ‘My Pregnancy Today’). ‘Baby Buddy’ encourages women to create a pregnant avatar of themselves (looking glamorous, well-dressed and happy). Some apps even advise users on how they should feel. As a screenshot from ‘Pregnancy Tracker Week by Week’ claims: ‘Victoria, your baby is growing in your body. You should be the happiest woman in the world.’Just as pregnancy games for little girls portrayal pregnancy as a commodified and asetheticised experience, the apps directed at pregnant women themselves tend to shy away from discomforting fleshly realities of pregnant and birthing embodiment. Pregnancy is represented as an enjoyable and fashionable state of embodiment: albeit one that requires constant self-surveillance and vigilance.‘Hello Mommy!’: The Personalisation and Aestheticisation of the FoetusA dominant feature of pregnancy-related apps is the representation of the foetus as already a communicative person in its own right. For example, the ‘Pregnancy Tickers – Widget’ app features the image of a foetus (looking far more like an infant, with a full head of wavy hair and open eyes) holding a pencil and marking a tally on the walls of the uterus. The app is designed to provide various icons showing the progress of the user’s pregnancy each day on her mobile device. The ‘Hi Mommy’ app features a cartoon-like pink and cuddly foetus looking very baby-like addressing its mother from the womb, as in the following message that appears on the user’s smartphone: ‘Hi Mommy! When will I see you for the first time?’ Several pregnancy-tracking apps also allow women to input the name that they have chosen for their expected baby, to receive customised notifications of its progress (‘Justin is nine weeks and two days old today’).Many apps also incorporate images of foetuses that represent them as wondrous entities, adopting the visual style of 1960s foetal photography pioneer Lennart Nilsson, or what Stormer (Stormer) has referred to as ‘prenatal sublimity’. The ‘Pregnancy+’ app features such images. Users can choose to view foetal development week-by-week as a colourful computerised animation or 2D and 3D ultrasound scans that have been digitally manipulated to render them aesthetically appealing. These images replicate the softly pink, glowing portrayals of miraculous unborn life typical of Nilsson’s style.Other apps adopt a more contemporary aesthetic and allow parents to store and manipulate images of their foetal ultrasounds and then share them via social media. The ‘Pimp My Ultrasound’ app, for example, invites prospective parents to manipulate images of their foetal ultrasounds by adding in novelty features to the foetal image such as baseball caps, jewellery, credit cards and musical instruments. The ‘Hello Mom’ app creates a ‘fetal album’ of ultrasounds taken of the user’s foetus, while the ‘Ultrasound Viewer’ app lets users manipulate their 3/4 D foetal ultrasound images: ‘Have fun viewing it from every angle, rotating, panning and zooming to see your babies [sic] features and share with your family and friends via Facebook and Twitter! … Once uploaded, you can customise your scan with a background colour and skin colour of your choice’.DiscussionPregnancy, like any other form of embodiment, is performative. Pregnant women are expected to conform to norms and assumptions about their physical appearance and deportment of their bodies that expect them to remain well-groomed, fit and physically attractive without appearing overly sexual (Longhurst "(Ad)Dressing Pregnant Bodies in New Zealand: Clothing, Fashion, Subjectivities and Spatialities"; Longhurst "'Corporeographies’ of Pregnancy: ‘Bikini Babes'"; Nash; Littler). Simultaneously they must negotiate the burden of bodily management in the interests of risk regulation. They are expected to protect their vulnerable unborn from potential dangers by stringently disciplining their bodies and policing to what substances they allow entry (Lupton The Social Worlds of the Unborn; Lupton "'Precious Cargo': Risk and Reproductive Citizenship"). Pregnancy self-tracking apps enact the soft politics of algorithmic authority, encouraging people to conform to expectations of self-responsibility and self-management by devoting attention to monitoring their bodies and acting on the data that they generate (Whitson; Millington "Amusing Ourselves to Life: Fitness Consumerism and the Birth of Bio-Games"; Lupton The Quantified Self: A Sociology of Self-Tracking).Many commentators have remarked on the sexism inherent in digital games (e.g. Dickerman, Christensen and Kerl-McClain; Thornham). Very little research has been conducted specifically on the gendered nature of app games. However our analysis suggests that, at least in relation to the pregnant woman, reductionist heteronormative, cisgendered, patronising and paternalistic stereotypes abound. In the games for girls, pregnant women are ideally young, heterosexual, partnered, attractive, slim and well-groomed, before, during and after birth. In self-tracking apps, pregnant women are portrayed as ideally self-responsible, enthused about their pregnancy and foetus to the point that they are counting the days until the birth and enthusiastic about collecting and sharing details about themselves and their unborn (often via social media).Ambivalence about pregnancy, the foetus or impending motherhood, and lack of interest in monitoring the pregnancy or sharing details of it with others are not accommodated, acknowledged or expected by these apps. Acknowledgement of the possibility of pregnant women who are not overtly positive about their pregnancy or lack interest in it or who identify as transgender or lesbian or who are sole mothers is distinctly absent.Common practices we noted in apps – such as giving foetuses names before birth and representing them as verbally communicating with their mothers from inside the womb – underpin a growing intensification around the notion of the unborn entity as already an infant and social actor in its own right. These practices have significant implications for political agendas around the treatment of pregnant women in terms of their protection or otherwise of their unborn, and for debates about women’s reproductive rights and access to abortion (Lupton The Social Worlds of the Unborn; Taylor The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction). Further, the gamification and ludification of pregnancy serve to further commodify the experience of pregnancy and childbirth, contributing to an already highly commercialised environment in which expectant parents, and particularly mothers, are invited to purchase many goods and services related to pregnancy and early parenthood (Taylor "Of Sonograms and Baby Prams: Prenatal Diagnosis, Pregnancy, and Consumption"; Kroløkke; Thomson et al.; Taylor The Public Life of the Fetal Sonogram: Technology, Consumption and the Politics of Reproduction; Thomas).In the games for girls we examined, the pregnant woman herself was a commodity, a selling point for the app. The foetus was also frequently commodified in its representation as an aestheticised entity and the employment of its image (either as an ultrasound or other visual representations) or identity to market apps such as the girls’ games, apps for manipulating ultrasound images, games for predicting the foetus’ sex and choosing its name, and prank apps using fake ultrasounds purporting to reveal a foetus inside a person’s body. As the pregnant user engages in apps, she becomes a commodity in yet another way: the generator of personal data that are marketable in themselves. In this era of the digital data knowledge economy, the personal information about people gathered from their online interactions and content creation has become highly profitable for third parties (Andrejevic; van Dijck). Given that pregnant women are usually in the market for many new goods and services, their personal data is a key target for data mining companies, who harvest it to sell to advertisers (Marwick).To conclude, our analysis suggests that gamification and ludification strategies directed at pregnancy and childbirth can serve to obfuscate the societal pressures that expect and seek to motivate pregnant women to maintain physical fitness and attractiveness, simultaneously ensuring that they protect their foetuses from all possible risks. In achieving both ends, women are encouraged to engage in intense self-monitoring and regulation of their bodies. These apps also reproduce concepts of the unborn entity as a precious and beautiful already-human. These types of portrayals have important implications for how young girls learn about pregnancy and childbirth, for pregnant women’s experiences and for concepts of foetal personhood that in turn may influence women’s reproductive rights and abortion politics.ReferencesAndrejevic, Mark. Infoglut: How Too Much Information Is Changing the Way We Think and Know. New York: Routledge, 2013. Print.Bogost, Ian. "Why Gamification Is Bullshit." The Gameful World: Approaches, Issues, Applications. Eds. Steffen Walz and Sebastian Deterding. Boston, MA: MIT Press, 2015. 65-80. Print.Declercq, E.R., et al. Listening to Mothers III: Pregnancy and Birth. New York: Childbirth Connection, 2013. Print.Derbyshire, Emma, and Darren Dancey. 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Refereed publications (also known as peer-reviewed) are the currency of academia, yet many PhD theses in Australia result in only one or two such papers. Typically, a doctoral thesis requires the candidate to present (and pass) a public Confirmation Seminar, around nine to twelve months into candidacy, in which a panel of the candidate’s supervisors and invited experts adjudicate upon whether the work is likely to continue and ultimately succeed in the goal of a coherent and original contribution to knowledge. A Final Seminar, also public and sometimes involving the traditional viva voce or oral defence of the thesis, is presented two or three months before approval is given to send the 80,000 to 100,000 word tome off for external examination. And that soul-destroying or elation-releasing examiner’s verdict can be many months in the delivery: a limbo-like period during which the candidate’s status as a student is ended and her or his receipt of any scholarship or funding guerdon is terminated with perfunctory speed. This is the only time most students spend seriously writing up their research for publication although, naturally, many are more involved in job hunting as they pin their hopes on passing the thesis examination.There is, however, a slightly more palatable alternative to this nail-biting process of the traditional PhD, and that is the PhD by Published Papers (also known as PhD by Publications or PhD by Published Works). The form of my own soon-to-be-submitted thesis, it permits the submission for examination of a collection of papers that have been refereed and accepted (or are in the process of being refereed) for publication in academic journals or books. Apart from the obvious benefits in getting published early in one’s (hopefully) burgeoning academic career, it also takes away a lot of the stress come final submission time. After all, I try to assure myself, the thesis examiners can’t really discredit the process of double-blind, peer-review the bulk of the thesis has already undergone: their job is to examine how well I’ve unified the papers into a cohesive thesis … right? But perhaps they should at least be wary, because, unfortunately, the requirements for this kind of PhD vary considerably from institution to institution and there have been some cases where the submitted work is of questionable quality compared to that produced by graduates from more demanding universities. Hence, this paper argues that in my subject area of interest—film and television studies—there is a huge range in the set requirements for doctorates, from universities that award the degree to film artists for prior published work that has undergone little or no academic scrutiny and has involved little or no on-campus participation to at least three Australian universities that require candidates be enrolled for a minimum period of full-time study and only submit scholarly work generated and published (or submitted for publication) during candidature. I would also suggest that uncertainty about where a graduate’s work rests on this continuum risks confusing a hard-won PhD by Published Papers with the sometimes risible honorary doctorate. Let’s begin by dredging the depths of those murky, quasi-academic waters to examine the occasionally less-than-salubrious honorary doctorate. The conferring of this degree is generally a recognition of an individual’s body of (usually published) work but is often conferred for contributions to knowledge or society in general that are not even remotely academic. The honorary doctorate does not usually carry with it the right to use the title “Dr” (although many self-aggrandising recipients in the non-academic world flout this unwritten code of conduct, and, indeed, Monash University’s Monash Magazine had no hesitation in describing its 2008 recipient, musician, screenwriter, and art-school-dropout Nick Cave, as “Dr Cave” (O’Loughlin)). Some shady universities even offer such degrees for sale or ‘donation’ and thus do great damage to that institution’s credibility as well as to the credibility of the degree itself. Such overseas “diploma mills”—including Ashwood University, Belford University, Glendale University and Suffield University—are identified by their advertising of “Life Experience Degrees,” for which a curriculum vitae outlining the prospective graduand’s oeuvre is accepted on face value as long as their credit cards are not rejected. An aspiring screen auteur simply specifies film and television as their major and before you can shout “Cut!” there’s a degree in the mail. Most of these pseudo-universities are not based in Australia but are perfectly happy to confer their ‘titles’ to any well-heeled, vanity-driven Australians capable of completing the online form. Nevertheless, many academics fear a similarly disreputable marketplace might develop here, and Norfolk Island-based Greenwich University presents a particularly illuminating example. Previously empowered by an Act of Parliament consented to by Senator Ian Macdonald, the then Minister for Territories, this “university” had the legal right to confer honorary degrees from 1998. The Act was eventually overridden by legislation passed in 2002, after a concerted effort by the Australian Universities Quality Agency Ltd. and the Australian Vice-Chancellors’ Committee to force the accreditation requirements of the Australian Qualifications Framework upon the institution in question, thus preventing it from making degrees available for purchase over the Internet. Greenwich University did not seek re-approval and soon relocated to its original home of Hawaii (Brown). But even real universities flounder in similarly muddy waters when, unsolicited, they make dubious decisions to grant degrees to individuals they hold in high esteem. Although meaning well by not courting pecuniary gain, they nevertheless invite criticism over their choice of recipient for their honoris causa, despite the decision usually only being reached after a process of debate and discussion by university committees. Often people are rewarded, it seems, as much for their fame as for their achievements or publications. One such example of a celebrity who has had his onscreen renown recognised by an honorary doctorate is film and television actor/comedian Billy Connolly who was awarded an Honorary Doctor of Letters by The University of Glasgow in 2006, prompting Stuart Jeffries to complain that “something has gone terribly wrong in British academia” (Jeffries). Eileen McNamara also bemoans the levels to which some institutions will sink to in search of media attention and exposure, when she writes of St Andrews University in Scotland conferring an honorary doctorate to film actor and producer, Michael Douglas: “What was designed to acknowledge intellectual achievement has devolved into a publicity grab with universities competing for celebrity honorees” (McNamara). Fame as an actor (and the list gets even weirder when the scope of enquiry is widened beyond the field of film and television), seems to be an achievement worth recognising with an honorary doctorate, according to some universities, and this kind of discredit is best avoided by Australian institutions of higher learning if they are to maintain credibility. Certainly, universities down under would do well to follow elsewhere than in the footprints of Long Island University’s Southampton College. Perhaps the height of academic prostitution of parchments for the attention of mass media occurred when in 1996 this US school bestowed an Honorary Doctorate of Amphibious Letters upon that mop-like puppet of film and television fame known as the “muppet,” Kermit the Frog. Indeed, this polystyrene and cloth creation with an anonymous hand operating its mouth had its acceptance speech duly published (see “Kermit’s Acceptance Speech”) and the Long Island University’s Southampton College received much valuable press. After all, any publicity is good publicity. Or perhaps this furry frog’s honorary degree was a cynical stunt meant to highlight the ridiculousness of the practice? In 1986 a similar example, much closer to my own home, occurred when in anticipation and condemnation of the conferral of an honorary doctorate upon Prince Philip by Monash University in Melbourne, the “Members of the Monash Association of Students had earlier given a 21-month-old Chihuahua an honorary science degree” (Jeffries), effectively suggesting that the honorary doctorate is, in fact, a dog of a degree. On a more serious note, there have been honorary doctorates conferred upon far more worthy recipients in the field of film and television by some Australian universities. Indigenous film-maker Tracey Moffatt was awarded an honorary doctorate by Griffith University in November of 2004. Moffatt was a graduate of the Griffith University’s film school and had an excellent body of work including the films Night Cries: A Rural Tragedy (1990) and beDevil (1993). Acclaimed playwright and screenwriter David Williamson was presented with an Honorary Doctorate of Letters by The University of Queensland in December of 2004. His work had previously picked up four Australian Film Institute awards for best screenplay. An Honorary Doctorate of Visual and Performing Arts was given to film director Fred Schepisi AO by The University of Melbourne in May of 2006. His films had also been earlier recognised with Australian Film Institute awards as well as the Golden Globe Best Miniseries or Television Movie award for Empire Falls in 2006. Director George Miller was crowned with an Honorary Doctorate in Film from the Australian Film, Television, and Radio School in April 2007, although he already had a medical doctor’s testamur on his wall. In May of this year, filmmaker George Gittoes, a fine arts dropout from The University of Sydney, received an honorary doctorate by The University of New South Wales. His documentaries, Soundtrack to War (2005) and Rampage (2006), screened at the Sydney and Berlin film festivals, and he has been employed by the Australian Government as an official war artist. Interestingly, the high quality screen work recognised by these Australian universities may have earned the recipients ‘real’ PhDs had they sought the qualification. Many of these film artists could have just as easily submitted their work for the degree of PhD by Published Papers at several universities that accept prior work in lieu of an original exegesis, and where a film is equated with a book or journal article. But such universities still invite comparisons of their PhDs by Published Papers with honorary doctorates due to rather too-easy-to-meet criteria. The privately funded Bond University, for example, recommends a minimum full-time enrolment of just three months and certainly seems more lax in its regulations than other Antipodean institution: a healthy curriculum vitae and payment of the prescribed fee (currently AUD$24,500 per annum) are the only requirements. Restricting my enquiries once again to the field of my own research, film and television, I note that Dr. Ingo Petzke achieved his 2004 PhD by Published Works based upon films produced in Germany well before enrolling at Bond, contextualized within a discussion of the history of avant-garde film-making in that country. Might not a cynic enquire as to how this PhD significantly differs from an honorary doctorate? Although Petzke undoubtedly paid his fees and met all of Bond’s requirements for his thesis entitled Slow Motion: Thirty Years in Film, one cannot criticise that cynic for wondering if Petzke’s films are indeed equivalent to a collection of refereed papers. It should be noted that Bond is not alone when it comes to awarding candidates the PhD by Published Papers for work published or screened in the distant past. Although yet to grant it in the area of film or television, Swinburne University of Technology (SUT) is an institution that distinctly specifies its PhD by Publications is to be awarded for “research which has been carried out prior to admission to candidature” (8). Similarly, the Griffith Law School states: “The PhD (by publications) is awarded to established researchers who have an international reputation based on already published works” (1). It appears that Bond is no solitary voice in the academic wilderness, for SUT and the Griffith Law School also apparently consider the usual milestones of Confirmation and Final Seminars to be unnecessary if the so-called candidate is already well published. Like Bond, Griffith University (GU) is prepared to consider a collection of films to be equivalent to a number of refereed papers. Dr Ian Lang’s 2002 PhD (by Publication) thesis entitled Conditional Truths: Remapping Paths To Documentary ‘Independence’ contains not refereed, scholarly articles but the following videos: Wheels Across the Himalaya (1981); Yallambee, People of Hope (1986); This Is What I Call Living (1988); The Art of Place: Hanoi Brisbane Art Exchange (1995); and Millennium Shift: The Search for New World Art (1997). While this is a most impressive body of work, and is well unified by appropriate discussion within the thesis, the cynic who raised eyebrows at Petzke’s thesis might also be questioning this thesis: Dr Lang’s videos all preceded enrolment at GU and none have been refereed or acknowledged with major prizes. Certainly, the act of releasing a film for distribution has much in common with book publishing, but should these videos be considered to be on a par with academic papers published in, say, the prestigious and demanding journal Screen? While recognition at awards ceremonies might arguably correlate with peer review there is still the question as to how scholarly a film actually is. Of course, documentary films such as those in Lang’s thesis can be shown to be addressing gaps in the literature, as is the expectation of any research paper, but the onus remains on the author/film-maker to demonstrate this via a detailed contextual review and a well-written, erudite argument that unifies the works into a cohesive thesis. This Lang has done, to the extent that suspicious cynic might wonder why he chose not to present his work for a standard PhD award. Another issue unaddressed by most institutions is the possibility that the publications have been self-refereed or refereed by the candidate’s editorial colleagues in a case wherein the papers appear in a book the candidate has edited or co-edited. Dr Gillian Swanson’s 2004 GU thesis Towards a Cultural History of Private Life: Sexual Character, Consuming Practices and Cultural Knowledge, which addresses amongst many other cultural artefacts the film Lawrence of Arabia (David Lean 1962), has nine publications: five of which come from two books she co-edited, Nationalising Femininity: Culture, Sexuality and Cinema in Britain in World War Two, (Gledhill and Swanson 1996) and Deciphering Culture: Ordinary Curiosities and Subjective Narratives (Crisp et al 2000). While few would dispute the quality of Swanson’s work, the persistent cynic might wonder if these five papers really qualify as refereed publications. The tacit understanding of a refereed publication is that it is blind reviewed i.e. the contributor’s name is removed from the document. Such a system is used to prevent bias and favouritism but this level of anonymity might be absent when the contributor to a book is also one of the book’s editors. Of course, Dr Swanson probably took great care to distance herself from the refereeing process undertaken by her co-editors, but without an inbuilt check, allegations of cronyism from unfriendly cynics may well result. A related factor in making comparisons of different university’s PhDs by Published Papers is the requirements different universities have about the standard of the journal the paper is published in. It used to be a simple matter in Australia: the government’s Department of Education, Science and Training (DEST) held a Register of Refereed Journals. If your benefactor in disseminating your work was on the list, your publications were of near-unquestionable quality. Not any more: DEST will no longer accept nominations for listing on the Register and will not undertake to rule on whether a particular journal article meets the HERDC [Higher Education Research Data Collection] requirements for inclusion in publication counts. HEPs [Higher Education Providers] have always had the discretion to determine if a publication produced in a journal meets the requirements for inclusion in the HERDC regardless of whether or not the journal was included on the Register of Refereed Journals. As stated in the HERDC specifications, the Register is not an exhaustive list of all journals which satisfy the peer-review requirements (DEST). The last listing for the DEST Register of Refereed Journals was the 3rd of February 2006, making way for a new tiered list of academic journals, which is currently under review in the Australian tertiary education sector (see discussion of this development in the Redden and Mitchell articles in this issue). In the interim, some university faculties created their own rankings of journals, but not the Faculty of Creative Industries at the Queensland University of Technology (QUT) where I am studying for my PhD by Published Papers. Although QUT does not have a list of ranked journals for a candidate to submit papers to, it is otherwise quite strict in its requirements. The QUT University Regulations state, “Papers submitted as a PhD thesis must be closely related in terms of subject matter and form a cohesive research narrative” (QUT PhD regulation 14.1.2). Thus there is the requirement at QUT that apart from the usual introduction, methodology and literature review, an argument must be made as to how the papers present a sustained research project via “an overarching discussion of the main features linking the publications” (14.2.12). It is also therein stated that it should be an “account of research progress linking the research papers” (4.2.6). In other words, a unifying essay must make an argument for consideration of the sometimes diversely published papers as a cohesive body of work, undertaken in a deliberate journey of research. In my own case, an aural auteur analysis of sound in the films of Rolf de Heer, I argue that my published papers (eight in total) represent a journey from genre analysis (one paper) to standard auteur analysis (three papers) to an argument that sound should be considered in auteur analysis (one paper) to the major innovation of the thesis, aural auteur analysis (three papers). It should also be noted that unlike Bond, GU or SUT, the QUT regulations for the standard PhD still apply: a Confirmation Seminar, Final Seminar and a minimum two years of full-time enrolment (with a minimum of three months residency in Brisbane) are all compulsory. Such milestones and sine qua non ensure the candidate’s academic progress and intellectual development such that she or he is able to confidently engage in meaningful quodlibets regarding the thesis’s topic. Another interesting and significant feature of the QUT guidelines for this type of degree is the edict that papers submitted must be “published, accepted or submitted during the period of candidature” (14.1.1). Similarly, the University of Canberra (UC) states “The articles or other published material must be prepared during the period of candidature” (10). Likewise, Edith Cowan University (ECU) will confer its PhD by Publications to those candidates whose thesis consists of “only papers published in refereed scholarly media during the period of enrolment” (2). In other words, one cannot simply front up to ECU, QUT, or UC with a résumé of articles or films published over a lifetime of writing or film-making and ask for a PhD by Published Papers. Publications of the candidate prepared prior to commencement of candidature are simply not acceptable at these institutions and such PhDs by Published Papers from QUT, UC and ECU are entirely different to those offered by Bond, GU and SUT. Furthermore, without a requirement for a substantial period of enrolment and residency, recipients of PhDs by Published Papers from Bond, GU, or SUT are unlikely to have participated significantly in the research environment of their relevant faculty and peers. Such newly minted doctors may be as unfamiliar with the campus and its research activities as the recipient of an honorary doctorate usually is, as he or she poses for the media’s cameras en route to the glamorous awards ceremony. Much of my argument in this paper is built upon the assumption that the process of refereeing a paper (or for that matter, a film) guarantees a high level of academic rigour, but I confess that this premise is patently naïve, if not actually flawed. Refereeing can result in the rejection of new ideas that conflict with the established opinions of the referees. Interdisciplinary collaboration can be impeded and the lack of referee’s accountability is a potential problem, too. It can also be no less nail-biting a process than the examination of a finished thesis, given that some journals take over a year to complete the refereeing process, and some journal’s editorial committees have recognised this shortcoming. Despite being a mainstay of its editorial approach since 1869, the prestigious science journal, Nature, which only publishes about 7% of its submissions, has led the way with regard to varying the procedure of refereeing, implementing in 2006 a four-month trial period of ‘Open Peer Review’. Their website states, Authors could choose to have their submissions posted on a preprint server for open comments, in parallel with the conventional peer review process. Anyone in the field could then post comments, provided they were prepared to identify themselves. Once the usual confidential peer review process is complete, the public ‘open peer review’ process was closed and the editors made their decision about publication with the help of all reports and comments (Campbell). Unfortunately, the experiment was unpopular with both authors and online peer reviewers. What the Nature experiment does demonstrate, however, is that the traditional process of blind refereeing is not yet perfected and can possibly evolve into something less problematic in the future. Until then, refereeing continues to be the best system there is for applying structured academic scrutiny to submitted papers. With the reforms of the higher education sector, including forced mergers of universities and colleges of advanced education and the re-introduction of university fees (carried out under the aegis of John Dawkins, Minister for Employment, Education and Training from 1987 to 1991), and the subsequent rationing of monies according to research dividends (calculated according to numbers of research degree conferrals and publications), there has been a veritable explosion in the number of institutions offering PhDs in Australia. But the general public may not always be capable of differentiating between legitimately accredited programs and diploma mills, given that the requirements for the first differ substantially. From relatively easily obtainable PhDs by Published Papers at Bond, GU and SUT to more rigorous requirements at ECU, QUT and UC, there is undoubtedly a huge range in the demands of degrees that recognise a candidate’s published body of work. The cynical reader may assume that with this paper I am simply trying to shore up my own forthcoming graduation with a PhD by Published papers from potential criticisms that it is on par with a ‘purchased’ doctorate. Perhaps they are right, for this is a new degree in QUT’s Creative Industries faculty and has only been awarded to one other candidate (Dr Marcus Foth for his 2006 thesis entitled Towards a Design Methodology to Support Social Networks of Residents in Inner-City Apartment Buildings). But I believe QUT is setting a benchmark, along with ECU and UC, to which other universities should aspire. In conclusion, I believe further efforts should be undertaken to heighten the differences in status between PhDs by Published Papers generated during enrolment, PhDs by Published Papers generated before enrolment and honorary doctorates awarded for non-academic published work. Failure to do so courts cynical comparison of all PhD by Published Papers with unearnt doctorates bought from Internet shysters. References Brown, George. “Protecting Australia’s Higher Education System: A Proactive Versus Reactive Approach in Review (1999–2004).” Proceedings of the Australian Universities Quality Forum 2004. Australian Universities Quality Agency, 2004. 11 June 2008 ‹http://www.auqa.edu.au/auqf/2004/program/papers/Brown.pdf>. Campbell, Philip. “Nature Peer Review Trial and Debate.” Nature: International Weekly Journal of Science. December 2006. 11 June 2008 ‹http://www.nature.com/nature/peerreview/> Crisp, Jane, Kay Ferres, and Gillian Swanson, eds. Deciphering Culture: Ordinary Curiosities and Subjective Narratives. London: Routledge, 2000. Department of Education, Science and Training (DEST). “Closed—Register of Refereed Journals.” Higher Education Research Data Collection, 2008. 11 June 2008 ‹http://www.dest.gov.au/sectors/research_sector/online_forms_services/ higher_education_research_data_ collection.htm>. Edith Cowan University. “Policy Content.” Postgraduate Research: Thesis by Publication, 2003. 11 June 2008 ‹http://www.ecu.edu.au/GPPS/policies_db/tmp/ac063.pdf>. Gledhill, Christine, and Gillian Swanson, eds. Nationalising Femininity: Culture, Sexuality and Cinema in Britain in World War Two. Manchester: Manchester UP, 1996. Griffith Law School, Griffith University. Handbook for Research Higher Degree Students. 24 March 2004. 11 June 2008 ‹http://www.griffith.edu.au/centre/slrc/pdf/rhdhandbook.pdf>. Jeffries, Stuart. “I’m a celebrity, get me an honorary degree!” The Guardian 6 July 2006. 11 June 2008 ‹http://education.guardian.co.uk/higher/comment/story/0,,1813525,00.html>. Kermit the Frog. “Kermit’s Commencement Address at Southampton Graduate Campus.” Long Island University News 19 May 1996. 11 June 2008 ‹http://www.southampton.liu.edu/news/commence/1996/kermit.htm>. McNamara, Eileen. “Honorary senselessness.” The Boston Globe 7 May 2006. ‹http://www. boston.com/news/local/articles/2006/05/07/honorary_senselessness/>. O’Loughlin, Shaunnagh. “Doctor Cave.” Monash Magazine 21 (May 2008). 13 Aug. 2008 ‹http://www.monash.edu.au/pubs/monmag/issue21-2008/alumni/cave.html>. Queensland University of Technology. “Presentation of PhD Theses by Published Papers.” Queensland University of Technology Doctor of Philosophy Regulations (IF49). 12 Oct. 2007. 11 June 2008 ‹http://www.mopp.qut.edu.au/Appendix/appendix09.jsp#14%20Presentation %20of%20PhD%20Theses>. Swinburne University of Technology. Research Higher Degrees and Policies. 14 Nov. 2007. 11 June 2008 ‹http://www.swinburne.edu.au/corporate/registrar/ppd/docs/RHDpolicy& procedure.pdf>. University of Canberra. Higher Degrees by Research: Policy and Procedures (The Gold Book). 7.3.3.27 (a). 15 Nov. 2004. 11 June 2008 ‹http://www.canberra.edu.au/research/attachments/ goldbook/Pt207_AB20approved3220arp07.pdf>.

The rise of expertise in the lives of women is a complex and prolonged process that began when the old networks through which women had learned from each other were being discredited or destroyed (Ehrenreich and English). Enclosed spaces of expert power formed separately from political control, market logistics and the pressures exerted by their subjects (Rose and Miller). This, however, was not a question of imposing expertise on women and forcing them to adhere to expert proclamations: “the experts could not have triumphed had not so many women welcomed them, sought them out, and … organised to promote their influence” (Ehrenreich and English 28). Women’s continuing enthusiasm for self-help books – and it is mainly women who buy them (Wood) – attests to the fact that they are still welcoming expertise into their lives. This paper argues that a major factor in the popularity of self-help is the reversal of the conventional ‘priestly’ relationship and ethic of confession, in a process of conversion that relies on the enthusiasm and active participation of the reader.Miller and Rose outline four ways in which human behaviour can be transformed: regulation (enmeshing people in a code of standards); captivation (seducing people with charm or charisma); education (training, convincing or persuading people); and conversion (transforming personhood, and ways of experiencing the world so that people understand themselves in fundamentally new ways). Of these four ways of acting upon others, it is conversion that is the most potent, because it changes people at the level of their own subjectivity – “personhood itself is remade” (Miller and Rose 35). While theories of conversion cannot be adequately discussed here, one aspect held in common by theories of religious conversion as well as those from psychological studies of ‘brainwashing’ is enthusiasm. Rambo’s analysis of the stages of religious conversion, for example, includes ‘questing’ in an active and engaged way, and a probable encounter with a passionately enthusiastic believer. Melia and Ryder, in their study of ‘brainwashing,’ state that two of the end stages of conversion are euphoria and proselytising – a point to which I will return in the conclusion. In order for a conversion to occur, then, the reader must be not only intellectually convinced of the truth, but must feel it is an important or vital truth, a truth she needs – in short, the reader must be enthused. The popularity of self-help books coincides with the rise of psy expertise more generally (Rose, "Identity"; Inventing), but self-help putatively offers escape from the experts, whilst simultaneously immersing its readers in expertise. Readers of self-help view themselves as reading sceptically (Simonds), interpretively (Rosenblatt) and resistingly (Fetterly, Rowe). They choose to read books as an educational activity (Dolby), rather than attending counselling or psychotherapy sessions in which they might be subject to manipulation, domination and control by a therapist (Simonds). I have discussed the nature of the advice in relationship manuals elsewhere (Hazleden, "Relationship"; "Pathology"), but the intention of this paper is to investigate the ways in which the authors attempt to enthuse and convert the reader.Best-Selling ExpertiseIn common with other best-selling genres, popular relationship manuals begin trying to enthuse the reader on the covers, which are intended to attract the reader, to establish the professional – or ‘priestly’ – credentials of the author and to assert the merit of the book, presenting the authors as experienced professionally-qualified experts, and advertising their bestseller status. These factors form part of the marketing ‘buzz’ or collective enthusiasm about a particular author or book.As part of the process of establishing themselves in the priestly role, the authors emphasise their professional qualifications and experience. Most authors use the title ‘Dr’ on the cover (Hendrix, McGraw, Forward, Gray, Cowan and Kinder, Schlessinger) or ‘PhD’ after their names (Vedral, DeAngelis, Spezzano). Further claims on the covers include assertions of the prominence of the authors in their field. Typical are DeAngelis’s claim to being “America’s foremost relationships expert,” and Hendrix’s claim to being “the world’s leading marital therapist.” Clinical and professional experience is mentioned, such as Spezzano’s “twenty-three years of counseling experience” (1) and Forward’s experience as “a consultant in many southern California Medical and psychiatric facilities” (iii). The cover of Spezzano’s book claims that he is a “therapist, seminar leader, author, lecturer and visionary leader.” McGraw emphasises his formal qualifications throughout his book, saying, “I had more degrees than a thermometer” (McGraw 6), and he refers to himself throughout as “Dr. Phil,” much like “Dr Laura” (Schlessinger). Facts and SecretsThe authors claim their ideas are based on clinical practice, research, and evidence. One author claims, “In this book, there is a wealth of tried and accurate information, which has worked for thousands of people in my therapeutic practice and seminars over the last two decades” (Spezzano 1). Another claims that he “worked with hundreds of couples in private practice and thousands more in workshops and seminars” and subsequently based his ideas on “research and clinical observations” (Hendrix xviii). Dowling refers to “four years of research … interviewing professionals who work with and study women.” She went to all this trouble because, she assures us, “I wanted facts” (Dowling, dust-jacket, 30).All this is in order to assure the reader of the relevance and build her enthusiasm about the importance of the book. McGraw (226) says he “reviewed case histories of literally thousands and thousands of couples” in order “to choose the right topics” for his book. Spezzano (7) claims that his psychological exercises come from clinical experience, but “more importantly, I have tested them all personally. Now I offer them to you.” This notion of being in possession of important new knowledge of which the reader is unaware is common, and expressed most succinctly by McGraw (15): “I have learned what you know and, more important, what you don't know.” This knowledge may be referred to as ‘secret’ (e.g. DeAngelis), or ‘hidden’ (e.g. Dowling) or as a recent discovery. Readers seem to accept this – they often assume that self-help books spring ‘naturally’ from clinical investigation as new information is ‘discovered’ about the human psyche (Lichterman 432).The Altruistic AuthorOn the assumption that readers will be familiar with other self-help books, some authors find it necessary to explain why they felt motivated to write one themselves. Usually these take the form of a kind of altruistic enthusiasm to share their great discoveries. Cowan and Kinder (xiv) claim that “one of the wonderful, intrinsic rewards of working with someone in individual psychotherapy is the rich and intense relationship that is established, [but] one of the frustrations of individual work is that in a whole lifetime it is impossible to touch more than a few people.” Morgan (26) assures us that “the results of applying certain principles to my marriage were so revolutionary that I had to pass them on in the four lesson Total Woman course, and now in this book.”The authors justify their own addition to an overcrowded genre by delineating what is distinctive about their own book, or what other “books, articles and surveys missed” (Dowling 30) or misinterpreted. Beattie (98-102) devotes several pages to a discussion of Dowling to assert that Dowling’s ‘Cinderella Complex’ is more accurately known as ‘codependency.’ The authors of another book admit that their ideas are not new, but claim to make a unique contribution because they are “writing from a much-needed male point of view” (Cowan and Kinder, back cover). Similarly, Gray suggests “many books are one-sided and unfortunately reinforce mistrust and resentment toward the opposite sex.” This meant that “a definitive guide was needed for understanding how healthy men and women are different,” and he promises “This book provides that vision” (Gray 4,7).Some authors are vehement in attacking other experts’ books as “gripe sessions,” “gobbledegook” (Schlessinger 51, 87), or “ridiculous” (Vedral 282). McGraw (9) writes “it is amazing to me how this country is overflowing with marital therapists, psychiatrists and psychologists, counselors, healers, advice columnists, and self-help authors – and their approach to relationships is usually so embarrassing that I want to turn my head in shame.” His own book, by contrast, will be quite different from anything the reader has heard before, because “it differs from what relationship ‘experts’ tell you” (McGraw 45).Confessions of an Author Because the authors are writing about intimate relationships, they are also keen to establish their credentials on a more personal level. “Loving, losing, learning the lessons, and reloving have been my path” (Carter-Scott 247-248), says one, and another asserts that, “It’s taken me a long time to understand men. It’s been a difficult and often painful journey and I’ve made a lot of mistakes along the way in my own relationships” (DeAngelis xvi). The authors are even keen to admit the mistakes they made in their previous relationships. Gray says, “In my previous relationships, I had become indifferent and unloving at difficult times … As a result, my first marriage had been very painful and difficult” (Gray 2). Others describe the feelings of disappointment with their marriages: We gradually changed. I was amazed to realize that Charlie had stopped talking. He had become distant and preoccupied. … Each evening, when Charlie walked in the front door after work, a cloud of gloom and tension floated in with him. That cloud was almost tangible. … this tension cloud permeated our home atmosphere … there was a barrier between us. (Morgan 18)Doyle (14) tells a similar tale: “While my intentions were good, I was clearly on the road to marital hell. … I was becoming estranged from the man who had once made me so happy. Our marriage was in serious trouble and it had only been four years since we’d taken our vows.” The authors relate the bewilderment they felt in these failing relationships: “My confusion about the psychology of love relationships was compounded when I began to have problems with my own marriage. … we gave our marriage eight years of intensive examination, working with numerous therapists. Nothing seemed to help” (Hendrix xvii).Even the process of writing the relationship manual itself can be uncomfortable: This was the hardest and most painful chapter for me to write, because it hit so close to home … I sat down at my computer, typed out the title of this chapter, and burst into tears. … It was the pain of my own broken heart. (DeAngelis 74)The Worthlessness of ExpertiseThus, the authors present their confessional tales in which they have learned important lessons through their own suffering, through the experience of life itself, and not through the intervention of any form of external or professional expertise. Furthermore, they highlight the failure of their professional training. Susan Forward (4) draws a comparison between her professional life as a relationship counsellor and the “Susan who went home at night and twisted herself into a pretzel trying to keep her husband from yelling at her.” McGraw tells of a time when he was counselling a couple, and: Suddenly all I could hear myself saying was blah, blah, blah. Blah, blah, blah, blah. As I sat there, I asked myself, ‘Has anybody noticed over the last fifty years that this crap doesn’t work? Has it occurred to anyone that the vast majority of these couples aren’t getting any better? (McGraw 6)The authors go to some lengths to demonstrate that their new-found knowledge is unlike anything else, and are even prepared to mention the apparent contradiction between the role the author already held as a relationship expert (before they made their important discoveries) and the failure of their own relationships (the implication being that these relationships failed because the authors themselves were not yet beneficiaries of the wisdom contained in their latest books). Gray, for example, talking about his “painful and difficult” first marriage (2), and DeAngelis, bemoaning her “mistakes” (xvi), allude to the failure of their marriage to each other, at a time when both were already well-known relationship experts. Hendrix (xvii) says: As I sat in the divorce court waiting to see the judge, I felt like a double failure, a failure as a husband and as a therapist. That very afternoon I was scheduled to teach a course on marriage and the family, and the next day, as usual, I had several couples to counsel. Despite my professional training, I felt just as confused and defeated as the other men and women who were sitting beside me.Thus the authors present the knowledge they have gained from their experiences as being unavailable through professional marital therapy, relationship counselling, and other self-help books. Rather, the advice they impart is presented as the hard-won outcome of a long and painful process of personal discovery.Peace and PassionOnce the uniqueness of the advice is established, the authors attempt to enthuse the reader by describing the effects of following it. Norwood (Women 4) says her programme led to “the most rewarding years of my life,” and Forward (10) says she “discovered enormous amounts of creativity and energy in myself that hadn't been available to me before.” Gray (268) asserts that, following his discoveries “I personally experienced this inner transformation,” and DeAngelis (126) claims “I am compassionate where I used to be critical; I am patient where I used to be judgmental.” Doyle (23) says, “practicing the principles described in this book has transformed my marriage into a passionate, romantic union.” Similarly, in discussing the effects of her ideas on her marriage, Morgan (26) speaks of “This brand new love between us” that “has given us a brand new life together.” Having established the success of their ideas and techniques on their own lives, the authors go on to relate stories about their successful application to the lives and relationships of their clients. One author writes that “When I began implementing my ideas … The divorce rate in my practice sharply declined, and the couples … reported a much deeper satisfaction in their marriages” (Hendrix xix). Another claims “Repeatedly I have heard people say that they have benefited more from this new understanding of relationships than from years of therapy” (Gray 7). Morgan, describing the effects of her ‘Total Woman’ classes, says: Attending one of the first classes in Miami were wives of the Miami Dolphin football players … it is interesting to note that their team won every game that next season and became the world champions! … Gals, I wouldn’t dream of taking credit for the Superbowl … (Morgan 188)In case we are still unconvinced, the authors include praise and thanks from their inspired clients: “My life has become exciting and wonderful. Thank you,” writes one (Vedral 308). Gray (6) talks of the “thousands of inspirational comments that people have shared” about his advice. Vedral (307) says “I have received thousands of letters from women … thanking me for shining a beam of light on their situations.” If these clients have transformed their lives, the authors claim, so can the reader. They promise that the future will be “exceptional” (Friedman 242) and “wonderful” (Norwood, Women 257). It will consist of “self fulfilment, love, and joy” (Norwood, Women 26), “peace and joy” (Hendrix xx), “freedom and a lifetime of healing, hope and happiness” (Beattie), “peace, relief, joy, and passion that you will never find any other way” (Doyle 62) – in short, “happiness for the rest of your life” (Spezzano 77).SummaryIn order to effect the conversion of their readers, the authors seek to create enthusiasm about their books. First, they appeal to the modern tradition of credentialism, making claims about their formal professional qualifications and experience. This establishes them as credible ‘priests.’ Then they make calculable, factual, evidence-based claims concerning the number of books they have sold, and appeal to the epistemological authority of the methodology involved in establishing the findings of their books. They provide evidence of the efficacy of their own unique methods by relating the success of their ideas when applied to their own lives and relationships, and those of their clients and their readers. The authors also go to some lengths to establish that they have personal experience of relationship problems, especially those the reader is currently presumed to be experiencing. This establishes the ‘empathy’ essential to Rogerian therapy (Rogers), and an informal claim to lay knowledge or insight. In telling their own personal stories, the authors establish an ethic of confession, in which the truth of oneself is sought, unearthed and revealed in “the infinite task of extracting from the depths of oneself, in between the words, a truth which the very form of the confession holds out like a shimmering mirage” (Foucault, History 59). At the same time, by claiming that their qualifications were not helpful in solving these personal difficulties, the authors assert that much of their professional training was useless or even harmful, suggesting that they are aware of a general scepticism towards experts (cf. Beck, Giddens), and share these doubts. By implying that it is other experts who are perhaps not to be trusted, they distinguish their own work from anything offered by other relationship experts, thereby circumventing “the paradox of self-help books’ existence” (Cheery) and proliferation. Thus, the authors present their motives as altruistic, whilst perhaps questioning the motives of others. Their own book, they promise, will be the one (finally) that brings a future of peace, passion and joy. Conversion, Enthusiasm and the Reversal of the Priestly RelationshipAlthough power relations between authors and readers are complex, self-help is evidence of power in one of its most efficacious forms – that of conversion. This is a relationship into which one enters voluntarily and enthusiastically, in the name of oneself, for the benefit of oneself. Such power enthuses, persuades, incites, invites, provokes and entices, and it is therefore a strongly subjectifying power, and most especially so because the relationship of the reader to the author is one of choice. Because the reader can choose between authors, and skip or skim sections, she can concentrate on the parts of the therapeutic diagnosis that she believes specifically apply to her. For example, Grodin (414) found it was common for a reader to attach excerpts from a book to a bathroom mirror or kitchen cabinet, and to re-read and underline sections of a book that seemed most relevant. In this way, through her enthusiastic participation, the reader becomes her own expert, her own therapist, in control of certain aspects of the encounter, which nonetheless must always take place on psy terms.In many conversion studies, the final stage involves the assimilation and embodiment of new practices (e.g. Paloutzian et al. 1072), whereby the convert employs or utilises her new truths. I argue that in self-help books, this stage occurs in the reversal of the ‘priestly’ relationship. The ‘priestly’ relationship between client and therapist, is one in which in which the therapist remains mysterious while the client confesses and is known (Rose, "Power"). In the self-help book, however, this relationship is reversed. The authors confess their own ‘sins’ and imperfections, by relating their own disastrous experiences in relationships and wrong-thinking. They are, of course, themselves enthusiastic converts, who are enmeshed within the power that they exercise (cf. Foucault History; Discipline), as these confessions illustrate. The reader is encouraged to go through this process of confession as well, but she is expected to do so privately, and to play the role of priest and confessor to herself. Thus, in a reversal of the priestly relationship, the person who ‘is knowledge’ within the book itself is the author. It is only if the reader takes up the invitation to perform for herself the priestly role that she will become an object of knowledge – and even then, only to herself, albeit through a psy diagnostic gaze provided for her. Of course, this instance of confession to the self still places the individual “in a network of relations of power with those who claim to be able to extract the truth of these confessions through their possession of the keys to interpretation” (Dreyfus and Rabinow 174), but the keys to interpretation are provided to the reader by the author, and left with her for her own safekeeping and future use. As mentioned in the introduction, conversion involves questing in an active and engaged way, and may involve joy and proselytising. Because the relationship must be one of active participation, the enthusiasm of the reader to apply these truths to her own self-understanding is critical. Indeed, the convert is, by her very nature, an enthusiast.ConclusionSelf-help books seek to bring about a transformation of subjectivity from powerlessness to active goal-setting, personal improvement and achievement. This is achieved by a process of conversion that produces particular choices and types of identity, new subjectivities remade through the production of new ethical truths. Self-help discourses endow individuals with new enthusiasms, aptitudes and qualities – and these can then be passed on to others. Indeed, the self-help reader is invited, by means of the author’s confessions, to become, in a limited way, the author’s own therapist – ie, she is invited to perform an examination of the author’s (past) mistakes, to diagnose the author’s (past) condition and to prescribe an appropriate (retrospective) cure for this condition. Through the process of diagnosing the author and the author’s clients, using the psy gaze provided by the author, the reader is rendered an expert in therapeutic wisdom and is converted to a new belief system in which she will become an enthusiastic participant in her own subjectification. ReferencesBeattie, M. 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Introduction The first “Aquarius Festival” came together in Canberra, at the Australian National University, in the autumn of 1971 and was reprised in 1973 in the small rural town of Nimbin, in northern New South Wales. Both events reflected the Zeitgeist in what was, in some ways, an inchoate expression of the so-called “counterculture” (Roszak). Rather than attempting to analyse the counterculture as a discrete movement with a definable history, I enlist the theory of cultural memes to read the counter culture as a Dawkinsian cluster meme, with this paper offered as “testimonio”, a form of quasi-political memoir that views shifts in the culture through the lens of personal experience (Zimmerman, Yúdice). I track an evolving personal, “internal” topography and map its points of intersection with the radical social, political and cultural changes spawned by the “consciousness revolution” that was an integral part of the counterculture emerging in the 1970s. I focus particularly on the notion of “consciousness raising”, as a Dawkinsian memetic replicator, in the context of the idealistic notions of the much-heralded “New Age” of Aquarius, and propose that this meme has been a persistent feature of the evolution of the “meme cluster” known as the counterculture. Mimesis and the Counterculture Since evolutionary biologist Richard Dawkins floated the notion of cultural memes as a template to account for the evolution of ideas within political cultures, a literature of commentary and criticism has emerged that debates the strengths and weaknesses of his proposed model and its application across a number of fields. I borrow the notion to trace the influence of a set of memes that clustered around the emergence of what writer Marilyn Ferguson called The Aquarian Conspiracy, in her 1980 book of that name. Ferguson’s text, subtitled Personal and Social Transformation in Our Time, was a controversial attempt to account for what was known as the “New Age” movement, with its late millennial focus on social and personal transformation. That focus leads me to approach the counterculture (a term first floated by Theodore Roszak) less as a definable historical movement and more as a cluster of aspirational tropes expressing a range of aspects or concerns, from the overt political activism through to experimental technologies for the transformation of consciousness, and all characterised by a critical interrogation of, and resistance to, conventional social norms (Ferguson’s “personal and social transformation”). With its more overtly “spiritual” focus, I read the “New Age” meme, then, as a sub-set of this “cluster meme”, the counterculture. In my reading, “New Age” and “counterculture” overlap, sharing persistent concerns and a broad enough tent to accommodate the serious—the combative political action of Students for a Democratic Society (SDS), say, (see Elbaum)—to the light-hearted—the sport of frisbee for example (Stancil). The interrogation of conventional social and political norms inherited from previous generations was a prominent strategy across both movements. Rather than offering a sociological analysis or history of the ragbag counterculture, per se, my discussion here focuses in on the particular meme of “consciousness raising” within that broader set of cultural shifts, some of which were sustained in their own right, some dropping away, and many absorbed into the dominant mainstream culture. Dawkins use of the term “meme” was rooted in the Greek mimesis, to emphasise the replication of an idea by imitation, or copying. He likened the way ideas survive and change in human culture to the natural selection of genes in biological evolution. While the transmission of memes does not depend on a physical medium, such as the DNA of biology, they replicate with a greater or lesser degree of success by harnessing human social media in a kind of “infectivity”, it is argued, through “contagious” repetition among human populations. Dawkins proposed that just as biological organisms could be said to act as “hosts” for replicating genes, in the same way people and groups of people act as hosts for replicating memes. Even before Dawkins floated his term, French biologist Jacques Monod wrote that ideas have retained some of the properties of organisms. Like them, they tend to perpetuate their structure and to breed; they too can fuse, recombine, segregate their content; indeed they too can evolve, and in this evolution selection must surely play an important role. (165, emphasis mine) Ideas have power, in Monod’s analysis: “They interact with each other and with other mental forces in the same brain, in neighbouring brains, and thanks to global communication, in far distant, foreign brains” (Monod, cited in Gleick). Emblematic of the counterculture were various “New Age” phenomena such as psychedelic drugs, art and music, with the latter contributing the “Aquarius” meme, whose theme song came from the stage musical (and later, film) Hair, and particularly the lyric that runs: “This is the dawning of the Age of Aquarius”. The Australian Aquarius Festivals of 1971 and 1973 explicitly invoked this meme in the way identified by Monod and the “Aquarius” meme resonated even in Australia. Problematising “Aquarius” As for the astrological accuracy of the “Age of Aquarius meme”, professional astrologers argue about its dating, and the qualities that supposedly characterise it. When I consulted with two prominent workers in this field for the preparation of this article, I was astonished to find their respective dating of the putative Age of Aquarius were centuries apart! What memes were being “hosted” here? According to the lyrics: When the moon is in the seventh house And Jupiter aligns with Mars Then peace will guide the planets And love will steer the stars. (Hair) My astrologer informants assert that the moon is actually in the seventh house twice every year, and that Jupiter aligns with Mars every two years. Yet we are still waiting for the outbreak of peace promised according to these astrological conditions. I am also informed that there’s no “real” astrological underpinning for the aspirations of the song’s lyrics, for an astrological “Age” is not determined by any planet but by constellations rising, they tell me. Most important, contrary to the aspirations embodied in the lyrics, peace was not guiding the planets and love was not about to “steer the stars”. For Mars is not the planet of love, apparently, but of war and conflict and, empowered with the expansiveness of Jupiter, it was the forceful aggression of a militaristic mind-set that actually prevailed as the “New Age” supposedly dawned. For the hippified summer of love had taken a nosedive with the tragic events at the Altamont speedway, near San Francisco in 1969, when biker gangs, enlisted to provide security for a concert performance by The Rolling Stones allegedly provoked violence, marring the event and contributing to a dawning disillusionment (for a useful coverage of the event and its historical context see Dalton). There was a lot of far-fetched poetic licence involved in this dreaming, then, but memes, according to Nikos Salingaros, are “greatly simplified versions of patterns”. “The simpler they are, the faster they can proliferate”, he writes, and the most successful memes “come with a great psychological appeal” (243, 260; emphasis mine). What could be retrieved from this inchoate idealism? Harmony and understanding Sympathy and trust abounding No more falsehoods or derisions Golden living dreams of visions Mystic crystal revelation And the mind’s true liberation Aquarius, Aquarius. (Hair) In what follows I want to focus on this notion: “mind’s true liberation” by tracing the evolution of this project of “liberating” the mind, reflected in my personal journey. Nimbin and Aquarius I had attended the first Aquarius Festival, which came together in Canberra, at the Australian National University, in the autumn of 1971. I travelled there from Perth, overland, in a Ford Transit van, among a raggedy band of tie-dyed hippie actors, styled as The Campus Guerilla Theatre Troupe, re-joining our long-lost sisters and brothers as visionary pioneers of the New Age of Aquarius. Our visions were fueled with a suitcase full of potent Sumatran “buddha sticks” and, contrary to Biblical prophesies, we tended to see—not “through a glass darkly” but—in psychedelic, pop-, and op-art explosions of colour. We could see energy, man! Two years later, I found myself at the next Aquarius event in Nimbin, too, but by that time I inhabited a totally different mind-zone, albeit one characterised by the familiar, intense idealism. In the interim, I had been arrested in 1971 while “tripping out” in Sydney on potent “acid”, or LSD (Lysergic acid diethylamide); had tried out political engagement at the Pram Factory Theatre in Melbourne; had camped out in protest at the flooding of Lake Pedder in the Tasmanian wilderness; met a young guru, started meditating, and joined “the ashram”—part of the movement known as the Divine Light Mission, which originated in India and was carried to the “West” (including Australia) by an enthusiastic and evangelical following of drug-toking drop-outs who had been swarming through India intent on escaping the dominant culture of the military-industrial complex and the horrors of the Vietnam War. Thus, by the time of the 1973 event in Nimbin, while other festival participants were foraging for “gold top” magic mushrooms in farmers’ fields, we devotees had put aside such chemical interventions in conscious awareness to dig latrines (our “service” project for the event) and we invited everyone to join us for “satsang” in the yellow, canvas-covered, geodesic dome, to attend to the message of peace. The liberation meme had shifted through a mutation that involved lifestyle-changing choices that were less about alternative approaches to sustainable agriculture and more about engaging directly with “mind’s true liberation”. Raising Consciousness What comes into focus here is the meme of “consciousness raising”, which became the persistent project within which I lived and worked and had my being for many years. Triggered initially by the ingestion of those psychedelic substances that led to my shocking encounter with the police, the project was carried forward into the more disciplined environs of my guru’s ashrams. However, before my encounter with sustained spiritual practice I had tried to work the shift within the parameters of an ostensibly political framework. “Consciousness raising” was a form of political activism borrowed from the political sphere. Originally generated by Mao Zedong in China during the revolutionary struggle to overthrow the vested colonial interests that were choking Chinese nationalism in the 1940s, to our “distant, foreign brains” (Monod), as Western revolutionary romantics, Chairman Mao and his Little Red Book were taken up, in a kind of international counterculture solidarity with revolutionaries everywhere. It must be admitted, this solidarity was a fairly superficial gesture. Back in China it might be construed as part of a crude totalitarian campaign to inculcate Marxist-Leninist political ideas among the peasant classes (see Compestine for a fictionalised account of traumatic times; Han Suyin’s long-form autobiography—an early example of testimonio as personal and political history—offers an unapologetic account of a struggle not usually construed as sympathetically by Western commentators). But the meme (and the processes) of consciousness raising were picked up by feminists in the United States in the late 1960s and into the 1970s (Brownmiller 21) and it was in this form I encountered it as an actor with the politically engaged theatre troupe, The Australian Performing Group, at Carlton’s Pram Factory Theatre in late 1971. The Performance Group I performed as a core member of the Group in 1971-72. Decisions as to which direction the Group should take were to be made as a collective, and the group veered towards anarchy. Most of the women were getting together outside of the confines of the Pram Factory to raise their consciousness within the Carlton Women’s Liberation Cell Group. While happy that the sexual revolution was reducing women’s sexual inhibitions, some of the men at the Factory were grumbling into their beer, disturbed that intimate details of their private lives—and their sexual performance—might be disclosed and raked over by a bunch of radical feminists. As they began to demand equal rights to orgasm in the bedroom, the women started to seek equal access within the performance group, too. They requested rehearsal time to stage the first production by the Women’s Theatre Group, newly formed under the umbrella of the wider collective. As all of the acknowledged writers in the Group so far were men—some of whom had not kept pace in consciousness raising—scripts tended to be viewed as part of a patriarchal plot, so Betty Can Jump was an improvised piece, with the performance material developed entirely by the cast in workshop-style rehearsals, under the direction of Kerry Dwyer (see Blundell, Zuber-Skerritt 21, plus various contributors at www.pramfactory.com/memoirsfolder/). I was the only male in the collective included in the cast. Several women would have been more comfortable if no mere male were involved at all. My gendered attitudes would scarcely have withstood a critical interrogation but, as my partner was active in launching the Women’s Electoral Lobby, I was given the benefit of the doubt. Director Kerry Dwyer liked my physicalised approach to performance (we were both inspired by the “poor theatre” of Jerzy Grotowski and the earlier surrealistic theories of Antonin Artaud), and I was cast to play all the male parts, whatever they would be. Memorable material came up in improvisation, much of which made it into the performances, but my personal favorite didn’t make the cut. It was a sprawling movement piece where I was “born” out of a symbolic mass of writhing female bodies. It was an arduous process and, after much heaving and huffing, I emerged from the birth canal stammering “SSSS … SSSS … SSMMMO-THER”! The radical reversioning of culturally authorised roles for women has inevitably, if more slowly, led to a re-thinking of the culturally approved and reinforced models of masculinity, too, once widely accepted as entirely biologically ordained rather than culturally constructed. But the possibility of a queer re-versioning of gender would be recognised only slowly. Liberation Meanwhile, Dennis Altman was emerging as an early spokesman for gay, or homosexual, liberation and he was invited to address the collective. Altman’s stirring book, Homosexual: Oppression and Liberation, had recently been published, but none of us had read it. Radical or not, the Group had shown little evidence of sensitivity to gender-queer issues. My own sexuality was very much “oppressed” rather than liberated and I would have been loath to use “queer” to describe myself. The term “homosexual” was fraught with pejorative, quasi-medical associations and, in a collective so divided across strict and sometimes hostile gender boundaries, deviant affiliations got short shrift. Dennis was unsure of his reception before this bunch of apparent “heteros”. Sitting at the rear of the meeting, I admired his courage. It took more self-acceptance than I could muster to confront the Group on this issue at the time. Somewhere in the back of my mind, “homosexuality” was still something I was supposed to “get over”, so I failed to respond to Altman’s implicit invitation to come out and join the party. The others saw me in relationship with a woman and whatever doubts they might have carried about the nature of my sexuality were tactfully suspended. Looking back, I am struck by the number of simultaneous poses I was trying to maintain: as an actor; as a practitioner of an Artaudian “theatre of cruelty”; as a politically committed activist; and as a “hetero”-sexual. My identity was an assemblage of entities posing as “I”; it was as if I were performing a self. Little gay boys are encouraged from an early age to hide their real impulses, not only from others—in the very closest circle, the family; at school; among one’s peers—but from themselves, too. The coercive effects of shaming usually fix the denial into place in our psyches before we have any intellectual (or political) resources to consider other options. Growing up trying to please, I hid my feelings. In my experience, it could be downright dangerous to resist the subtle and gross coercions that applied around gender normativity. The psychoanalyst D. W. Winnicott, of the British object-relations school, argues that when the environment does not support the developing personality and requires the person to sacrifice his or her own spontaneous needs to adapt to environmental demands, there is not even a resting-place for individual experience and the result is a failure in the primary narcissistic state to evolve an individual. The “individual” then develops as an extension of the shell rather than that of the core [...] What there is left of a core is hidden away and is difficult to find even in the most far-reaching analysis. The individual then exists by not being found. The true self is hidden, and what we have to deal with clinically is the complex false self whose function is to keep this true self hidden. (212) How to connect to that hidden core, then? “Mind’s true liberation...” Alienated from the performative version of selfhood, but still inspired by the promise of liberation, even in the “fuzzy” form for which my inchoate hunger yearned (sexual liberation? political liberation? mystical liberation?), I was left to seek out a more authentic basis for selfhood, one that didn’t send me spinning along the roller-coaster of psychedelic drugs, or lie to me with the nostrums of a toxic, most forms of which would deny me, as a sexual, moral and legal pariah, the comforts of those “anchorage points to the social matrix” identified by Soddy (cited in Mol 58). My spiritual inquiry was “counter” to these institutionalised models of religious culture. So, I began to read my way through a myriad of books on comparative religion. And to my surprise, rather than taking up with the religions of antique cultures, instead I encountered a very young guru, initially as presented in a simply drawn poster in the window of Melbourne’s only vegetarian restaurant (Shakahari, in Carlton). “Are you hungry and tired of reading recipe books?” asked the figure in the poster. I had little sense of where that hunger would lead me, but it seemed to promise a fulfilment in ways that the fractious politics of the APG offered little nourishment. So, while many of my peers in the cities chose to pursue direct political action, and others experimented with cooperative living in rural communes, I chose the communal lifestyle of the ashram. In these different forms, then, the conscious raising meme persisted when other challenges raised by the counterculture either faded or were absorbed in the mainstream. I finally came to realise that the intense disillusionment process I had been through (“dis-illusionment” as the stripping away of illusions) was the beginning of awakening, in effect a “spiritual initiation” into a new way of seeing myself and my “place” in the world. Buddhist teachers might encourage this very kind of stripping away of false notions as part of their teaching, so the aspiration towards the “true liberation” of the mind expressed in the Aquarian visioning might be—and in my case, actually has been and continues to be—fulfilled to a very real extent. Gurus and the entire turn towards Eastern mysticism were part of the New Age meme cluster prevailing during the early 1970s, but I was fortunate to connect with an enduring set of empirical practices that haven’t faded with the fashions of the counterculture. A good guitarist would never want to play in public without first tuning her instrument. In a similar way, it is now possible for me to tune my mind back to a deeper, more original source of being than the socially constructed sense of self, which had been so fraught with conflicts for me. I have discovered that before gender, and before sexuality, in fact, pulsing away behind the thicket of everyday associations, there is an original, unconditioned state of beingness, the awareness of which can be reclaimed through focused meditation practices, tested in a wide variety of “real world” settings. For quite a significant period of time I worked as an instructor in the method on behalf of my guru, or mentor, travelling through a dozen or so countries, and it was through this exposure that I was able to observe that the practices worked independently of culture and that “mind’s true liberation” was in many ways a de-programming of cultural indoctrinations (see Marsh, 2014, 2013, 2011 and 2007 for testimony of this process). In Japan, Zen roshi might challenge their students with the koan: “Show me your original face, before you were born!” While that might seem to be an absurd proposal, I am finding that there is a potential, if unexpected, liberation in following through such an inquiry. As “hokey” as the Aquarian meme-set might have been, it was a reflection of the idealistic hope that characterised the cluster of memes that aggregated within the counterculture, a yearning for healthier life choices than those offered by the toxicity of the military-industrial complex, the grossly exploitative effects of rampant Capitalism and a politics of cynicism and domination. The meme of the “true liberation” of the mind, then, promised by the heady lyrics of a 1970s hippie musical, has continued to bear fruit in ways that I could not have imagined. References Altman, Dennis. Homosexual Oppression and Liberation. Sydney: Angus & Robertson, 1972. Blundell, Graeme. The Naked Truth: A Life in Parts. 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