{"id":197,"date":"2017-09-04T18:47:15","date_gmt":"2017-09-04T18:47:15","guid":{"rendered":"http:\/\/medicalrhetoric.com\/symposium2017\/?page_id=197"},"modified":"2018-05-31T14:40:00","modified_gmt":"2018-05-31T14:40:00","slug":"melissa-carrion","status":"publish","type":"page","link":"https:\/\/medicalrhetoric.com\/symposium2017\/profiles\/melissa-carrion\/","title":{"rendered":"Melissa Carrion"},"content":{"rendered":"

\"MelissaTitle: <\/strong>Assistant Professor of Technical and Professional Communication<\/p>\n

University: <\/strong>Georgia Southern University<\/p>\n

Email: <\/strong>mcarrion@georgiasouthern.edu<\/p>\n

Twitter: <\/strong>N\/A<\/p>\n

Website: <\/strong>N\/A<\/p>\n

Description of Work:<\/strong><\/h3>\n

Broadly speaking, my research lies at the intersection of rhetoric, health communication, and women\u2019s studies.\u00a0 I\u2019m especially interested in how individuals come to make sense of and decisions about health controversies, and how gendered discourses shape that sense-making process.\u00a0 My present research is focused on maternal vaccine refusal\u2014what are the common messages and experiences that influence this decision, how are they bound up with particular social constructions of motherhood, and how can we design communication to successfully address concerns?\u00a0 To answer these questions, I draw from feminist, rhetorical, and social scientific theories, as well as from both written texts and interview data.\u00a0\u00a0\u00a0<\/span><\/p>\n

This symposium submission is based on a study involving semi-structured interviews with fifty mothers who refused vaccines for their child(ren).\u00a0 Results suggested that mothers\u2019 concerns were based less in specific misconceptions about vaccine safety (e.g., a link between vaccines and autism) and more in meanings constructed intertextually in relation to other related health discourses (e.g., prenatal nutrition).\u00a0 This paper uses the interview data as a jumping off point to identify and map these health discourses, proposing a model for and specific example of a risk ecology<\/i>\u2014a network of intertextual messages which shape and constrain sense-making about risk as it emerges within a particular moment and bio-social community.\u00a0 This ecology becomes a way to visualize the many discourses influencing public understanding about vaccines, and can help to identify texts for analysis as well as points of rhetorical intervention.\u00a0\u00a0\u00a0<\/span><\/p>\n

I am currently working on two additional, related projects.\u00a0 The first draws from semi-structured interviews with registered nurses to identify the common themes, barriers, and challenges that emerge in their communication with vaccine hesitant patients and\/or parents.\u00a0 The second analyzes public documents from the National Vaccine Injury Compensation Program in order to explore how risk and causation are rhetorically constructed.\u00a0 Collectively, I\u2019m hopeful that this research can contribute theoretically but also guide the design of effective vaccine messages and campaigns.\u00a0\u00a0\u00a0<\/span><\/p>\n

Symposium Submission:<\/strong><\/h3>\n

\u201cI don\u2019t understand how these two things go together\u201d: Toward a vaccine risk ecology<\/strong><\/p>\n

\u201cI\u2019m going, \u2018I don\u2019t know,\u2019 \u2018cause all the doctors are telling me that I\u2019m only supposed to give my baby breast milk\u2014like \u2018breast milk is the be all end all, don\u2019t give formula to your baby, don\u2019t do this, don\u2019t do that.\u2019 And then I\u2019m gonna inject all these things into my baby? And it was just kind of this\u2014I don\u2019t understand how these two things go together.\u201d – <\/em>Claire, 33 year-old mother of one<\/p>\n

Rates of vaccine refusal, also called intentional under-vaccination, have risen steadily in the United States for the past two decades (Omer, Richards, Ward & Bednarczyk, 2012).\u00a0 A recent study found that 15% of parents reported refusing one or more recommended vaccine (Gilkey et al., 2016), and vaccination rates in some communities are well below the thresholds required to maintain herd immunity (Dredze, Broniatowski, Smith & Hilyard, 2016).\u00a0 The medical, economic, and social costs of this trend are significant, and calls to better understand and respond to vaccine concerns (e.g. National Vaccine Advisory Committee, 2015) have prompted a significant body of research and interventions spanning approaches from the perspectives of public health (e.g., Kennedy, Brown & Gust, 2005; Yang, Delamater, Leslie, & Mello, 2016), public policy (e.g., Parasidis & Opel, 2017; Omer et al., 2006), sociology (e.g., Berezin & Eads, 2016; Reich, 2014), and communication (e.g., Goldstein, MacDonald & Guirguis, 2015; Krieger & Sarge, 2013), to name a few.<\/p>\n

From a health communication perspective, vaccine refusal is especially frustrating because it doesn\u2019t seem to matter whether misconceptions about safety\u2014a prime motivator of vaccine refusal (Salmon, Dudley, Glanz & Omer, 2015)\u2014are corrected.\u00a0 Indeed, a 2014 study published in the journal Pediatrics<\/em> found that successfully refuting participants\u2019 vaccine safety concerns\u2014in this case, debunking a link between vaccines and autism\u2014nevertheless left them less <\/em>inclined to vaccinate their children (Nyhan & Reifler, 2014).\u00a0 This evidence points to the inadequacy of current deficit models of vaccine communication. That is, as the quote above from Claire suggests, successfully responding to vaccine refusal also requires attending to the discursive field in which messages about vaccines are embedded.<\/p>\n

Certainly, communication scholars have documented the ways in which risk is discursively constructed (e.g., Grabill & Simmons, 1998; Katz & Miller, 1996).\u00a0 Drawing from that recognition, this paper calls upon the notion of rhetorical ecologies (Edbauer, 2005; Jensen, 2015) in order to analyze semi-structured interviews with mothers (n <\/em>= 50) who refused vaccines for their children.\u00a0 Doing so enables identification of the intertextual discourses that exist surrounding vaccine risk perception and communication; in particular, I argue that, for participants in this study, sense-making about vaccine risk is inextricably bound up with messages about prenatal and infant nutrition, pregnancy, fertility, childbirth, and breastfeeding, and especially the discourses of scientific and intensive motherhood (Apple, 2006; Liss, Schiffrin, Mackintosh, Miles-McLean & Erchull, 2012) that permeate these messages. Using this interview data as a jumping off point, this project then explores the related texts identified by participants in order to construct what I call a risk ecology<\/em>\u2014a network of intertextual messages which shape and constrain sense-making about risk as it emerges within a particular moment and bio-social community.\u00a0 This framework offers both a theory and method for understanding and responding to risk-related concerns in the context of vaccination.<\/p>\n

Theoretically, this project builds upon existing scholarship that has utilized rhetorical ecological frameworks to examine health discourses (e.g., Jensen, 2015; Johnson).\u00a0 However, whereas much previous work in this vein has focused on rhetorical histories\u2014tracing rhetoric as it progresses through time\u2014this project focuses instead on multiple messages that exist contemporaneous to each other in a given moment.\u00a0 Because such ecologies can be difficult to bound (indeed, they span the boundaries of multiple argument spheres and discursive spaces), I argue that this is one place where field methods\u2014 such as interviews and participant observation\u2014offer an important source in the identification of texts that can further elucidate the ecology.\u00a0 In this sense, what I propose draws from a rhetorical\/qualitative mixed-methods approach, both in terms of data collection and analysis.\u00a0 In terms of data collection, these were rhetorical field methods\u2014examining vernacular rhetorics through interviews, but also identifying written texts for analysis.\u00a0 In terms of data analysis, this was part thematic analysis (e.g., analyzing interview data to identify discussion of related risk messages\u2014this was itself an inductive code) but was rhetorical insomuch as it examined how those different messages were deployed\u2014how they work\u2014in terms of enabling certain kinds of sense-making.<\/p>\n

Overall, this project is in line with Ker\u00e4nen\u2019s (2014) call to \u201cidentify places and strategies for rhetorical intervention in matters of public health\u201d (p. 105) and offers pragmatic implications for the design of effective vaccine communication, especially with regard to the need to identify and cross-test messages that can reasonably be assumed as part of the related risk ecology.<\/p>\n

References<\/p>\n

Abhyankar, P., O’Connor, D. B., & Lawton, R. (2008). The role of message framing in promoting MMR vaccination: Evidence of a loss-frame advantage. Psychology, Health and Medicine<\/em>, 13<\/em>(1), 1-16.<\/p>\n

Berezin, M., & Eads, A. (2016). Risk is for the rich? Childhood vaccination resistance and a Culture of Health. Social Science & Medicine<\/em>, 165<\/em>, 233-245.<\/p>\n

Dredze, M., Broniatowski, D. A., Smith, M. C., & Hilyard, K. M. (2016). Understanding Vaccine Refusal. American Journal of Preventive Medicine<\/em>, 50<\/em>(4), 550-552.<\/p>\n

Edbauer, J. (2005).\u00a0 Unframing models of public distribution: From rhetorical situation to rhetorical ecologies.\u00a0 Rhetoric Society Quarterly<\/em>, 35<\/em>(4), 5-24.<\/p>\n

Gilkey, M. B., McRee, A. L., Magnus, B. E., Reiter, P. L., Dempsey, A. F., & Brewer, N. T. (2016). Vaccination confidence and parental refusal\/delay of early childhood caccines. PLoS One<\/em>, 11<\/em>(7), e0159087.<\/p>\n

Goldstein, S., MacDonald, N. E., & Guirguis, S. (2015). Health communication and vaccine hesitancy. Vaccine<\/em>, 33<\/em>(34), 4212-4214.<\/p>\n

Grabill, J. T., & Simmons, W. M. (1998). Toward a critical rhetoric of risk communication: Producing citizens and the role of technical communicators. Technical Communication Quarterly<\/em>, 7<\/em>(4), 415441.<\/p>\n

Jensen, R. E. (2015).\u00a0 Improving upon nature: The rhetorical ecology of chemical language, reproductive endocrinology, and the medicalization of infertility.\u00a0 Quarterly Journal of Speech<\/em>, 101<\/em>(2), 329353.<\/p>\n

Jensen, R. E. (2015b). An ecological turn in rhetoric of health scholarship: Attending to the historical flow and percolation of ideas, assumptions, and arguments. Communication Quarterly<\/em>, 63<\/em>(5), 522-526.<\/p>\n

Johnson, J. (2014).\u00a0 American lobotomy: A rhetorical history<\/em>.\u00a0 Ann Arbor: University of Michigan Press.<\/p>\n

Katz, S. B., & Miller, C. R. (1996). The low-level radioactive waste siting controversy in North Carolina: Toward a rhetorical model of risk communication. Green culture: Environmental rhetoric in contemporary America<\/em>, 111-140.<\/p>\n

Kennedy, A. M., Brown, C. J., & Gust, D. A. (2005). Vaccine beliefs of parents who oppose compulsory vaccination. Public Health Reports<\/em>, 120<\/em>(3), 252-258.<\/p>\n

Knaak, S. J. (2010).\u00a0 Contextualizing risk, constructing choice: Breastfeeding and good mothering in risk society.\u00a0 Health, Risk & Society<\/em>, 12<\/em>(4), 345-355.<\/p>\n

Krieger, J. L., & Sarge, M. A. (2013). A serial mediation model of message framing on intentions to receive the human papillomavirus (HPV) vaccine: revisiting the role of threat and efficacy perceptions. Health communication<\/em>, 28<\/em>(1), 5-19.<\/p>\n

McDonald, K., Amir, L. H., & Davey, M. (2011).\u00a0 Maternal bodies and medicines: A commentary on risk and decision-making of pregnant and breastfeeding women and health professionals.\u00a0 BMC Public Health<\/em>, 11<\/em>(S5), 1-8.<\/p>\n

National Vaccine Advisory Committee. (2015).\u00a0 Assessing the state of vaccine confidence in the United States: Recommendations from the national vaccine advisory committee.\u00a0 Public Health Reports<\/em>, 130<\/em>, 573-595.<\/p>\n

Nyhan, B., & Reifler, J. (2014).\u00a0 Does correcting myths about the flu vaccine work? An experimental evaluation of the effects of corrective information.\u00a0 Vaccine<\/em>, 33<\/em>(3), 459-464.<\/p>\n

Omer, S. B., Richards, J. L., Ward, M., & Bednarczyk, R. A. (2012) Vaccination policies and rates of exemption from immunization, 2005-2011. New England Journal of Medicine, 367<\/em>, 1170\u20131171.<\/p>\n

Omer, S. B., Pan, W. K., Halsey, N. A., Stokley, S., Moulton, L. H., Navar, A. M., … & Salmon, D. A. (2006). Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence. Journal of the American Medical Association<\/em>, 296<\/em>(14), 1757-1763.<\/p>\n

Parasidis, E., & Opel, D. J. (2017). Parental Refusal of Childhood Vaccines and Medical Neglect Laws. American Journal of Public Health<\/em>, 107<\/em>(1), 68-71.<\/p>\n

Reich, J. A. (2014). Neoliberal mothering and vaccine refusal: Imagined gated communities and the privilege of choice. Gender & Society<\/em>, 0891243214532711.<\/p>\n

Rivers, N. A., & Weber, R. P. (2011). Ecological, pedagogical, public rhetoric.\u00a0 College Composition and Communication<\/em>, 63<\/em>(2), 187-218.<\/p>\n

Scott, J. B. (2006).\u00a0 Kairos as indeterminate risk management: The pharmaceutical industry\u2019s response to bioterrorism.\u00a0 Quarterly Journal of Speech<\/em>, 92<\/em>(2), 115-143.<\/p>\n

Yang, Y. T., Delamater, P. L., Leslie, T. F., & Mello, M. M. (2016). Sociodemographic predictors of vaccination exemptions on the basis of personal belief in California. American ournal of Public Health<\/em>, 106<\/em>(1), 172-177.<\/p>\n

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Title: Assistant Professor of Technical and Professional Communication University: Georgia Southern University Email: mcarrion@georgiasouthern.edu Twitter: N\/A Website: N\/A Description of Work: Broadly speaking, my research lies at the intersection of … Continue reading “Melissa Carrion”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-197","page","type-page","status-publish","hentry"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages\/197","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/comments?post=197"}],"version-history":[{"count":6,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages\/197\/revisions"}],"predecessor-version":[{"id":774,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages\/197\/revisions\/774"}],"up":[{"embeddable":true,"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/pages\/2"}],"wp:attachment":[{"href":"https:\/\/medicalrhetoric.com\/symposium2017\/wp-json\/wp\/v2\/media?parent=197"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}