Alan Stanley
Wed, 11/03/2021 - 07:47
Edited Text
The Infestation of Stigma: An Ecological Systems
Approach to the Stigmatization of Head Lice

By
Stefani Ann Paladino

A thesis submitted in partial fulfillment of the requirements for graduation with
Honors in Sociology

Whitman College
2014

Certificate of Approval
This is to certify that the accompanying thesis by Stefani Ann Paladino has been accepted
in partial fulfillment of the requirements for graduation with Honors in Sociology.

________________________
Michelle Janning

Whitman College
May 14, 2014

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TABLE OF CONTENTS

Introduction………………………………………………………………………1
Theoretical Frameworks
Ecological Systems Theory………………………………………………7
Stigma……………………………………………………………………11
Literature Review………………………………………………………………..22
Medical Sociology……………………………………………………….22
Costs of Head Lice……………………………………………………….24
Head Lice Policy in Schools……………………………………………..32
Treatment of and Knowledge about Head Lice………………………….34
Methods……………………………………………………………………..39
Research Process and Design…………………………………………….39
Parent and Teacher Surveys………………………………………………41
Quantitative Data Analysis……………………………………………….43
Student Interviews…………………………………………………………48
Qualitative Data Analysis…………………………………………………50
Methodological Limitations………………………………………………51
Ethical Considerations…………………………………………………….53
Results…………………………………………………………………………….57
Participant Demographics…………………………………………………57
The Power of (No) Words…………………………………………………58
Parent-Child Interactions…………………………………………..58

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Teacher-Student Interactions……………………………………….63
Parent-Teacher Interactions…………………………………………66
The “Cootie” Concept: School Socialization……………………………….67
Student-Peer Interactions……………………………………………67
Patterns of Misinformation about Head Lice……………………………….70
Semantics of Head Lice…………………………………………….71
Fact or Fiction………………………………………………………72
The Hygiene Problem………………………………………………73
Conclusion…………………………………………………………………………..75
References……………………………………………………………………………80
Appendix……………………………………………………………………………83
Appendix A. Survey Questions……………………………………………..83
Appendix B. Tables and Figures……………………………………………100
Appendix C. Questions from Kirchofer et al. 2001…………………………105
Appendix D. Interview Questions…………………………………………...107
Appendix E. Letters………………………………………………………….110

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LIST OF ILLUSTRATIONS
Figure 1. Example of Goffman in Bronfenbrenner’s Ecological Systems Theory……19
Table 1. Stigma Questions and Parent-Child Communication…………………………61
Table 2. Educator Responses to Stigma Questions…………………………………….65
Table 3. Parent-Teacher Communication and Stigma…………………………………67

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ACKNOWLEDGEMENTS
I would like to thank several people for their support throughout this research
project. First, I would like to thank Jennifer Douglas for introducing me to the topic of
head lice and for being a wealth of information about where to find empirical data on a
topic that is underrepresented in academic literature. Her guidance and wisdom helped
drive this project. I would also like to thank Dr. Linda Boggs at Walla Walla Public
Schools, who helped me through the district’s proposal process. I would also like to
extend the biggest thank you to Green Park Elementary’s Principal Gina Yonts and staff
for their support and accommodation for my research project. Their flexibility and
willingness to let me open up the computer lab during conferences was a huge help in
collecting data. To Simon Mendoza, I thank him for his never-ending support and
encouragement, as well as the multiple Spanish translations he provided me throughout
the process—and through multiple project proposals and changes in my research design.
Finally, I would like to extend eternal gratitude to my thesis chair, Michelle
Janning. Her support, guidance, and patience through this process made my research
possible. From the emails to the meetings to the bumps in the road, she was always ready
to lend a helping hand and reassure me. I would also like to thank Alissa Cordner and
Helen Kim for their feedback and guidance. Finally, the biggest thank you to the entire
Department of Sociology at Whitman College, without whom I would not be able to
write this thesis. Your guidance and mentorship over the last four years has sparked my
passion for social research, and I am thankful for having had the opportunity to go on this
stressful, challenging, incredible journey called a thesis.
Thank you all, with all of my heart.

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INTRODUCTION
When I reminisce on my childhood, I remember growing up in a middle-class
suburb of Seattle, WA. I remember afternoons spent outside with my older brother,
building forts in the woods behind our house. I remember the walk to my elementary
school and the countless hours spent in class with peers who came from my
neighborhood. I remember the few times I went to the nurse’s office for the yearly vision
and hearing exams, and the occasional fall on the playground at recess. I remember that
one time we had a major lice “scare” at my elementary school, and I remember my
classmates and I not worrying because “we weren’t poor or dirty, so we couldn’t possibly
get head lice, could we?” I remember going through my childhood without being aware
of one person with head lice. I lived in a safe bubble of ignorance and to me, head lice
was some far away, mythical problem that had no bearing on my life. I spent the majority
of my childhood blissfully unaware of the head lice problem that pervades our schools—
and our society.
I first became interested in school health issues in May 2013 when I volunteered
to give a presentation at a health fair in rural Washington. I was approached by a group of
people starting the non-profit organization Rural Health Education and was asked to
create a presentation on any health topic that interested me. Having had no experience in
the medical field, I was at a complete loss as to what topic I could even teach others
about, so naturally I turned to the sociologist in me. I began exploring the connection
between student health and student academic achievement, and from this discovered my
passion for school health. As I began to brainstorm possible school health topics that I

could research for my thesis, I decided to meet with Walla Walla Public School’s
Director of Health Services, Jennifer Douglas. Jennifer and I discussed the most pressing
health issues in Walla Walla schools, and through this conversation my thesis topic was
born: the stigmatization of head lice.

What is Head Lice?
Before I begin our investigation of the stigmatization of head lice, it is important
to have a basic understanding of the biological side of head lice. According to the Centers
for Disease Control and Prevention’s website (2013), “lice are parasitic insects that can
be found on people’s heads, and bodies, including the pubic area. Human lice survive by
feeding on human blood. Lice found on each area of the body are different from each
other.” For the purposes of this research, I will be talking specifically about head lice
because this specific type of lice is the most prevalent in schools and has been at the
forefront of stigmatization in Walla Walla schools.
The life cycle of head lice is also important to understand, as some school policies
target certain stages of the life cycle (Scott, Gilmer, and Johannessen 2004). The lice life
cycle has three stages (Centers for Disease Control and Prevention 2013). The first stage
is called “nits,” or eggs. In this stage, the nits cannot be transmitted from person to
person, as they are immobile. It takes lice about seven days to hatch into the second
stage. In this second stage, lice are called “nymphs” and it takes lice another week to molt
into the adult louse. Once full-grown, head lice can live up to thirty days on a host’s
head—however, lice cannot live longer than one or two days without a host.

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In a preliminary thesis meeting with Jennifer Douglas on August 14, 2013, I
learned that head lice cannot spread diseases from host to host. She told me that, in fact,
the only health problem people tend to have with head lice is staph infections from
scratching their heads to the point of infection—and this is a very rare occurrence.
According to Jennifer, some people hold the belief that head lice are a health condition
when, in reality, the lice are mostly a nuisance. Throughout my research, I refer to the
idea that head lice is a “health condition” or “medical condition.” These terms can be
ambiguous, so for the purposes of my research, unless otherwise explicitly stated,
whenever I use the words “health” or “medical,” they are interchangeable and refer to a
condition that is harmful to a person’s physical well being, and is a condition which may
need to be addressed by a medical professional. As I learned from Jennifer Douglas on
August 14, 2013, head lice do not pose any physical threat to their human hosts. The
reality is that head lice are mostly just a nuisance, and it is the stigmatization of head lice
that is more damaging to a person than the head lice themselves.

Head Lice in Walla Walla
In Walla Walla, WA, head lice is one of main reasons elementary school students
visit the school nurse. According to the Walla Walla School District Office Visit Report
Summary for 2006-2014, there were 866 reported visits to the school nurse for head lice.
While the report by itself could not provide a comparison of the number of head lice
visits to other reasons for visiting the school nurse, in a conversation on February 20,
2014, Jennifer Douglas explained that this number is significant. As Jennifer explained
this report to me, however, it also became clear that these numbers are not accurate due to

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discrepancies in reporting. For example, one school nurse may report head lice under the
“head lice” designation, whereas another school nurse could view head lice as a
“hygiene” problem. These differences in reporting are not the only difficulties districts
face when it comes to head lice. According to Jennifer Douglas, the most difficult aspect
of dealing with head lice in schools is the stigma that is attached to the condition—the
stigma that head lice only infect children who come from lower socioeconomic
backgrounds, and who have poor hygiene.

Head Lice Policy in Washington State
Changes in Washington State’s Infectious Disease Control Guide for School Staff
illustrate contradictions between viewing head lice as a medical concern and viewing
head lice as a social concern. In the 2004 “Infectious Disease Control Guide for School
Staff,” head lice—also known as “pediculosis” (64)—is listed as a communicable
disease, wherein the guide defines a communicable disease as an “illness” (121).
Interestingly, the guide seems to contradict itself when it states that “head lice are not a
health hazard” (64). The guide also includes individual district policies. Spokane School
District’s policy on communicable diseases only specifically lists pediculosis as a
communicable disease—with no mention of any actual medical conditions such as
measles, chicken pox, etc. (179). The updated 2014 guide still includes head lice as a
communicable disease, but there is an emphasis on dispelling myths, controlling the
stigma that can lead to a student being “ostracized, isolated, humiliated, or
psychologically traumatized” (77), and it urges against “No-Nit Policies” (77). My own
research focuses on the social aspect of the head lice condition, looking specifically at

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how stigmas surrounding head lice are still infesting our society, despite these changes in
medical knowledge about head lice.

The Head Lice Problem
Sociological research on head lice is very limited, and yet the condition of head
lice has infested itself on our playgrounds, in our social contact, and even in the policy of
our educational and political institutions. The stigmatization of head lice has even
infested itself in the media. Just this year, the popular American television show “Modern
Family” aired an episode that explicitly demonstrated the misperception that head lice
comes from families who are unclean and have low-socioeconomic status. When the
character Mitchell says that there was a report of a case of head lice in their daughter’s
class, his fiancée Cameron comments, “Ugh, it’s probably from Portia. You know, she is
always so filthy. They had to kick her out of swim buddies because she left a ring around
the pool” (Case 2014). Such a comment illustrates the stigma that head lice is a condition
associated with uncleanliness. The episode never offered a correction of this
misperception, thus perpetuating the stigmas attached to head lice.
Much of the body of academic literature regarding head lice is quantitative in
nature, with a focus on the medical treatment of head lice. Many studies skim the surface
of the stigmatization of head lice in our society, but they do not fully address the origins
and transmission of these stigmas. In the broad view of research on stigmatized health
conditions, head lice is not a star topic. Scamble (2009) explains that the most common
research on stigmatized disease is in relation to conditions such as HIV and mental
illness. While head lice is not actually a health condition that causes physical harm, and

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therefore should not be in the same category as these stigmatized diseases, head lice is
still a specific condition of the body, and therefore appears in academic research as a
stigmatized health condition. This is evident in the types of journals in which head lice
research is published, which includes The Journal of School Health and The Journal of
School Nursing.
As a result of these gaps in research literature, I decided to conduct research that
addresses the big question “How is the stigmatization of head lice transmitted and
perpetuated in our society?” which I approach through two sub-questions. The first
question is “What are the current stigmas associated with head lice in Walla Walla?” The
second question is “How are people socialized to perceptions of head lice?” Although
looking at a town as small as Walla Walla, WA may not enable us to generalize about
society, the patterns that emerged could provide some degree of insight into the larger
societal stigmatization of head lice.
The next few chapters will explore Bronfenbrenner’s ecological systems theory
and Goffman’s theory of stigma relations. I will also discuss the findings of past research
on both head lice and the broader stigmatization of health conditions. After explaining
my methodology, I then analyze the results of my research and look at how both
Goffman’s theory and Bronfenbrenner’s theory help explain the data. As the
stigmatization of head lice is explored, it will become clear that the stigmas associated
with head lice have infested themselves in the interactions people have with one another.

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THEORETICAL FRAMEWORKS
Ecological Systems Theory
Ecological systems theory was first proposed by social psychologist Urie
Bronfenbrenner in the 1970’s, and has been revised several times since. This theory is
widely used as a developmental theory in psychology, but it has extended into the
discipline of sociology. Bronfenbrenner believed that in order to understand human
development, we must take into account the environments in which individuals grow,
interact, and immerse themselves. According to Steinberg’s explanation of ecological
systems theory, “we focus not only on the developing individual but on the interrelations
between the individual and his or her contexts, and on the interconnections between the
contexts themselves” (2011:10). Bronfenbrenner’s (1979) ecological systems consist of
five categories of social interaction. The first is the microsystem, which pertains to the
direct relationships and interactions an individual has with his/her immediate
environment. The second is the mesosystem, which is the interaction between players in
the microsystem, such as parents and teachers. The third category is the exosystem,
which is the larger society in which the individual lives. The fourth is the macrosystem,
which encompasses the individual’s broader culture (beliefs, attitudes, etc.). The last
category is the chronosystem, which is the time and sociohistorical events between life
events. In this theory, various levels of interaction ranging from family, schools, and
neighborhoods to larger societal values and beliefs influence an individual’s experience
in childhood and his/her outcome.
While Bronfenbrenner’s theory is most often applied to human development,
sociologists use various forms of systems theory in areas such as family studies. Smith et
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al. (2009) discuss ecological systems theory as a variation of family systems theory, in
which we see not only the impact that parents have on children, but also the impact that
children have on their parents. According to Smith et al., in Bronfenbrenner’s theory,
“we see that not only are children being influenced by parents, the school, and the
neighborhood, but also that the child impacts those environments and helps to shape them
as well” (2009:124). The dynamic, bi-directional influence between a child and his/her
environment is the focus of my research. In the subsequent sections, I explore how these
interactions influence the transmission of stigmas about head lice.
The concept of role is also important to Bronfenbrenner’s ecological systems
theory. According to Bronfenbrenner, a role is “a set of behaviors and expectations
associated with a position in society, such as that of mother, baby, teacher, friend, and so
on” (1979:25). It is important to discuss roles when thinking about the socialization to
stigmas. In respect to parents and teachers, the role of the child is to listen to these
authority figures. If parents and teachers spread certain information about head lice, it is
possible that beliefs may distort factual information about the lice, and thus children are
exposed to—and expected to adhere to—what is considered a normative perception to
have in regard to head lice.
My own research investigates how information and attitudes towards head lice are
transmitted to students via the ecological systems that surround them. I explore the
microsystem and investigate what parents’ perceptions of head lice are and what
information children are told about head lice. I also focus on students’ mesosystems,
looking at the interaction between teachers and parents in regard to head lice. While my
research does not specifically address the relationship between stigma and the broader

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exosystems and macrosystems, some of my survey questions do, at a surface level, look
at individuals’ interactions with the larger society in terms of head lice information
consumption.

Microsystem: A closer look
At first glance, Bronfenbrenner’s microsystem appears straightforward. The
microsystem consists of a child’s immediate environment. The focus at this level is on
dyadic relationships between a child and his or her parents, teachers, peers, neighbors,
and so forth. Bronfenbrenner emphasizes that the microsystem is something that a
developing person experiences. The microsystem is different from the other ecological
systems because it is observable by the individual. When a child is speaking with her
mother, she is experiencing an interpersonal relationship within her microsystem. It is
important to note that the microsystem does not merely consist of objective facts. The
microsystem also has an emphasis on how an individual perceives his or her
environment, and what subjective reality they experience through their interactions.
Bronfenbrenner acknowledges that this concept of the microsystem is not
“original in this formulation” (1979:22). Many other theorists have studied the subjective
perspective of reality, and Bronfenbrenner credits sociologists such as George Herbert
Mead (1934) and Thomas and Thomas (1928) for their “definition of the situation”
(Bronfenbrenner 1979:22-23). As cited in Smith et al., the definition of the situation
explains that “you cannot understand human behavior without also understanding the
subjective perspectives of the people involved in the interaction” (2009:12-13).
Bronfenbrenner believes that when it comes to development, what matters most is how an

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environment is “perceived rather than as it may exist in ‘objective’ reality” (2009:4). In
the case of my research, the specific behavior I am looking at is the stigma people attach
to head lice. My research looks at whether and why negative perceptions about head lice
exist in spite of objective truths about head lice that should dispel these perceptions. In
order to understand why people have these stigmas, it is important to understand what
subjective experiences they have had with head lice, including interactions in which they
discussed head lice with other members of their microsystem.

Mesosystem: A closer look
The mesosystem is born out of the interactions that occur in the microsystem. In
the mesosystem, members from at least two different settings of an individual’s
microsystem interact. Examples of these relations include parents interacting with
teachers and staff at the schools, peers interacting with other peers, and so forth. It is in
the mesosystem that home life can be linked with life at school or in other settings. The
crossover of communication between actors in each setting can lead to the diffusion of
knowledge and exchange of ideas between two groups. The ecological system becomes a
network, and the mesosystem is “a system of microsystems” (Bronfenbrenner 1979:25).
While the individual’s movement into different settings creates the opportunity for the
mesosystem to form, the focus of the mesosystem is on the interactions between the other
people in an individual’s microsystem who come into contact with one another.
The indirect links that occur in the social networks of the mesosystem serve
certain functions. For Bronfenbrenner, the most important function of these social
networks is the transmission of “information or attitudes about one setting to the other”

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(1979:216). Because people have different definitions of the situation, there can
sometimes be a gap in communication between settings. For example, what is being
taught at school about head lice may not be what parents teach at home. Bronfenbrenner
stresses the importance of “twoway communication” (1979:217) between settings such as
home and schools, with open dialogue to see where discrepancies in knowledge are
coming from. My own research investigates this communication between teachers and
parents to see if dialogue about head lice even exists between home and schools. In trying
to uncover how stigmas about head lice are transmitted through interactions, it is
important to look not only at the direct interactions individuals have with members in
their microsystem, but also to take into account what information is being indirectly fed
into the microsystems via social networks.

Goffman’s Stigma
Bronfenbrenner’s theory helps illustrate the networks through which stigma may
be transmitted in society, but it is also important to understand the nature of stigmas, as
well as what functions stigmas serve in human social interactions. This is where we turn
to Goffman’s theory of stigma relations. According to Erving Goffman, a stigma “is an
attribute that is deeply discrediting” (1963:3), and whether or not an attribute is
stigmatized is dependent upon the social relations and context within which individuals
are interacting. The attribute is not discrediting by itself, but rather it becomes an
“undesired differentness” (Goffman 1963:5) when compared to attributes that are
considered to be normal in a society. In this sense, a stigmatized attribute serves to
reaffirm norms. Stigmas are also constructed in order to help us explain our social world.

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Goffman explains that one function of stigma is to “explain his [a stigmatized
individual’s] inferiority” (1963:5) and to rationalize our treatment of others based on their
differences from “normals” (1963:5)—people who do not possess the stigmatized
attribute.
Goffman states that there are three types of stigma: “physical deformities,”
“blemishes of individual character,” and “the tribal stigma of race, nation, and religion”
(1963:4). My research touches upon all three types of stigma. Physical deformities refer
to the physical, bodily attributes that are stigmatized. Goffman refers to these as
“abominations of the body” (1963:4), which, in my research, would be having the actual
condition of head lice. The blemishes of individual character that Goffman discusses
refer to the attributes we ascribe to people’s character when they are infected with head
lice. When people who have head lice are described as poor or unclean, these words are
targeted as flaws in their character. My research explores the stigmas that are attributed to
flaws in people’s character, such as the idea of associating head lice with uncleanliness
(Burgess, Pollack, and Taplin 2003). The last type of stigma that Goffman outlines is
tribal stigma. These are stigmas that “can be transmitted through lineages and equally
contaminate all members of a family” (Goffman 1963:4). Tribal stigmas are against
different races, nations, religions, socioeconomic groups, and so forth. When it comes to
head lice stigmatization, marginalized groups in society tend to receive the brunt of the
stigma—particularly lower socioeconomic groups and the homeless (Kane, Green, and
Jacobs 2010). I address tribal stigma in my research and try to understand which groups
are more likely to be attributed with the stigmas of head lice.

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Management of stigma
In order for a stigma to truly be discrediting, there has to be a general social
consensus on which attributes are considered normal. In other words, “the stigmatized
individual tends to hold the same beliefs about identity that we do; this is a pivotal fact”
(Goffman 1963:7). This means that stigmatized individuals value the same attributes as
normal people do, and therefore share similar beliefs about stigmatized attributes. This
can lead to feelings of shame when a person possesses a stigmatized attribute. As
Goffman states, “shame becomes a central possibility, arising from the individual’s
perception of one of his attributes as being a defiling thing to possess” (1963:7). In
dealing with the feelings associated with possessing a stigma, people choose to manage
their stigmas in several ways.
One of the ways people approach the management of stigma is through attempts
to correct or eradicate the stigmatized attribute. For instance, if an individual were to
discover that they had head lice, they would take steps to treat the condition and get rid of
the lice. It is important to note that the desire to correct a stigmatized attribute opens
individuals up to what Goffman refers to as “victimization” (1963:9). For example,
companies might market certain shampoos intended to kill head lice. Because of the
demand inelasticity a stigmatized individual may have for that product—fueled, no
doubt, by the desire to get rid of a stigma—, companies are able to sell products at higher
prices, which “provides a special indication of the extremes to which the stigmatized can
be willing to go” (Goffman 1963:9). Stigmatized individuals want to correct their
stigmatized attributes in order to have the status of a normal person again, but as
Goffman explains, “what often results is not the acquisition of fully normal status, but a

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transformation of self from someone with a particular blemish into someone with a
record of having corrected a particular blemish” (1963:9). So even if a person were
successful in eradicating head lice from their head, Goffman would argue that they do not
automatically return to normal status. The stigma of having had a stigmatized attribute is
not as temporary as the attribute itself. While my own research does not address the
length of time that head lice stigmatization typically lasts, future research could look into
the resiliency of stigma over time.
Another way in which the stigmatized manage their conditions is to partake in
activities typically considered inaccessible to a person due to their condition. Goffman
gives examples of physically disabled people taking up a sport or some sort of movement
that able-bodied people are able to do, but that the stigmatized individuals are not
expected to be able to do. In the case of head lice, this activity may be simply attending
school. Pulling students out of the classroom can cause embarrassment (Scott et al. 2004),
and by staying in school, children with head lice would be able to at least disguise their
stigmatized attribute easier. The concealment of a stigma can be a coping mechanism,
particularly for a condition that is not outwardly noticeable such as head lice.

Moral careers
The socialization of an individual to a stigma has two phases, and it is this
learning process and change in identity from normal status to the status of a stigmatized
individual that Goffman terms the “moral career” (1963:32). In one phase, an individual
is socialized to “the standpoint of the normal” (Goffman 1963:32), wherein the individual
accepts the larger societal beliefs about identity and certain stigmas. In the other phase,

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an individual becomes aware that he or she has a stigmatized attribute and learns the
consequences of possessing such a stigma. According to Goffman, the timing of these
two phases determines which moral careers are open to a stigmatized individual.
There are four patterns, or four combinations of the timings of the two phases, of
the moral career. The first pattern is when a stigma is inborn. This means that the
stigmatized attribute was inherent in an individual at birth, or shortly after, and therefore
the individual is simultaneously socialized to the normal standards and expectations of a
society, as well as to his or her stigmatized condition.
The second pattern of the moral career still involves an inborn stigma. However,
family and the community protect the stigmatized individual. The individual grows up
unaware of the stigma they possess, and identifies as a normal person. Eventually, the
individual can no longer be protected from the stigma and becomes aware of his or her
status as a stigmatized person, and learns what such a status means. According to
Goffman, “public school entrance is often reported as the occasion of stigma learning”
(1963:33), as children are introduced to peers who are truly considered normal. It can be
hard on children to abruptly be pulled from an illusion of normalcy, in that, “he will be
told that he will have an easier time of it among ‘his own,’ and thus learn that the own he
thought he possessed was the wrong one, and that this lesser own is really his” (Goffman
1963:33).
The third pattern of the moral career is when a person discovers that he or she
possesses a stigma later in life. It can be hard for an individual to shift their identity from
normal to stigmatized after many years of living with normal status. This identity shift is
particularly challenging for individuals who discover that they’ve had a stigmatized

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attribute all along, and therefore must have a “radical reorganizing of his view of his
past” (Goffman 1963:34). More often than not, this correction of the past is not necessary
because stigmas later in life tend to be ones that develop out of sudden physical
handicaps.
The fourth and final pattern of the moral career involves growing up in a
community outside of the main society. When people “are initially socialized in an alien
community…[they]…then must learn a second way of being that is felt by those around
them to be the real and valid one” (Goffman 1963:35). This fourth pattern relates back to
Bronfenbrenner’s discussion of the definition of the situation, wherein different people
see reality from different perspectives. Immigrants, for example, have one perception of
reality and idea of what it means to be normal, but when they move to another country,
the standards for normal may not be the same. They must then be socialized to new
norms and may come to realize that they possess an attribute that is considered a stigma
in the new society.
It is in this fourth pattern of the moral career that we can see Bronfenbrenner’s
macrosystem. In this ecological level, the development of an individual is impacted by
the values and norms of the society they are living in. When a person is socialized in one
society and then enters into a new society, they may experience a disruption to their
understanding of the macrosystem, which can change the ways in which they interact
with the norms. If they have not yet learned the new society’s expectations and values, an
individual may not be aware of stigmas associated with certain conditions. This could
lead to a disconnect between individuals and their macrosystems, wherein they do not

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subscribe to their new society’s norms and therefore maintain a value system in which
some stigmas may not exist.
An example of this disconnect with the new society’s macrosystem stems from
some of my discussions with Jennifer Douglas. When I first met with Jennifer on August
14, 2013, she explained that head lice is not a stigmatized condition in all regions of the
world. In parts of Africa, head lice is easily dealt with by putting oils in hair and combing
out the head lice—and as a result there is no fuss and no fear about head lice. If someone
immigrated to the United States from one of these regions, they would be transitioning
from a macrosystem in which head lice is not stigmatized to a macrosystem in which the
values and norms of the society have shaped a stigma about head lice. The immigrant,
having already been socialized to not hold a stigma about head lice, may choose to
abstain from believing in this new stigma, and therefore he rejects a part of his new
macrosystem.
Each of these patterns represents the acquisition of new knowledge and
individuals having to shift their identities to adhere to their stigmatized conditions. My
research on head lice appeals most directly to the third pattern of the moral career, where
a stigma is acquired later in life. Head lice is an interesting stigmatized condition in that it
can be a brief, one-time condition. While this might mean that the second phase of the
moral career may also be brief because the consequences of having head lice may be
short-lived, more research could be done to explore the longevity of head lice
stigmatization. Do people who have had head lice experience residual effects of the
stigma, even long after the actual head lice are gone?

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Although the third moral career is most relevant to the stigmatization of head lice,
all of the patterns of the moral career play a role in the stigmatization of head lice. In
terms of the first pattern, families can serve as barriers protecting their children, to some
extent, from the stigmas of head lice. With the second pattern, the abrupt change from
normal status to stigmatized status that comes along with socialization in schools can
help describe the interactions between children and their peers, and the moral education
that school provides. In the fourth pattern, a child may originally come from a community
where head lice is more prevalent, and less stigmatized, than it is in America, and
therefore they may receive a second socialization to what it means to have head lice in
the eyes of Americans.

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Stigma in Ecological Systems
Figure 1. Example of Goffman in Bronfenbrenner’s Ecological Systems Theory

Chronosystem
Macrosystem
Exosystem
Mesosystem
Microsystem
Parents teach their
children that if they
don’t wash their
hair, they will get
head lice

Figure 1 illustrates the interconnectedness between the different ecological
systems. Each of the ecological systems engages in a bidirectional relationship with each
of the other systems, as shown by the arrows between levels. These arrows also depict the
ways in which information is shared and consumed by an individual. In each of the

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categories of interaction, an example is listed. These interactions, when combined, can
help explain how a stigma might come to exist in society. Let’s start with the
chronosystem, the ecological system in which sociohistorical events are taking place at a
given time. For this example, the event that is occurring is a case of head lice in a
student’s classroom. Looking to the macrosystem helps us understand which underlying
values in society will help individuals form beliefs about what makes a normal body. In
this particular society, cleanliness is valued, and having the condition of head lice is seen
as abnormal. In the exosystem, the pharmaceutical institution is marketing insecticide
shampoos as the solution to getting rid of head lice.
Now let’s focus on the interactions in the mesosystem and microsystem. Parents
hear about the case of head lice at their children’s school and immediately discuss head
lice with their children. Perhaps the parents are influenced by the combination of the
macrosystem’s value of cleanliness and the exosystem’s marketing of head lice
shampoos. Packaged together, this information might mislead the parent into thinking
that head lice is a hygiene problem. Parents may then teach their children that in order to
avoid getting head lice, they should wash their hair often. At this point, head lice
becomes associated with uncleanliness. Parents may then discuss head lice with other
parents at their children’s school, thus passing on their beliefs and perpetuating the
stigma that unclean people get head lice.
As this hypothetical situation illustrates, the interactions between ecological
systems are complex and interconnected. What occurs in one system can affect the
interactions in a different system. This interconnectedness serves as the perfect breeding
ground for Goffman’s stigma. Because a stigma can only exist with social consensus

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about what a normal identity is, when interactions across ecological systems agree on
values and norms, the stigma is strengthened, reinforced, and perpetuated. While it could
be possible for disagreement to occur across ecological systems, because the systems are
so interconnected and influence one another, the tendency will be for the ecological
systems to work in cooperation with one another.
Bronfenbrenner’s (1979) ecological systems theory provides a foundation through
which to view how and where individuals learn about head lice. Goffman’s (1963) theory
of stigma expands on this socialization and describes the various processes a stigmatized
individual goes through. Together, these two theorists create the framework through
which to study the socialization to the stigmatization of head lice in our society. What are
the current stigmas associated with head lice? Where do these stigmas come from? How
are they transmitted via our ecological systems? These questions are explored throughout
this research.

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LITERATURE REVIEW
As I began my research investigating the stigmatization of head lice, it quickly
became clear that social science research on the topic is very limited. The social issues
surrounding head lice are underrepresented in head lice research, which inspired me to
conduct my own research to add a more qualitative perspective to the stigmatization of
head lice. My research looks at head lice through a sociological lens and attempts to not
only address which stigmas exist about head lice, but also why these stigmas exist and
how they are perpetuated by interactions in society.

Medical Sociology
While research on the stigmatization of head lice is very limited, research on
stigmatized diseases in general exists within the field of medical sociology. Scambler
wrote about stigma in relation to health concerns, in which he notes that “the judgment
[about a person or group] is based on an enduring feature of identity conferred by a health
problem or health-related condition, and the judgment is in some essential way medically
unwarranted” (2009:441). Head lice, which is not actually a health problem in the sense
that it is not a physical illness, is an example of the misinformed judgment that is placed
on people with head lice.
Research on stigmatized health conditions tends to focus on HIV, physical
disabilities, or mental illness. The specific research and findings of the stigmatization
such as HIV, however, can still be useful in studying head lice. Scambler cites van Brakel
(2006), who states “the consequences of stigma are ‘remarkably similar in different
health conditions’” (Scambler 2009:448). Such a statement indicates that Scambler’s

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(2009) discussion on researching stigmatized diseases such as epilepsy and HIV can be
applied to other specific stigmatized health conditions, such as head lice. In his research,
Scambler argues that we must reframe research on stigmatized conditions to look beyond
the scope of stigma as a “personal tragedy” (2009:449) and look at stigma from the
perspective of “conflict as well as interactionist sociology” (2009:453). In my own
research, I do not look specifically at conflict theory, but discontinuities may arise
between relations and interactions in the different ecological systems.
Parker and Aggleton (2003) also take a sociological approach to the study of HIV
and AIDS-related stigma. They argue that past research has focused on stigma in a way
that limits our understanding of the discrimination against people with conditions such as
HIV. They critique the overuse of Goffman’s theory in stigma research, saying that too
often the research makes stigma appear “as a static attitude rather than a constantly
changing (and often resisted) social process” (Parker and Aggleton 2003:14). Parker and
Aggleton research turns toward social inequality and power dynamics to explain the
stigma of HIV because they believe that it is within the structures and processes in
society that stigmas are reinforced—some people are “devalued” so that others can feel
“superior” (Parker and Aggleton 2003:16). While they focus specifically on the power
relations that lead to the discrimination of people with HIV, their approach can be used to
help explain other stigmas—including head lice. My own research does utilize Goffman’s
theory of stigma, but I felt that Goffman’s ideas needed to be supplemented with a more
structured theory that Bronfenbrenner’s ecological systems theory provides, which helps
explain how social interactions shape and perpetuate stigmas.

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The research literature directly related to the condition of head lice falls into three
overarching themes: a) the social and economic costs of head lice; b) schools’ head lice
policies; and c) various treatments and knowledge of head lice. The following literature
review contains articles from a wide range of academic disciplines, including
psychology, economics, medicine, and sociology.

The Costs of Head Lice
Social costs of head lice
One of the main areas of focus in past head lice research addresses the costs of
head lice. More specifically, these costs are the social costs (the stigmas, the
misperceptions, the social rejection, and so forth) and the economic costs of head lice.
Parison, Speare and Canyon’s (2013) research begins our investigation of the social costs
of head lice. They studied some of the emotional aspects of dealing with head lice by
conducting an online questionnaire in which they asked participants “what were your
feelings upon discovery of head lice?” (Parison et al. 2013:169). Their participants were
mostly females from Australia, the United States, Canada, and the United Kingdom.
From this group of 294 respondents, there were no positive reactions to head lice (Parison
et al. 2013:170). All of the respondents stated that they had some sort of negative feeling
towards head lice, with a large percentage responding with strong negative emotions,
such as disgust, horror, and feeling dirty (Parison et al. 2013:170). Parison et al.’s
research sheds light on the psychological implications of head lice. Their study uncovers
the feelings individuals have towards head lice, but does not address the question of why
individuals have these feelings. Their work can be seen as a gateway to understanding the

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stigmatization of head lice because it addresses the initial responses that people tend to
have when discovering head lice. By exploring the individual feelings toward head lice,
we can start to understand what the stigmas attached to head lice are. Despite all of this,
Parison et al. (2013) do not uncover why people had the negative feelings about head
lice, which is a question that my own research will try to address.
Moving away from the individual’s perceptions of head lice to look at the
perceptions of the broader society reveals some of the social costs of head lice. As
Parison et al.’s (2013) study shows, head lice elicit negative emotional responses from
individuals. Head lice also has implications in terms of social standing and interactions.
For example, Feldmeier and Heukelbach (2009) studied epidermal parasitic skin diseases
(EPSD) and looked at the rates of incidence among those living in poverty. Pediculosis—
or head lice—is one of the six main EPSDs that Feldmeier and Heukelbach investigate.
Their research investigates the biology behind how conditions in resource-poor areas of
the world tend to be areas where EPSDs thrive. These conditions often include
“crowding, sharing of beds, frequent population movements, poor hygiene, lack of access
to health care, inadequate treatment, malnutrition and social attitudes” (Feldmeier and
Heukelbach 2009:154). When discussing the transmission of head lice, Feldmeier and
Heukelbach argue that the risk of infestation is often dependent upon the income of the
country as a whole. They use the example of a low-income neighborhood in Brazil where
higher morbidity is positively correlated with lower family incomes, and they contrast
this with high-income countries, where “children of all socioeconomic groups are at
similar risk for infestation” (Feldmeier and Heukelbach 2009:154). Americans have
often viewed head lice as something that only affects the lower classes, particularly those

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living in unclean conditions (Burgess et al. 2003). Head lice, and other “povertyassociated plagues” (Feldmeier and Heukelbach 2009:152), can serve as devices to
further segregate the classes in our society. The higher incidence of head lice among
those with fewer resources contributes to the stigmatization of head lice. When we see
these statistics of higher incidence, we may begin to believe that head lice is mostly
contracted in poor, dirty conditions. Further, when somebody who holds these beliefs
contracts head lice, he or she may be more prone to feel all of the negative emotions—the
disgust, the feeling dirty—that Parison et al. (2013) discuss.
Now that we have seen what head lice research has accomplished in terms of the
individual and the larger society, it’s important to look at the interactions that take place
within the various levels of our ecological systems. One of the important interactions that
we encounter in our everyday lives is the social exchange that occurs between ourselves
and the people in our communities—our neighbors, our coworkers, and even strangers on
the streets.
Kane, Green and Jacobs (2010) conducted research on social work students’
perceptions of homeless men and women. Kane et al. believe that the attitudes held by
human services workers can impact the quality of the services given to impoverished
populations. Kane et al. (2010:265) surveyed 207 students enrolled in social work classes
in South Florida. The surveys contained one of four vignettes of characters—a younger
woman, an older woman, a younger man, and an older man—portraying behaviors that
might be associated with homelessness, mental illness or substance abuse. After reading
the vignettes, participants were asked questions about their perceptions of their
character’s possible state of homelessness, mental illness, substance abuse, or health

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issues. When asked the probability of their character having head lice, the majority of
participants answered that there was at least a “50/50 chance” that they had head lice
(Kane et al. 2010:271). In addition, the students perceived the homeless as having a
higher occurrence of specific health problems such as STDs, mental illness, and head
lice. What is interesting about these findings is that it suggests that even social workers,
who work with these impoverished populations, have certain perceptions about the
connections between head lice and the poor. Again, this research does not address why
these students have these perceptions of the homeless, but the results demonstrate that
people who work closely with these poorer populations often have certain attitudes that
might affect the ways they interact with the homeless. Kane et al. (2010) open the door to
questioning how stigma is transmitted, and the influence interactions have in perpetuating
the idea that head lice is, like Feldmeier and Heukelbach stated, a “poverty-associated
plague” (2009:152).
Current literature on head lice research also includes those people who directly
interact with other people infected with head lice. There is limited research in the field on
the effects of caring for persistent head lice, but Gordon (2007) addresses the impact that
head lice on children tends to have on parents and caregivers. She conducted in-depth
interviews with, and observations of, 20 parents or caregivers, in which she studied the
experiences that parents and caregivers had when caring for children with head lice.
Gordon introduces the term “caregiver strain” (2007:286) to explain the stress that
parents and caregivers feel when dealing with head lice. Based on the results of her
research, Gordon identifies four stages of vulnerability that parents often experience: “(a)
being ostracized, (b) losing integrity of the self, (c) struggling with persistence, and (d)

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managing strain” (2007:286). What is interesting about Gordon’s research is that it
demonstrates that the stigmatization of head lice and negative psychological feelings go
beyond just the person affected with head lice. When a child has head lice, there may
exist implications about the family’s life circumstances and socioeconomic status. As
cited in Gordon (2007:286), Burgess et al. (2003) explain that head lice “is often
associated with being unclean, living in poverty, and/or poor parenting.” Parents may feel
socially judged for having children with head lice.
Goffman coins the term “wise persons” to describe the “persons who are normal
but whose special situation has made them intimately privy to the secret life of the
stigmatized individual and sympathetic with it, and who find themselves accorded a
measure of acceptance, a measure of courtesy membership in the clan” (1963:28). This
idea of a courtesy membership can be further reinforced when the tribal stigma of head
lice is discussed. As Burgess et al. (2003) point out, there exists a perception that head
lice has some connection to social class and family. It would make sense, therefore, for
the stigma given to a child infected with head lice to spread to the family, as the head lice
condition can be seen as reflective of familial conditions. Parents of children who have
head lice, therefore, can share the stigma associated with the lice.
Mclaury (1983) sheds light on some of the misperceptions of head lice and
provides research-grounded advice for health care providers who are looking to treat head
lice and instruct parents on the proper care of children with head lice. Mclaury (1983)
begins her article with a description of head lice and information about their life cycle,
and she then discusses the environments that lice tend to thrive in. It has long been
believed that children contract head lice mainly in schools, but as research began to

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emerge in the 1980s, it became evident that “lice are more likely to be spread in the
home” (Mclaury 1983:1301). This new knowledge can feed into the fears of
stigmatization that families feel when their children contract head lice, as the home
environment becomes the number one suspect for head lice contraction.
As Gordon’s (2007) research shows, parents can be very sensitive and experience
a degree of vulnerability when their family experiences head lice infestation. Mclaury
expands on this vulnerability and discusses how children can also have perceptions of
head lice. According to Mclaury, “children readily adopt their parents’ attitudes toward
head lice, and an infested child may feel ashamed, guilty, and stigmatized” (1983:1303).
Mclaury’s research only skims the surface of children’s perceptions of head lice, but she
shows that negative feelings about having head lice can be transmitted via the
interactions between parents and children. In this case, the transmission of stigma is
partially explained by the dyadic relationships between parents in the microsystem. At
this point, there is still very little data on children’s feelings about and attitudes towards
head lice, and this remains an area in the field that needs to be studied further so that we
can understand what stigmas related to head lice are being circulated to our children, and
how the interactions between various levels of their ecosystems serve to socialize
children to these stigmas.

Economic costs of head lice
The other costs associated with head lice that have been described by researchers
are the economic costs. Bennett, Gilson, and Mills (2008) have explored the various costs
of health care policy to the outcomes of families living in poverty. The chapters in the

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edited collection Health, Economic Development and Household Poverty were written by
a wide range of contributors who explored topics ranging from the connection between a
community’s health and economic development (Bennett et al. 2008) to ways in which
health care reform can improve health equity (Bennett 2008). By looking at the ways in
which health systems fail those living in poverty, Bennett et al. point out that unequal
access to health services can contribute to the poor being stuck in a cycle of poverty for
various economic reasons, including productivity. In their chapter in this volume,
contributors Alsan et al. (2008) discuss the connection between a population’s health and
their educational achievement. According to these authors, “healthier children have
enhanced cognitive function and higher school attendance, enabling them to become
better-educated, higher-earning adults” (2008:35). In the past, many school policies
regarding head lice have stated that children with head lice were not allowed in school.
Such policies have adverse affects on students’ educational experiences. Children who
are healthier tend to attend school more often than their peers who are less healthy, which
means their education is less interrupted. With more access to education comes the
possibility of higher wages and a brighter future outlook. For children who experience
persistent cases of head lice, policies that keep them out of school could lead to lengthy
absences, which in turn would lead to gaps in their education, thus preventing children
who are already in conditions of poverty from being able to escape their circumstances
via education. In this way, health can be seen as a contributing factor to limited social
mobility for those living in poverty.
In their cost-effectiveness analysis of head lice treatments, Gur and Schneeweiss
(2009) investigate how much head lice costs families to get rid of. These researchers

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studied the costs of three different head lice treatments: combing, permethrin 1%, and
malathion 0.5%. They used decision-tree models and related software to calculate
probabilities for successful treatments and the various costs for each treatment type. The
costs that were calculated include the cost of the treatment itself and the health care
provider co-pays, as well as the cost of babysitters for the days the children missed
school, the educational costs from missed school days, and the time it takes to shop for
treatments or go to the doctor. They determined the probabilities for success rate by
looking at different resistance rates resulting from the fact that head lice can become
resistant to certain insecticides, particularly permethrin 1%. Looking at all of the various
costs associated with head lice, Gur and Schneeweiss found that “the cost-effectiveness
ratio of a comb strategy increases as a student loses more school days” (2009:730). They
gave an example that if a child using the combing method misses ten days of school, it
would cost the parents “as high as $2,440 per successful treatment” (2009:730). They
also found that because the cure rate of permethrin 1% is dependent upon how resistant a
particular case of head lice is to the various chemicals, malathion 0.5% is the most costeffect treatment strategy because it minimizes the costs of missing school and maximizes
the probability of being cured. Unfortunately, malathion 0.5% is also the most expensive
treatment, when looking at the cost of the treatments alone. A head lice comb costs
relatively little money, but these medicated treatments can cost upwards of hundreds of
dollars. For many families, the burden of the cost of the malathion 0.5% treatment is
likely to be impossible to reconcile, and they must settle for whichever treatment method
is both cheaper and allows for their children to return to schools fastest—a fact that often
means that the treatment does not properly get rid of the head lice, ultimately resulting in

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a persistent head lice problem. This can feed into the perception of head lice being a
condition that only poor families have to face because they do not have the resources to
properly get rid of head lice in the first place. In this way, institutions such as
pharmaceutical companies help perpetuate the stigmas surrounding head lice in our
society. By making treatment largely unaffordable, head lice continue to be more of a
problem among poor families and the gap between those who have resources and those
who do not increases.
Head Lice Policy in Schools
School policy is directly tied to the cost analysis of head lice for parents. For
some parents, the costs of care, or the costs of missing work to stay home with their
children, are not realistic for their family, and therefore they might feel forced to use
chemical treatments that will allow their children back into school earlier. Some school
policies state that you cannot attend school—or you risk facing consequences such as
suspension—if you have nits in your hair. Scott, Gilmer, and Johannessen (2004) looked
at these no-nit school policies and created an alternative process for sending students with
head lice home, called the Nit Rating Scale. They acknowledged that no-nit policies
could have negative impacts on students such as “social stigma and excessive
absenteeism” (2004:108), and they tell the story of one elementary school in Tennessee
that used to have a no-nit policy. The school nurses at this school began to notice that
students were being sent home even when no live lice were found. When the students
were sent home, they were “embarrassed and teased by their peers” (Scott et al.
2004:109).

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The Nit Rating Scale was created to address the problems associated with high
rates of absenteeism for certain students. The scale has five categories ranging from no
nits to “1/4 of all hair or more covered with nits” (Scott et al. 2004:109). The scale
experienced much success, and teachers “reported that children chronically absent with
the no nit policy had improved attendance and grades since implementation of the Nit
Rating Scale” (2004:109). This research shows that school policy related to head lice can
either perpetuate stigmas or help dispel myths and misinformation about head lice. When
the Nit Rating Scale was implemented over a decade ago, it was a step in the right
direction for school head lice policy, and it helped begin to change the attitudes that
school officials have often had towards head lice.
Not all researchers support the removal of children from school due to nits,
however. For example, Sciscione and Krause-Parello (2007) researched no-nit policies in
schools and discussed why these policies should not exist. According to these authors,
no-nit policies in schools are outdated and based upon myths and lack of knowledge
about head lice. Nits are the eggs laid by adult lice, which hatch into nymphs and take
about a week to become full grown lice. Mclaury (1983) and Sciscione and KrauseParello (2007) have stated that there is misinformation about where head lice are mostly
transmitted. Mclaury (1983) dispels the myth that the majority of head lice cases are from
contact in schools, while Sciscione and Krause-Parello discuss that the “transmission of
lice occurs most often among family members due to the close proximity of living
conditions” (2007:15), and that, “lice transmission in schools is rare because close headto-head contact” (2007:15). No-nit policies are implemented in order to prevent the
sharing of head lice in schools, but in reality, head lice are hard to acquire in the school

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setting, and nits by themselves cannot be transmitted (Sciscione and Krause-Parello
2007). Lack of knowledge about head lice seemed to be an issue even for school nurses
screening children for head lice. Thus, Sciscione and Krause-Parello discuss the frequent
misdiagnosis of head lice by school nurses and parents, and that nurses and parents “were
generally unable to distinguish between active and inactive infestations” (2007:18).
Pollack, Kiszewski and Spielman’s (2000) research on the misdiagnosis of head lice
supports this claim. They found that, more often than not, children who don’t have head
lice receive insecticide treatment more than children who do actually have the head lice.
These authors then conclude that children should not be kept out of school due to head
lice because such policy creates more problems than it solves. In fact, the frequent
misdiagnosis of head lice could lead to students being kept out of school for no reason—
though even with live lice, “there is no scientific evidence to justify exclusion of students
from school because of head lice and/or viable nits” (Sciscione and Krause-Parello
2007:18). As Sciscione and Krause-Parello (2007) show, there is a considerable lack of
knowledge about the condition of lice among those who are taking care of the problems
and creating policies about them. These no-nit policies unnecessarily keep students out of
class and can serve to perpetuate stigmas and social isolation to students who miss
school.

Treatment of and Knowledge About Head Lice
The majority of research related to head lice centers around the facts and
misinformation about head lice, and what steps parents and health care providers should
take to get rid of head lice. In 1919, Moore and Hirschfelder conducted a series of

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experiments to get rid of lice. Their research was sparked by an increase in a louse
problem for soldiers at war—particularly clothing lice. This was during World War I, and
according to Moore and Hirschfelder, “hundreds of papers dealing with investigations of
this problem have been printed since 1914” (1919:2). There have been countless
experiments in the past trying to figure out the best way to get rid of lice, and Moore and
Hirschfelder are a part of that research. On the one hand, their work is wildly outdated
because scientific knowledge of lice has progressed in the almost-one-hundred years it
has been since Moore and Hirschfelder first published their work. Nonetheless, their
research shows how people attempted to get rid of lice in the early years of scientific
research. In their particular case, Moore and Hirschfelder experimented with different
temperatures and chemicals to get rid of the lice. Their goal was to find a cheap, effective
chemical that would destroy mass numbers of lice who were using soldiers as their hosts.
Moore and Hirschfelder’s (1919) work is an example of where we’ve come from in
dealing with lice, and it allows us to see how much our understanding of this health
condition has changed over time.
More recent research on ways to treat lice tends to be related to school policy.
Some of the literature on head lice provides analysis the various ways in which school
nurses address cases at their schools (e.g. through no-nit policies). Adding to this
literature, Speare, Thomas and Cahill (2002) address the question of whether or not lice
can be transmitted via floors. They studied seven elementary schools in Australia, in
which they vacuumed classroom floors and examined the dust for lice, and then
examined students’ heads for live lice. If lice were found, hair was then treated with one
of four insecticides and a lice comb. These authors found that out of 118 classrooms,

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“108 had at least one child with active pediculosis [head lice]” (2002:209-10) and yet no
trace of head lice or eggs was found in the dirt from the classroom floors that was
collected by the vacuums. These findings add some clarity to the misinformation about
head lice that often circulates. Many schools will spend time vacuuming or applying
pesticides in classrooms with infected children. However, Speare et al.’s (2002) findings
urge for a focus on getting rid of head lice on the head rather than being concerned with
the environment. More generally, their research adds to the literature on head lice by
exposing the truth behind the question of whether or not lice can be transmitted at school
via surfaces such as carpets, and it moves us in the direction of fully understanding how
to properly treat head lice.
A lack of knowledge about head lice and concerns about the treatment of head
lice seemed to be a common problem discovered in the research that I reviewed. For
example, Kirchofer, Price, and Telljohann (2001) investigated the knowledge that
teachers had about head lice, as well as how prepared the teachers felt to handle head lice
infestations in their classrooms. To do so, they surveyed first and third grade teachers in
order to see what the teachers knew about head lice. Results show that the three questions
most commonly answered correctly (with an answer of “disagree” on the questionnaire)
were the following: a) “head lice is primarily in poor families” b) “head lice is found
mainly in families who are not clean” and c) “African-Americans are more likely than
Whites to get head lice” (Kirchofer et al. 2001:450). The questions that were most
commonly answered incorrectly were the ones that asked about the characteristics of
head lice, such as whether or not they can “fly, jump, or hop” (Kirchofer et al. 2001:450).
What is interesting about these results is that they show that teachers tend to have

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knowledge about the social aspects of head lice—such as knowledge that poor families
are not the only population susceptible to infestations—but that they lack knowledge
about the actual head lice themselves. Kirchofer et al.’s (2001) study also investigates the
experiences that teachers had had with providing instruction about head lice. The
majority of teachers stated that they only taught about head lice when there was an
infestation of it. However, Kirchofer et al. discovered that teachers “who always taught
about head lice were significantly more knowledgeable than those who never taught
about head lice” (2001:451). Teachers do not always discuss head lice, and there appears
to be “an absence of head lice information in professional training programs” (Kirchofer
et al. 2001:452). This research reaffirms that parents, teachers, and even school nurses
tend to have limited knowledge about what head lice really is and how it should be
treated. This gap of knowledge can lead to the spreading of falsities about head lice,
which in turn can serve to perpetuate stigmas that form as the result of a misperception of
the nature of head lice.

Conclusion of Literature Review
The existing literature on head lice addresses several key questions relating to the
head lice problem. This research has looked at the social and economic costs of head
lice—the stigmas, the perceptions, and the economic burden placed on families who have
to deal with an infestation. It has also looked at the impact of various school policies,
with special attention paid to no-nit policies. These policies can serve to perpetuate
stigmas surrounding head lice and call unwarranted attention to students who miss school
due to head lice. Finally, research has looked at the various treatments of head lice and

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the body of knowledge that exists about the lice themselves. There appears to be a
general lack of understanding of the basic nature of head lice—the life cycle, how it’s
transmitted, etc. All of these factors combine to produce the stigmatization of head lice.
Despite the growing body of research that explains the condition of head lice and that
works to dispel the myths surrounding it, people continue to look at head lice as a
condition faced mostly by people from a lower socioeconomic status. While a body of
research addressing stigmatized illnesses exists, very little research has been conducted
that looks specifically at the stigmatization of head lice. My research investigates why
people have the perceptions that they do about head lice, and how interactions that occur
in various levels of our ecosystems can serve to reinforce the stigmas attached to head
lice.

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METHODS
Research Process and Design
I first started on this thesis journey in August 2013. When I began, I developed a
clear vision of the direction I wanted my research to go. I originally designed a three-part
study that would address the stigmatization of head lice in terms of Bronfenbrenner’s
microsystem, mesosystem, and exosystem. I planned to conduct short interviews with
elementary and middle school students in Walla Walla Public Schools in order to get the
student perspective on head lice—data that is currently lacking in research. I planned on
distributing surveys to parents and teachers to supplement these interviews. I planned on
doing an expansive content analysis of pharmaceutical company websites to look at how
head lice products are being marketed to the public. I had these visions in my head about
what my research would look like, and I quickly learned that social research does not
always go the way you plan—especially when it comes to studying students.
There were many obstacles to overcome in the research I conducted. Because I
wanted to study individuals in the Walla Walla Public Schools, I first needed to gain
approval from the district office. I submitted my first proposal to the district with high
hopes. I had drafted an extensive packet that included letters and permission forms for
student participation to parents in both English and Spanish. I had taken care to ensure
that the questions I had drafted for the semi-structured interviews were unobtrusive and
clear. I even pulled questions for the parent and teacher surveys from Kirchofer et al.’s
2001 study in order to help validate the types of questions I was asking of parents and
teachers. Unfortunately, I was asked to revise my project because that district did not feel

39

comfortable with me pulling students out of class and away from their education. What at
first felt like a major disappointment and roadblock quickly became a blessing. I was
given a new perspective on what it meant to be a social researcher. The social sciences
are not cut and dry. Any time you are working with and studying other people, there are
bound to be complications with your initial plan. People are dynamic, and social science
research needs to be flexible enough to accommodate the fluidity of the human
experience.
As I marched forward with my second proposal to the Walla Walla Public
Schools, my thesis vision began to become more focused, yet flexible. I allowed myself
to be open to any changes the district would suggest and was willing to compromise
within the parameters of my research. I decided to drop the content analysis part of my
research due to limited time and resources, but maintained a sharp eye for any trace of
head lice in the media. The most important components of my research were to collect
the perspectives about head lice from parents and from students, in whatever form that
would look like. The final design approved by Walla Walla Public Schools allowed for a
triangulation of methods. I was able to distribute online surveys to parents and teachers,
and conducted in-depth interviews with several students from Walla Walla Community
College. With this design approved by the school district, I then set forward to receive
approval from Whitman College’s Institutional Review Board. My proposal was finally
approved, with a few amendments along the way, and I set out to investigate the
stigmatization of head lice in Walla Walla.
Following Lareau’s (2012) call for qualitative researchers to develop a
research question instead of a hypothesis, I triangulated my research through qualitative

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and quantitative means in order to address my research question of “How is the
stigmatization of head lice transmitted and perpetuated in our society?” which is
answered more specifically in terms of local Walla Walla through the questions “what are
the current stigmas associated with head lice in Walla Walla?” and “how are people
socialized to perceptions of head lice?”
The methods I used in my research were semi-structured interviews with students
from Walla Walla Community College and online surveys via the survey software
Qualtrics completed by parents and teachers from Green Park Elementary. I did not have
a hypothesis because I wanted to be responsive to the social world and dynamic
interactions I was studying, but each of the questions in my surveys and interviews serves
to address different variables. I also found that through these methods and through being
flexible with all the changes that took place during the research process, I left room for
my research question to “emerge, grow, develop, and change during the process of doing
research” (Lareau 2012: 674).

Parent and Teacher Surveys
I distributed online surveys regarding experiences and perceptions of head lice to
parents and teachers at Green Park Elementary School in Walla Walla, WA. While
interviews would have enabled me to receive in-depth answers to my questions, my time
and resources were limited so distributing surveys seemed the most appropriate method
of data collection with the parent and teacher demographic. I originally planned to collect
data from several schools in the district, but because I had to revise my proposal to the
district, my timeline was cut short. In order to determine the viable schools in Walla

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Walla, I went onto Washington State’s Office of the Superintendent of Public
Instruction’s (OSPI) website and compared the percent of students eligible for free and
reduced lunch between elementary schools. At 69.3%, Green Park Elementary seemed to
be in the middle of the pack (OSPI 2014). This was an important factor to me because I
wanted access to parents from diverse backgrounds, especially in terms of socioeconomic
status. I then spoke with Jennifer Douglas about which schools would have a wide range
of SES and again Green Park was mentioned. I also encountered obstacles with principal
communication at other schools, so I decided to collect from Green Park due, in part to
the mixed demographics of the parents at the school, and in part due to Principal Gina
Yonts’ willingness to communicate and work with me on this project. It was important to
me to sample from an elementary school with a diverse range of socioeconomic statuses
in order to see if there were patterns between parents’ SES and the stigmas they
associated with head lice. The surveys were made available in English and Spanish in
order to be accessible to a wider sample of parents. I have included copies of these
surveys in Appendix A.

Distribution of Surveys
My online Qualtrics surveys were sent out to parents and educators at Green Park
Elementary. Principal Gina Yonts sent out the link to the parent surveys in the weekly
newsletter on February 21, 2014. Gina also allowed me to open up the computer lab at
Green Park during parent-teacher conferences on February 26, 2014 and February 27,
2014 from 5pm-7pm each day. By opening up the computer lab, I was able to reach out
to parents who may not have had access to a computer at home, or who may not have

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otherwise had the time to complete the survey. These efforts only brought in a handful of
respondents, however, and I therefore consulted Michelle Janning for assistance in
distributing the surveys via email to the Green Park PTA. I also had a separate survey for
Green Park educators, which did not receive many respondents. In fact, there was only
one respondent to the educator survey, so I chose to omit this one survey and only use the
data from the parent survey respondents. There seemed to be confusion with teachers
taking the parent survey, so I decided to keep the teacher respondents in the parent
dataset. The most important questions on the educator survey were the same set of
questions on the parent survey, and therefore I do not believe the integrity of my results
are compromised by including parents and teachers in the same grouping.

Quantitative Data Analysis
I analyzed the quantitative data collected from my surveys in Qualtrics. I
originally cross-tabulated variables and ran chi-square tests on different groupings of
variables to determine if significant relationships existed between the variables. I
discovered that my sample size (n=20) did not fulfill requirements to run any meaningful
significance tests such as chi-squares, and therefore I felt that using inferential statistics
was not appropriate with my dataset. I did, however, utilize the descriptive statistics that
the results from the surveys offered. I separated the educator responses from the parent
responses in my results by filtering for only respondents who said they had a child
attending Green Park Elementary, and then using the reverse filter to look at the educator
responses. I used this filter when looking at variables specifically related to parent-child
interactions, such as whether or not parents talk with their children about head lice. Even

43

though statistically significant data could be collected from these surveys due to the small
sample size, the descriptive statistics derived from my data were still able to provide
some insight into the stigmatization of head lice, and may indicate what direction future
research on the stigmatization of head lice should take.
The findings from the surveys are presented in textual form in the results section,
as well as in tables generated by Qualtrics, Microsoft Excel, and Microsoft Word. For a
more extensive collection of these figures, refer to Appendix B.

Variables and Measurement
The survey I created includes several types of variables. I use nominal measures,
ordinal measures, and ratio measures. I structured the survey into several sections. The
first section of the survey asks parents general questions about their child’s health. In this
section, nominal measures were used to ask how often their child(ren) visit the doctor per
year, the biggest health concern they have for children in their child(ren)’s age group, and
whether or not they speak to their child(ren) about health topics (and if so, which topics).
After the surveys were completed, I coded the answers to the open response questions in
this section.
The second section of the survey contained ordinal measures that asked about
stigmas and knowledge about head lice. This was the section that was the same in both
the parent survey and the original educator survey I created. The questions themselves
were pulled directly from Kirchofer et al.'s 2001 study "Primary Grade Teachers'
Knowledge and Perceptions of Head Lice," with a few variations. I modified the response
categories to allow more accuracy in responses from parents and teachers. The answer

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categories were created using a Likert scale with answer options of “Agree” “Somewhat
Agree” “Neutral” “Somewhat Disagree” “Disagree” and “Unsure.” I think that my
amendment to Kirchofer et al.’s (2001) question set improved the accuracy of responses
because they were non-dichotomous answers that allowed for a degree of freedom for
respondents to express their opinions. I chose to use the questions from Kirchofer et al.
(2001) for several reasons. First, because I was working with Walla Walla Public Schools
to get my research approved, I felt that it would strengthen my proposal if I used
questions that other districts had approved the use of in the past. By using Kirchofer et
al.’s (2001) questions, I was also able to add some element of validity to my questions. I
knew that the measures for this section were asking what I needed them to actually ask
because I had seen how they worked for Kirchofer et al.’s (2001) own research.
The questions in this second section are split into two parts. The first set of
questions measures the stigmas typically associated with head lice. One question asks if
children with head lice came from poor families, another asks if children who have head
lice come from unclean families, and the third stigma question asks if certain ethnic
groups are more likely than others to get head lice. In the original question set, the ethnic
group stigma asked specifically about whether or not African-Americans were more
likely to have head lice. I changed this wording to be specifically about Spanish groups,
but then was asked by the district to not target one certain ethnicity, and therefore the
question become broad. These revisions demonstrate some of the challenges I faced when
creating the surveys. These challenges and other methodological limitations are discussed
later on.

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The three stigma questions measure various concepts within Goffman’s (1963)
theory of stigma. To some degree, all the stigma questions reflect the notion of tribal
stigma because they ask about family groups and ethnic groups. The questions also
involve the other two types of stigma as well. Attributing head lice to children who come
from families who are unclean measures the concept of stigma as a blemish of character
because it implies that it is a flaw of the person—their uncleanliness—that results in the
stigma. This measurement also illustrates physical deformities because uncleanliness, and
to some extent even the condition of head lice itself, is something that can be observed
and is the physical infestation of the stigma. The stigma question that asked if children
with head lice come from families who are poor also measures the attribution of a stigma
to a flaw in character. Like Kane et al.’s (2010) study in which students perceived
homeless people as having higher occurrences of head lice, measuring the stigma of
attributing head lice to someone who is poor illustrates a flaw in character “inferred from
a known record of, for example, mental disorder, imprisonment, addiction, alcoholism,
homosexuality, unemployment, suicidal attempts, and radical political behaviors”
(Goffman 1963:4).
The second set of questions that were derived from Kirchofer et al.’s (2001) study
is about the knowledge people have about head lice. These questions measure knowledge
about the biological facts on head lice—such as how they are able to move—as well as
measuring knowledge about how people can transmit head lice (from dirt? from pets?).
These questions were included to uncover if parents, who may or may not be teaching
head lice information to their children, know the facts about head lice themselves. If
parents do not have correct knowledge about head lice, it could be possible that they are

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spreading these myths about head lice to their children. A full list of these questions from
my survey is included in Appendix A, and the original questions borrowed from
Kirchofer et al.’s (2001) study are included in Appendix C.
The third section of the survey asks questions about parent interactions with
people and experiences with head lice. This section includes nominal measures that ask
where parents receive information on head lice, what they would do to treat head lice if
an occurrence of it hit their household, if they talk to their child(ren) about head lice, if
they talk about head lice with the adults at their children’s school, if they ever spoke
about head lice with their own parents, and if they have ever had head lice themselves,
have ever lived with someone who had head lice, or ever had a child with head lice.
These questions were asked to help uncover where information about head lice is being
distributed and in which interrelations between a child’s microsystem and mesosystem
are head lice discussed. By looking at the interactions, and the actions, parents take with
head lice, we can begin to link how information, which possibly leads to stigma
socialization, seeps into the child’s immediate microsystem.
The final section of the survey contains demographic questions. These measures
are a combination of nominal and ratio. This section measures for sex, language spoken
at home, household size, age, and socioeconomic status as measured by education level
and occupational prestige. Respondents were asked to list their occupation, which I then
cross-referenced with occupational prestige scores in the National Opinion Research
Center’s (2011) General Social Surveys Cumulative Codebook from 1972 to 2010. I used
these scores to get at least a broad picture of respondents’ general SES. In making sure
my SES measures were standardized throughout my research, I also used this codebook

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when cross-referencing parental occupations that were uncovered in the interviews that I
conducted with students at Walla Walla Community College. My research does not look
specifically at responses from different ethnicities, although my question about the
language spoken at home hints at it. Although I could have measured ethnicity outright,
the focus of my research is specifically on the interactions people have with others about
head lice, and what information is being spread. Therefore, the demographic questions
were not a major focus for me.

Student Interviews
My initial plan was to interview 5th and 8th grade students about their
experiences with, and perceptions about, head lice. I saw a lack of student perspective in
head lice research, and I was hoping to gain new insight into the stigmatization by
looking at the problem from the point of view of children. However, due to some
logistical issues, I was unable to interview elementary school students, so I decided to do
the next best thing: I interviewed students from Walla Walla Community College about
their experiences with head lice in childhood. What at first seemed like a limitation in my
research soon became a benefit.
While asking college students to reflect on their childhood experiences may make
room for errors in memory, it could be the case that asking adults to reflect on childhood
could, indeed, bring forth more accurate and articulate stories of the past. Gullestad
argues that these adult narrations of childhood memories “in some ways can be no less
real for being narratively (re)constructed many years later, by the adult who is no longer a
child” (2004:12). Gullestad then goes on to say that children “do not usually have enough

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experience to analyze what is happening to them” and therefore “adults can thus have the
advantage of a clearer perspective on childhood” (2004:24). When I first thought about
interviewing elementary school students, I did have worries about children’s cognitive
abilities to answer the questions that were asked. Even with questions that were simple,
would children really understand what was being asked? With the community college
students, I was more confident that the answers I was getting were as accurate as the
students could make them. While perhaps the exact stories may have been muddled along
the years, I was able to catch the “glimpses” (Gullestad 2004:23) of what their childhood
experiences with head lice were. As a result of this, I conducted four semi-structured, 1520 minute interviews with students from Walla Walla Community College.
I believe semi-structured interviews allow for flexibility in research because “in
qualitative work, it is helpful to ask a core set of questions to everyone in the sample, but
it is highly appropriate to change the interview as the research question emerges over
time” (Lareau 2012:674). I developed a set of interview questions that stayed consistent
for each student interview related to stigmas and knowledge about head lice, but there
were some variations in what follow-up questions were asked for each respondent. This
flexibility helped the conversation flow naturally and gave interviewees the opportunity
to expand on their answers.

Interview Recruitment and Location
I recruited participants for my interviews from Walla Walla Community College.
The participants came from two of Professor Susan Palmer’s Introduction to Sociology
classes. In recruiting participants, I requested that interviewees be over the age of 18 for

49

consent purposes, and preferred to interview students who were alum of Walla Walla
Public Schools. Once the students and I arranged times to have the interviews, I worked
with Walla Walla Community College to secure quiet, enclosed locations in which to
conduct my interviews. The interviews were conducted in a boardroom with a closed
door and only the interviewee and myself were present.

Qualitative Data Analysis
All interviews were recorded in a Microsoft Word Notebook file and after the
interviews, the files were encrypted and saved on in a locked folder on my passwordprotected computer. I then transcribed the interviews for analysis. I began coding my
interviews with open coding, in which “data are broken down into discrete parts, closely
examined, and compared for similarities and differences” (Strauss and Corbin 1998:102).
I then took the themes that I found in the interviews and created concept maps. I taped
paper up to my wall and connected the themes with key concepts from Bronfenbrenner’s
(1979) ecological systems theory and Goffman’s (1963) theory of stigma. After coding
and mapping out the main themes that emerged from the interviews, I went back through
the quantitative data collected from the parent and educator surveys and found
connections to the theories and themes. The quantitative results were then also added to
the concept map. These connections are explained in depth in the results section.

Addressing the Research Question
The semi-structured interviews were divided into four main question sets aimed at
answering parts of my research question. These sets were: 1) what do students know

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about head lice; 2) where did students learn about head lice; 3) what are students’ own
perceptions about head lice; and 4) demographic questions. Each set of questions had a
subset of smaller questions that were standard for each of the interviews I collected. I
only wandered from this script when I needed to ask a clarification question or needed to
ask follow-up questions to develop a deeper answer to my questions. As stated above, the
answers to these questions were recorded, transcribed, and coded for unifying themes.
The complete list of questions is included in Appendix D.

Methodological Limitations
There were several limitations with the research I conducted. The first limitation
was my sample size and location. Because I conducted my research in Walla Walla, WA,
which is a small, rural town, the sample size is relatively homogenous. The demographic
variations in Walla Walla are much different than they would be in, say, a big city such
as Seattle. For example, only 2 out of the 20 surveys collected from parents and teachers
at Green Park Elementary came from respondents who speak Spanish at home. My
interview sample had a little more diversity, with half the respondents being native
Spanish speakers. My interview sample, however, did not have diversity in terms of
experience with head lice. None of my interview participants said that they had actually
had head lice themselves, and therefore were only able to give the perspective of
“normals” (Goffman 1963:5) and not the perspective of the stigmatized. However, such a
sample can also be seen as a benefit because it is from the normal person that a stigma is
derived. If there was no normal, there would be no stigma. By looking at the individuals

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who are part of the stigma-creating group, we can get a sense of how these normal people
are socialized to believe in, and perpetuate, certain stigmas in our society.
The small sample size also posed some challenges. Due to the small number of
survey respondents, I was unable to run inferential statistical analysis between variables.
As stated previously, the chi-square tests I ran cannot be considered reliable because the
sample size does not meet minimum requirements to run the test. While the sample size
and location do seem like negative limitations, I still think some social benefit can come
from analysis of these samples. Even if results are not generalizable, we can still see
patterns that may or may not exist in larger samples.
Another limitation I faced came in the form of the protocol I had to follow in
order to conduct my research. I had to follow the guidelines of both Walla Walla Public
Schools and Whitman College’s Institutional Review Board. I think that in the
construction of my survey questions, I erred on the side of caution and tried to make my
questions as neutral and unobtrusive as possible. I think that in worrying about getting
my project approved, I may have left out questions that would have gone more in-depth
about people’s stigma about head lice. Along these lines, I also had little room to revise
my survey questions once the district, the IRB, and Green Park Elementary approved
them. Now that I have been through the process and had the time to mull over some of
the questions I ask, I definitely would have liked to ask more questions that dug deeper
into the topic of head lice. For example, I would have liked to ask parents exactly what
they tell their child(ren) about head lice, instead of just asking whether or not they do talk
to their child(ren) about head lice. My interviews do make up for some of the data I was

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unable to get from my surveys, but it would strengthen the research to have more parent
narrative.
Working with multiple groups to receive research approval also played into the
limits of time and resources I had as a researcher. Because I was working with different
timelines and had to submit multiple proposals, the amount of time I had to actually
collect my data was relatively short. I will also readily admit that quantitative data
analysis is not one of my strengths, and therefore I was limited to some extent by my
novice level of knowledge about running statistical tests. There are perhaps better, more
efficient ways to analyze the survey data I collected, but I think that the process I went
through was sufficient to complement the qualitative data I analyzed from the interviews.
There were other road bumps along the way. I’ve already mentioned the
challenges I faced with my research design, so I will not go into depth about them here.
The limitations do, however, lead to the inability to generalize about my results. Overall,
the limitations in my research served as a way for the research to adjust and evolve, and
through those limitations, I learned to find the blessings in disguise. What became
limitations in my own research may have opened new doors through which future social
scientists can explore the head lice problem.

Ethical Considerations
There were several ethical considerations to address with my methodologies.
First, because my research involved the participation of human subjects, I had to go
through the proper channels to get my research approved. This meant that I had to get my
research approved by Walla Walla Public Schools, individual school principals, Walla

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Walla Community College, and Whitman’s Institutional Review Board. I needed to
explain any possible risks my research would pose to my participants, and I needed to
address how I would set up precautions to minimize the risks my participants were
exposed to. Those risks are expanded upon below.
One possible concern with my research was the fact that head lice is a sensitive
topic. My research could have possibly had an emotional impact on the participants if
they had experienced traumatic experiences with head lice in the past. I needed to be
careful in how I constructed my surveys and interviews so as to minimize the
psychological harm that discussing head lice may have caused. I reminded participants
that participating in the research was optional, and that they did not have to answer any
questions they felt uncomfortable answering. When I conducted interviews, I paid
attention to whether or not a question I asked made a participant uneasy (as demonstrated
by body language—shifting around, hesitant to answer, watery eyes, etc.), and I was
prepared to use discretion to stop the interview, skip the question, or provide a safe
environment for the participant to share his/her reactions. I had previous training as a
peer listener at Whitman College and felt that I had the tools necessary to be attentive to
peoples’ emotional states.
In terms of the online survey distribution, there may have been ethical concern
over the use of the computer lab. Because the lab was a semi-public environment, I had to
take precautions to minimize the influence the setting might have had on respondents’
answers. I did not have surveys opened on survey computer, and space the survey stations
so that only the respondents themselves could see their answers. This meant that no
stations were open right next to each other, and the computer screens were not faced in a

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direction that others could see the answers. I also tried to minimize the influence a
researcher may have on respondents. My presence may have made respondents feel like
they were being watched, so I made sure not to place myself in the computer lab while
respondents were actively taking the surveys. This also protected me from knowing who
actually completed surveys, thus preserving the anonymity of my survey respondents.
Other ethical considerations included researcher bias, confidentiality, and
concerns about what the research would be used for. I aimed to be as objective as
possible in this research. This meant that I remained aware of my position as a researcher
and tried to not let my own perceptions and attitudes toward head lice color the
interviews I had with participants. I let the interviewees tell their own stories and
attitudes, and then we debriefed and discussed head lice more informally after the
interviews had finished. I also tried to keep the wording of my surveys as neutral as
possible, so as not to sway respondents into answering one way or another. I believe that
as someone who is inexperienced with head lice, I am in a position in which my own
emotional experiences did not interfere with the research I conducted, which helped me
approach the topic with an open mind. However, this outside perspective also limited me
in terms of sympathy. Because I myself have never experienced head lice, I would not be
able to offer the same level of comfort and sympathy to respondents as someone who had
a experience with it in the past would be able to.
In terms of confidentiality, any information gathered from participants, as well as
any data collected from the school district, remained confidential, which I was especially
diligent about considering the sensitive nature of my topic. The surveys I sent to parents
and teachers were anonymous, and any papers related to these surveys were kept locked

55

in my senior locker in the library. Any files containing data from these surveys were
saved as encrypted files, stored in encrypted folders on my password-protected computer.
The interviews I conducted were confidential and papers were also kept locked in a
locker. When traveling to and from the interview location, the papers were stored in a
sealed envelope in my closed backpack. I also stored the recordings from the interviews
as encrypted files in encrypted folders on my password-protected computer. The only
people who had access to the raw data I collected were my thesis chair and committee.
Finally, I needed to address concerns about how this research would be used. Primarily,
the research serves as my thesis, which will allow me to satisfy graduation requirements
for Whitman College. Hopefully, however, my research also serves as a useful tool for
the school district and Walla Walla community to understand the stigmas that exist
surrounding head lice, as well as what knowledge is circulating among parents and school
officials and trickling down to students. This research will hopefully provide a wellrounded picture about the various perceptions and misperceptions about head lice and
will enable schools to develop educational programs and curriculum that can combat
these stigmas.

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RESULTS
Participant Demographics
The sample size for my research was very small. In all, I collected 20 combined
surveys from teachers and parents (n=20). Of these, four of the respondents were
educators, including one paraeducator—a school employee who provides instructional
support to teachers. Of the educators, three said that English was the main language
spoken at home and one said that Spanish was the main language spoken at home. The
educator sample consisted of three female respondents and one male respondent. The
other 16 responses came from parents of students at Green Park Elementary. Of the
parent respondents, 13 said that English was the main language spoken at home and two
said that Spanish was the main language spoken at home. The parent sample consisted of
18 female respondents and two male respondents.
The sample size of my interview pool was also small. I was able to complete
interviews with four students at Walla Walla Community College (n=4). Of these
respondents, two said that English was the primary language spoken at home while
growing up, and two said that Spanish was the primary language. The interview sample
consisted of three male participants and one female participant. While it was my aim to
conduct interviews with Walla Walla Community College Students who had been
through the Walla Walla Public Schools, two of my participants came from schools
outside of the district—one from College Place, Washington and one from schools in
Arizona. I made the decision to include these two interviews in my data because, while
we cannot draw any conclusions about Walla Walla per se from such data, we can see

57

patterns that are consistent across region and therefore strengthen the data that comes
from the students who grew up in Walla Walla. All of the interview participants came
from working-class backgrounds, which was determined by cross-referencing the
interviewee’s parents’ jobs with the occupational prestige scores in the General Social
Surveys Cumulative Codebook from 1972 to 2010 (National Opinion Research Center
2011).

Infestation of Themes
Three overarching themes emerged from the four interviews that were conducted,
and the data collected from the surveys serve to expound on these findings. The first
theme emerged from the communication about head lice in both the microsystem and
mesosystem. The second theme was the result of interactions on the playgrounds at
schools and in peer relationships in general. The final theme emerged out of a common
set of misunderstandings that participants had about head lice. These themes are
interconnected and are the results of the interplay between stigma and ecological systems.

The Power of (No) Words
Parent-child interactions
In Bronfenbrenner’s (1979) ecological systems theory, interactions between
individuals and people in their microsystems shape individuals’ development. Likewise,
looking at these interactions can help us understand where stigmas about head lice
develop and how individuals are socialized to the stigmas. The parent-child relationship
is a dyadic relationship in which the balance of power is tilted towards the parent, which

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“provides the opportunity for learning both to conceptualize and to cope with differential
power relations” (Bronfenbrenner 1979:57). In other words, the power difference
between a parent and a child teaches the child certain norms about interacting with
authority figures—such as listening and obeying these authorities. In the case of head
lice, this could mean the child is more influenced by what the parent has to say. However,
as the interviews uncovered, what a parent doesn’t say can be just as influential as what a
parent does say.
Throughout the interviews, participants were asked to reflect on their childhood
experiences with head lice. When I asked if their parents ever talked to them about head
lice, the responses were varied, but shared a common thread. Students reported that, in
the cases where parents talked about head lice with their children, the information was
minimal. One interviewee said that his parents didn’t speak with him about head lice at
all. The other participants said that parental discussions about head lice were always
prompted by specific events, such as schools sending home letters or news of other
students with head lice:
They talked about if like one of the kids had it, like if one of my friends or one of
the students had it, they were like “you should avoid them at all cost” type of
thing so that you don’t get it, like if they wear a hat or something you shouldn’t
wear it.
This response is demonstrative of how parents can socialize their children to have the
same perceptions and beliefs about head lice as them. By telling their child to “avoid
them [children who have head lice] at all cost,” the parents are teaching their child not to
associate with a group of people who have an undesirable attribute—a stigma. According
to the interviewees, the parents do not want their child in contact with the stigmatized.

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The parent survey tried to uncover any link between parent-child communication
and parents’ stigma. While my own dataset was too small to find any statistically
significant relationship between the variables of parent-child communication and parents’
own belief in certain head lice stigmas, and therefore running inferential statistics such as
the chi-square would not have been appropriate, there were still interesting small patterns
in the descriptive statistics that should be discussed. One interesting finding is that all of
the parents who don’t speak to their child(ren) about head lice said that they disagree
with all of the stigma questions, which means that some parents who speak to their
children about head lice do agree with certain stigmas. This is illustrated in Table 1.

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Table 1. Stigma Questions and Parent-Child Communication

Most children who
have head lice come
from poor families

Most children who
have head lice come
from families who are
not clean

Certain ethnic groups
are more likely than
others to get head lice

Agree

Do you talk about head lice with
your child(ren)?
Yes
No
0
0

Total
0

Somewhat
Agree
Neutral

2

0

2

2

0

2

Somewhat
disagree
Disagree

1

0

1

7

3

10

Not Sure

1

0

1

Total
Agree

13
3

3
0

16
3

Somewhat
Agree
Neutral

1

0

1

1

0

1

Somewhat
disagree
Disagree

1

0

1

6

3

9

Not Sure

1

0

1

Total
Agree

13
0

3
0

16
0

Somewhat
Agree
Neutral

1

0

1

2

0

2

Somewhat
disagree
Disagree

0

0

0

9

3

12

Not Sure

1

0

1

Total

13

3

16

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When looking at parent-child communication about head lice, it is also important
to consider the content that is being discussed. As illustrated in Table 1, parents do
sometimes agree with certain stigmas attached to head lice, and some parents do speak
with their child(ren) about head lice. Once these two facts are established, it becomes
important to uncover what information about head lice is being transmitted to children
from their parents. When interviewees responded that their parents did talk to them about
head lice when they were kids, I then asked what their parents talked about. The
responses were varied. One participant reflected on the information her mom gave her
about head lice:
That’s where I learned that you pretty much have to clean everything in your
house. My mom was really the one who taught me about it, more so than in school.
I just remember her mentioning how she thought it was pretty contagious and so
you just had to really sanitize everything in the house…just the sanitizing of it, we
didn’t talk about the biology of it at all, unfortunately.
Another student responded that his parents spoke about head lice as a joke, that “they
would just joke with us, like if we scratched our head, they would just make fun like ‘you
probably have head lice or something’ but no, other than that…”
The two narratives illustrate that the parents did not discuss the biological
information about head lice, such as how head lice are actually transmitted. The first
narrative points at a reactive approach to discussions of head lice—what actions to take
once head lice is contracted. The second narrative uncovers an even more problematic
approach to head lice—by joking about head lice, the parents have taught their child that
head lice is a condition you can tease people about. Boskin and Dorison (1985) discuss
humor as a tool to exert power in society in their work that looks specifically at ethnic
humor. They quote Thomas Hobbes’ idea that “the passion of laughter, he sensed, was

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nothing more than the proclaiming of ‘some eminency in ourselves by comparison with
the infirmity of others’…” (Boskin and Dorison 1985:81). In the case of using humor
with head lice, parents are trying to separate themselves from a group of people who are
seen as stigmatized. This helps perpetuate stigmas because as Goffman states, when it
comes the formation of a stigma, “it should be seen that a language of relationships, not
attributes, is really needed” (1963:3). Because parents are joking about head lice and
creating a distance between not having head lice and having head lice, a stigma is born—
and it is being socialized to children from these interactions with their parents.

Teacher-student interactions
Another important relationship in a child’s microsystem is the relationship they
have with teachers and school staff. According to Ballantine and Hammack (2012), one
of the five main functions of education is socialization, in which “children learn the rights
and wrongs, values, and role expectations of the society into which they are born. In
learning their role, children are socialized, or taught, how to meet the expectations placed
on them” (2012:29). Schools are a socializing agent in our society, and it is within these
walls that children become socialized to norms and therefore are also introduced to
stigmas. Goffman agrees that schools are a powerful socializing setting, that “public
school entrance is often reported as the occasion of stigma learning” (1963:33).
Just as there was a lack of communication about head lice between parents and
their children, there was also a lack of communication about it between students and
teachers. When I asked the interviewees if they remembered learning about head lice
from their teachers, none of the participants recalled their own teachers discussing head

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lice in class. When teachers mentioned it at all, it was either just sending a letter about
head lice home to parents or having students go to the nurse for routine head lice checks.
Students said that they received no formal instruction from their teachers about head lice.
Aside from teachers, school nurses also play a big role in interacting with students
about head lice. The interviewees reported that they remembered being sent to the school
nurse at least once or twice a year for head lice checks. When I asked students if they
spoke to the nurse about head lice during these checks, one student recalled:
I think we just sat there and she ran like…I think it was like a long q-tip kind of
looking thing through our hair. Other than that it was just like one kid, like an
assembly line kind of…you know, ‘kid and then out, kid and then out.’ We didn’t
really talk to hear about it.
Other respondents recalled similar experiences where they would go get checked for head
lice, and then be sent back to class without being given information about head lice.
Because of the confusion between the educator surveys and the parent surveys, I
was unable to gather data about the teacher-student communication from the perspective
of educators. However, it could be important to look at what stigmas some teachers might
hold. If teachers do subscribe to stigmas surrounding head lice, and they do speak with
students about head lice, it could be the case that they are accidentally socializing
students to the stigmas. While my data does not reflect whether or not teachers speak
with their students about head lice, it does show that some teachers do agree with some
stigmas. This might suggest that schools need to better educate teachers about conditions
such as head lice to standardize what information students are receiving—and to ensure
this information is accurate. Educator responses to certain stigmas associated with head
lice are displayed below in Table 2.

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Table 2. Educator Responses to Stigma Questions
Table 2.1: Educator responses to “Most children who have head lice come from poor
families”
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
0
1
0
1
2
0
4

Table 2.2: Educator responses to “Most children who have head lice come from families
who are not clean”
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
1
0
1
0
2
0
4

Table 2.3: Educator responses to “Certain ethnic groups are more likely than others to get
head lice”
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
0
0
1
1
2
0
4

As these tables illustrate, there is a range of opinions about these stigmas between
the four educators who took my survey. Although with only four educator responses, the
sample is too small to make any sweeping generalizations, the fact that there were such a

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variety of responses among the educators may indicate some degree of difference in
knowledge about head lice among educators.
While it’s important to note that these findings should be taken with a grain of
salt, the findings may also highlight a phenomenon that is overlooked by schools. School
policy on head lice has changed over the last decade, as demonstrated by changes to
Washington State’s Infectious Disease Control Guide for School Staff. However, if
nurses and teachers are still not capitalizing on opportunities to teach students the facts
about head lice, they are missing out on opportunities to dispel head lice myths—which
might be the only information that children are receiving if the schools are not stepping
up and teaching students about head lice.

Parent-teacher interactions
Stepping out of the microsystem and looking at the mesosystem, communication
between parents and teachers may also help explain how children are socialized to
stigmas associated with head lice. Again due to issues with collecting data from the
educator-specific survey, I can only look at the parent-teacher communication from the
perspective of the parents. When asked on the survey if they speak with adults at their
child(ren)’s school about head lice, only five parents said that they do, versus the 11
parents who do not speak about head lice with adults at their child(ren)’s. Interestingly,
the results for the stigma question that asked parents’ opinion on the stigma “most
children come from families who are poor,” showed that the only respondents who
agreed with this stigma were parents who also said that they speak with the adults at their
child(ren)’s school about head lice. This is illustrated in Table 3.

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Table 3. Parent-Teacher Communication and Stigma

Most children who
have head lice come
from poor families

Agree

Do you talk about head lice with
adults at your child(ren)’s school?
Yes
No
0
0

Total
0

Somewhat
Agree
Neutral

2

0

2

0

2

2

Somewhat
disagree
Disagree

0

1

1

2

8

10

Not Sure

1

0

1

Total

5

11

16

As shown in the section about teacher-student communication, teachers did report
agreeing with some of the head lice stigmas. While no statistical significance can be
pulled from this data, these findings may hint at a larger pattern of communication
between parents and teachers—a pattern in which stigmas may be transmitted from
teachers to parents, and vice versa.

The “Cootie” Concept: School Socialization
Student-peer interactions
Teachers and staff are not the only people who help socialize students to stigmas
in school. Students spend a significant portion of their days interacting with peers.
Bronfenbrenner discusses how peer influence increases as children age, and the influence
of adults begins to diminish. According to Bronfenbrenner, “the exposure of the child to
group experience with peers tends, at least in contemporary American society, to
undermine socialization efforts of adults and tend to invite the emergence of egocentrism,
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aggression, and antisocial behavior” (1979:194). So even if adults are trying to socialize
children to belief certain stigmas, interactions with peers may be countering these efforts.
If parents and teachers are not speaking to students about head lice, or if the information
they are providing is very minimal, where else could individuals learn about head lice?
As my interviews explored, there does appear to exist a peer influence in terms of
attitudes towards head lice.
When I asked students if they remembered speaking to peers about head lice, one
theme cropped up in almost every response. Whenever students mentioned head lice
interactions with peers, the word “cooties” appeared:
People always thought ‘oh it’s gross! It’s gross!’ and yeah, it was kind of a scary
thing for people. We just really felt like it was…I don’t know a lot about it, but I
do know that when you’re younger, you look at these things as more ‘my
goodness, you have cooties’ and it’s a horrible, horrible thing. I don’t know how I
would look at it now if I studied it more, but it’s not going to kill you. When
you’re younger, you think that about stuff. You think that it’s really going to be
an awful, awful thing.
Another student reflected:
Because back then they were like ‘ooo it’s some kind of cootie if you have it in
your hair’ it’s like a transmitted cootie kind of thing….I think they were just
saying if someone had head lice or something like that, they called it cooties then,
but they were saying that we should avoid the kid so we don’t get it type of thing.
In these interactions, children were taught by their peers to associate head lice with an
attribute that was undesirable to have—a stigma. This narrative illustrates the
consequences of peers connecting head lice with “cooties.” If a child were to have head
lice, the other students would avoid the stigmatized student. Head lice was turned into a
way of ostracizing other peers, and tool to exert power on the playground. Children
turned the word “head lice” into a game: “But they were just using that just as a, kind of
like a game. Like if they said ‘oh, someone has head lice’ they’d just run away from them

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type of thing…” In these games, avoidance and social isolation were the results, “if
someone didn’t shower that day, they’d probably make fun of them and then walk away,
try to get away from them, like ‘oh you probably have head lice’…”
These tales from the playground show a dark side to peer groups. Because
children are increasingly influenced by their peers, calling head lice “cooties” and using
head lice as a way to isolated certain students from the larger group socializes students to
see head lice as a condition that is stigmatized—a condition that creates an “us vs. them”
mentality. As Bronfenbrenner (1979) suggests, these peer influences lead to aggression
towards the stigmatized. When a student is called out by his or her peers for having head
lice—or for appearing to have it—feelings of embarrassment ensue.
When asked how they would feel if their peers found out that they had head lice,
my interviewees responded with resounding tones of embarrassment and fear of isolation:
I’d be so embarrassed. I would be so embarrassed. Again, it’s because of the
whole stigma that people have in this society about you know, just, when you’re a
certain age, I think your self-esteem and self-image are more prevalent and you
care more about what other people think, and so when you’re in school and you’re
young, I would be very embarrassed.
Another student recalled:
If they knew about it, they would kind of leave you alone, kind of desert you—
you wouldn’t have any friends type of thing. Which is kind of sad because a lot of
people did that. They used it as a way to single out kids, so they wouldn’t have as
much friends.
This fear of social isolation could lead to students trying to conceal the stigma. One
student explained that he would try to hide having head lice “because when you were a
kid, people would make fun of you, so I would try to hide it.” Some parents, too, said that
they would try to hide the head lice. From the survey, three parents said that if their child
contracted head lice, they would not tell anyone outside of the home about it.

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Concealing a stigma is one reaction the stigmatized have to their condition.
Goffman (1963) discusses what occurs in situations of mixed contact, when the
stigmatized is place in the same situation as the normal. According to Goffman, “during
mixed contacts, the stigmatized individual is likely to feel that he is ‘on,’ having to be
self-conscious and calculating about the impression he is making” (1963:14). For the
students, fear of having their stigma uncovered by their peers results in this desire to
cover-up the stigma. Head lice is a fairly concealable stigma because unless the case of
head lice is severe, the lice themselves are small and hard to see without close inspection.
However, head lice is also a “discreditable stigma” (Goffman 1963:4), meaning that peers
may not immediately know or uncover that a student has head lice, but there is potential
for them to find out that the student has the condition. As demonstrated in the narratives,
children tease other children for having head lice and these stigmatized students become
stigmatized, social outcasts. Therefore, hiding the condition seems the best way to
preserve one’s status as a normal.

What’s the Dirt? Patterns of Misinformation about Head Lice
The third theme that appeared throughout both the surveys and interviews
revolved around the language people used to talk about head lice and the information
they believed to be true. By looking at the broad sets of misinformation people have
about head lice and looking at the connection between groups’ knowledge, we can start to
unravel how head lice information circulates.

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The semantics of head lice
Throughout the interviews I conducted, I heard an array of language used to
describe head lice. When asked if they knew what head lice are, the common answer was
“little white bugs.” However, the physical description of head lice was the extent of their
accurate knowledge about head lice. From there, the students talked about the various
ways they believed that people can contract head lice. One student compared head lice to
chickenpox:
I think it’s kind of the same as chicken pox. If people are exposed to someone
who has the active illness going on, then they can definitely pick it up, so it’s
definitely being exposed to someone. I don’t know. I think it’s airborne, but I’m
not for sure.
This student was not the only one to struggle with understanding how head lice are
contracted. Another student admitted “I don’t think you’re born with it, I don’t think it’s
genetic. I don’t know where...” This stream of consciousness reveals that even when
students do not know what causes a person to get head lice, the first thoughts that come to
mind are to attribute the condition to an illness or to inborn characteristics. If students are
conceptualizing head lice as a condition that some people are more pre-determined to get,
this could strengthen the stigmas surrounding of head lice. People might be more likely to
see head lice as a condition that only certain types of people get, and therefore reinforce
Goffman’s idea that stigma is attributed to a perceived flaw in character or a bodily
blemish.
These narratives illustrate the difficulties people have thinking through where
head lice come from. As their thought processes were revealed, they uncovered the
thought that head lice has medical roots. The word “illness” was used in associated with
head lice several times throughout the interviews. Students talked about how if they had

71

head lice, they would go visit the doctor and get medication. One student even put head
lice in the same category as impetigo, which is a very contagious skin infection. By
perceiving head lice as a medical condition, which as a reminder refers to a condition that
is a physical ailment of the body and may need the attention of a medical professional,
students demonstrate the belief that the condition is more serious than it actually is. When
individuals speak about head lice in these terms, the people they interact with could then
be influenced to think about head lice as an “illness” and therefore perpetuate
misinformation about the condition.

Fact or fiction
Students were not the only ones to believe false information about head lice.
Parents, and even educators, struggled in content knowledge about head lice. The biggest
misunderstanding parents had about head lice revolves around where and how head lice
are contracted. According to the surveys I collected, eight parents believed that head lice
can fly, jump, or hop. This means that at least eight parents did not demonstrate that they
have the basic understanding about the biology of head lice. Further, 13 parents
incorrectly believe that school is where most children contract head lice. There was no
statistically significant relationship found between these knowledge questions and
whether or not parents speak to their children about head lice (p>.05). However, because
the majority of the parents answered these knowledge questions incorrectly, it could be a
red flag for schools. Parents, who serve as an important socializer in children’s
microsystems, need to have the correct knowledge about head lice. If they themselves do
not actually know the facts, what information do they pass onto their children? By

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looking at the areas in which parents lack knowledge about head lice, we can see that
there does exist a gap in the information parents actually know about head lice—which
could then be transmitted to students.

The Hygiene Problem
The final area in which knowledge was insufficient between parents and students
alike had to do with belief in the connection between hygiene and head lice. Feldmeier
and Heukelbach (2009) argue that low-income countries have the highest morbidity rates
of conditions such as head lice due to the types of environments these parasites thrive in.
Low-income areas tend to be full of people, and therefore full of hosts. However, people
tend to misunderstand why head lice thrive in such conditions. When telling the story of a
friend’s child who had recently caught head lice, one interviewee explained:
They were visiting some friends and family, and they went to an area where I
think there was a lot of homeless people and stuff, and she just interacted with
some of the kids down there and she caught it.
This narrative aligns with Kane et al.’s (2010) finding that people associate higher head
lice occurrence with homeless populations. Such a response also shows Goffman’s
(1963) idea of a tribal stigma, where certain groups, such as the homeless, are seen as
more likely to have a certain stigmatized attribute. When asked where people pick up
head lice, the student responded by saying “the dirtier their environment is, they could be
more susceptible to it.”
Other students spoke about hygiene in terms of washing their hair. Even when
students said that they didn’t think washing their hair protected them from head lice, they
would later make comments in their interviews about a relationship between having head

73

lice and having poor hygiene. One student, who had previously said that they didn’t
believe washing their hair protected them from head lice, mentioned that the kids who got
head lice “seemed to be the kids where their hygiene wasn’t as good as other kids.”
Another interviewee got caught up in contradiction as well. The student, despite
admitting that he had read some facts about head lice dispelling this myth, said that he
believed people who didn’t shower as much were the ones who got head lice. So even
though he was given information to help stop the spread of misinformation, he stuck with
his belief in a stigma.
Hygiene was also a hot topic for parents. On the surveys, I asked parents to list
what health topics they discuss with their children. The responses were coded into six
categories: germs and illness, hygiene, healthy eating, exercise, body awareness, and
general health. The top two topics discussed were hygiene and healthy eating, with nine
parents saying that they talked about each. The question that is not answered, however, is
whether or not parents include head lice in the category of “hygiene.” Similar to how
school nurses sometimes report head lice under hygiene, perhaps parents, too, view head
lice as a hygienic problem. Further research should be done to clarify what parents
include under the category of hygiene.

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CONCLUSION
What stigmas exist in our society about head lice? Where do these stigmas
originate from? How are people socialized to the stigmas? My research attempted to
provide a snapshot into possible answers to these questions. By focusing specifically on
Bronfenbrenner’s (1979) microsystems and mesosystems, I was able to collect data
related to the interactions people have within these ecological systems. Through these
interactions, certain stigmas related to head lice were teased out and individual’s head
lice knowledge gap was exposed. Through the ecological systems, we are able to discuss
possible social relations and networks through which stigma is transmitted in our society.

Generalizability and Implications
While the results of my results are not generalizable, the discussion that came out
of the study provides insight into some possibilities about what might be feeding and
driving the stigmatization of head lice. Neither my surveys nor my interviews had
representative samples. However, patterns that emerged between the two provide a
foundation with which future research can—and should—be done to try to understand
why head lice is stigmatized in our society.
It is in the wide range of answers that I received on my survey questions that we
can actually find strength with my research. Even in chaotic, varied results we learn
something. In the case of head lice, the spread of answers about stigmas and factual
knowledge from parents (and a few educators) illustrates that perhaps one reason the
stigma exists is because there is so much disagreement and misunderstanding about the

75

condition. Without a standardized head lice curriculum, people are exposed and
socialized to knowledge about head lice in a variety of fragmented ways. As
Bronfenbrenner (1979) suggests, what is being taught at home may not be what is being
taught at school. To this end, parents and teachers need to be communicating and trying
to get on the same page—and they need to make sure they are on the correct page.
My research yielded mixed results in terms of where students talked and learned
about head lice. Some parents talk with their students about it, some don’t. For the most
part, teachers do not communicate with their students about head lice. Even school
nurses, at least in the past, didn’t talk with students about head lice. For some students,
this means that the only place they are learning about head lice is on the playground. In
other words, they are learning about head lice from students with a wide range of
knowledge about head lice themselves, and what is fact becomes jumbled in with what is
agreed upon as true on the playground.
So what stigmas about head lice exist? Well, it depends on the individual. Some
people believe that head lice are more prevalent in poor populations. Other people believe
that head lice afflicts those with bad hygiene. Still others believe that your ethnic group
influences your susceptibility to head lice. Some people think head lice can fly. Others
believe that you can get it from the dirt or the air. As this list continues, I begin to wonder
if out of this confusion, out of this chaos, we can see order. Maybe, just maybe, these
stigmas exist because there is no iron fist pounding down the mistruths and properly
socializing people to what head lice actually is.
And, how are these stigmas being transmitted to individuals? In the spirit of
Bronfenbrenner (1979), it is perhaps all of the ecological systems working together that

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produces an individual’s set of stigmas about head lice. From the information parents and
teachers share (and don’t share) with one another to the parent-child discussions about
hygiene to the joking about head lice with other children on the playground, our beliefs
and knowledge are shaped, and continuously evolved, by these interactions. My research
does not uncover where the stigmas stem from, however. Where did they begin? What is
it about head lice that makes people react with the fear that they do? Why, when I showed
the students a picture of head lice, did the words “fear,” “surprise,” and “eerie,” emerge?
Future research should look into the macrosystemic factors that may also be feeding into
the stigmatization of head lice. What is happening in Bronfenbrenner’s (1979) exosystem
and macrosystem? How might values in our society perpetuate negative responses to
head lice? By taking the step to look at microsystemic interactions, we begin to unravel to
complicated web that is the stigmatization of head lice.

Future Research
My research is just a nit in a whole universe of head lice research that is waiting
to be discovered. As discussed in my limitations section, I was relatively limited as a
researcher. I did not have nearly enough time to collect all the data I would have liked to,
and I faced obstacles in the form of research proposals that prevented me from collecting
certain types of data. However, future research could be done to expand upon my study.
One such area of research would be to look at students and parents who come from the
same families and look at how their interactions shape stigmas about head lice. Because
students and parents in my own research were not immediately connected, it was a little
more challenging to connect parent responses with the interviews I conducted. However,

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general themes emerged from both and I think these could be looked at more closely
from case studies of entire families.
Along those family lines, future research could look at family structure itself and
see if certain family types are more likely than others to transmit stigmas about head lice.
My surveys assumed that the people responding were parents of students at Green Park
Elementary. I recognize the limitations in such an assumption, as some children are not
raised by their parents. Some students are raised by grandparents, aunts, uncles, foster
parents, siblings, and so forth, and my research does not distinguish these types of
familial structures.
Another angle at which to study the stigmatization of head lice would be to look
at different regions and compare socialization to the stigmas in these regions. Are
children in urban areas socialized to head lice differently than children in rural towns? Do
states in the Northwest have different stigmas about head lice than states in the South?
Looking at different types of settings is something Bronfenbrenner (1979) would urge,
and it would allow for a better understanding on the generalizability of how people are
socialized to stigmas.
Finally, more research could be done to look at the exosystem and macrosystem.
My own research does not focus on cultural group differences in the socialization of
stigmas, but perhaps different cultures transmitted stigmas in different ways—and
perhaps different cultures have different head lice stigmas entirely. Research could also
look into how mass media and big corporations, such as pharmaceutical companies,
contribute to the transmission of stigma. It might also be worthwhile to study head lice

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stigmatization in terms of broader social values, particularly values of cleanliness, and
how Foucault’s notions of the docile body play into why head lice might be stigmatized.

Final Thoughts
What at first appears to be a topic entirely removed from sociology, head lice is
actually infested in the structures and interactions in our society. Stigmas about head lice
influence the ways in which we interact with our parents, our peers, and our teachers.
How we learn about head lice, and how we react to it, is shaped every day by our
interactions in the social world. We are constantly trying to make sense of the world we
live in, and stigmas help us do that. We try to understand others’ differentness and in
doing so, construct our “stigma-theory, an ideology to explain his inferiority” (Goffman
1963:5). Stigma construction is a part of our every day interactions, and by looking at one
specific attribute that is stigmatized, we can begin to understand why we believe the
stigmas that we do—even when, in the face of science and facts, the stigma should not
exist. Head lice is important to study because we have made it important—we, as social
actors, are the infestation of stigma.

79

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Consequences of Population Health for Economics Performance.” Pp. 21-39 in
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Bennett, Sara. 2008. “Alternative Approaches to Extending Health Services to the
Poorest.” Pp. 117-133 in Health, Economic Development, and Household
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Burgess, Ian, Richard J. Pollack, and David Taplin. 2003. Cutting Through the
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Case, Ryan. 2014. “The Feud.” Modern Family. American Broadcasting Company.
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Gur, Itzhak, and Ronald Schneeweiss. 2009. “Head Lice Treatment and School Policies
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Gullestad, Marianne. 2004. “Imagined Childhoods: Modernity, Self and Childhood in
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Kirchofer, Gregg M., James H. Price, and Susan K. Telljohann. 2001. “Primary Grade
Teachers’ Knowledge and Perceptions of Head Lice.” Journal of School Health
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Parison, Julie C., Richard Speare, and Deon V. Canyon. 2013. “Head Lice: The Feelings
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Pollack, Richard J., Anthony Kiszewski, and Andrew Spielman. 2000. “Overdiagnosis
and Consequent Mismanagement of Head Louse Infestations in North America.”
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Scambler, Graham. 2009. “Health-Related Stigma.” Sociology of Health & Illness
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Psychology, Health and Medicine 11: 307–34.

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APPENDIX A:
Survey Questions
In this appendix, you will find a copy of the online survey parents and educators from
Green Park Elementary took. Due to participant confusion about the surveys, I have
excluded the separate educator version of the survey. All of the educator data included in
my results came from Green Park Elementary educators who filled out the parent version
of the survey. Respondents had the option to take this survey in either English or Spanish,
and both versions are included in this section.

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WWPS Parent Head Lice Survey
Dear Participants,
Thank you for choosing to participate in my study. Please read the information below. If
you understand and agree to it, then please sign below. Let the researcher know if you
have any questions about the information provided.
Who is the researcher? Stefani Paladino, a senior in the Department of Sociology at
Whitman College, is conducting this study for her senior thesis.
What is the goal of this research? This study is about the stigmatization of head lice and
how these stigmas are transmitted and perpetuated through various interactions. The
Institutional Review Board of Whitman College (a committee that protects research
participants’ rights) approved this project. The information collected from this researcher
will enable the researcher to write her senior thesis and complete her graduation
requirement.
What does participation involve? You will need to fill out an online survey that will take
from 5-10 minutes. The questions are about your experiences with head lice, and some
questions are personal.
Is it voluntary and confidential? Participation in this study is completely voluntary. There
is no penalty if you choose not to participate, if you stop participating, if you choose not
to answer certain questions, or if you withdraw the information you gave. Your answers
are completely confidential and anonymous. You will not be asked to submit your name
with your online survey, and access to your responses will only be granted to the
professors on my thesis committee and myself.
What are the benefits and risks? Your participation may help us better understand the
stigmatization of head lice. There are some minimal risks to you as a participant. You
may feel uncomfortable answering questions about yourself or about situations that
occurred in your past. However, most people find these questions easy to answer. If a
question makes you feel uncomfortable, you may skip it. You may also end the survey at
any point.
What if I have questions or concerns? If you have questions about the study or your rights
as a participant, then please contact Stefani Paladino at Whitman College, 280 Boyer
Ave, Walla Walla, WA 99362, phone: 253-880-4759, email: [email protected] If
you have concerns about this research, you may either contact Professor Michelle
Janning at [email protected], phone: 509-527-4952, or write to the Chairperson of
the Whitman College Institutional Review Board ([email protected]; 345 Boyer Ave.,
Walla Walla, WA 99362).

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If you complete the survey, then you agree that you understand the information above,
agree that you are over the age of 18, and you agree to participate in the research. If you
are ready and willing to participate in the research, please continue forward with the
survey.
The following questions will ask you about the general health of your students. Answer
the following questions to the best of your ability.
Q1 How often does your child visit his/her medical provider each year? (Answer in
number of visits per year)
Q2 What do you think is the biggest health concern for children in your child's age
group?
Q3 Do you talk about health with your child?
 Yes
 No
Q4 If you answered "Yes" to the previous question, what specific health topics do you
discuss with your child? (Skip if you answered "No" to the previous question)
For each of the following questions, please answer the degree to which you agree or
disagree with these statements by selecting “Agree,” “Somewhat Agree,” “Neutral,”
“Somewhat Disagree,” “Disagree,” or “Not sure.”
Q5 Most children who have head lice come from poor families.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure
Q6 Most children who have head lice come from families who are not clean.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure

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Q7 Certain ethnic groups are more likely than others to get head lice.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure
Q8 Anyone who comes into contact with a person infested with head lice should be
treated.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure
Q9 You can get head lice from your pets.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure
Q10 You can get head lice (nits) from dirt.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure
Q11 Children usually get head lice at school.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure

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Q12 The best treatment for head lice is over-the-counter insecticide shampoo.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure
Q13 It’s easy to contract head lice because they are able to fly, jump, or hop.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure
Q14 Head lice are a greater problem today than they were 25 years ago.
 Agree
 Somewhat Agree
 Neutral
 Somewhat Disagree
 Disagree
 Not sure
For each of the following questions, please select all the options that apply to you.
Q15 Where do you receive information about head lice?
 School nurse
 Child's teacher
 General media (radio, television, etc.)
 Child’s medical care provider
 Internet
 Newspaper
 I have not received instructional information about head lice
 Other ____________________

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Q16 If you found out that your child had head lice, what action would you take?
 Visit a medical-care provider
 Clean your house
 Keep your child out of school
 Buy lice-killing shampoo
 Educate yourself on the latest head lice research
 Get tips from other families who you know have also dealt with head lice
 Take care of the head lice without telling anyone outside of your home
 Other ____________________
The following questions ask you about your general experience with head lice. If you are
not comfortable answering a question, you may skip it. As a reminder, all answers are
kept confidential and will not be released to the public.
Q17 Have you ever had head lice?
 Yes
 No
Q18 Have you ever lived with anybody who has had head lice?
 Yes
 No
Q19 Have any of your children ever had head lice?
 Yes
 No
Q20 Do you talk about head lice with your child(ren)?
 Yes
 No
Q21 Did your parents ever talk about head lice with you?
 Yes
 No
Q22 Do you talk about head lice with adults at your child’s school?
 Yes
 No
The following questions ask about your personal information. None of your individual
information will be disclosed.

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Q23 What is your sex?
 Male
 Female
Q24 How old are you?
Q25 How many people (including yourself) live in your household?
 1
 2
 3
 4
 5
 6
 7
 8
 9
 10
 Prefer not to answer
Q26 What is the main language spoken at home?
Q27 Do you have a paid job?
 Yes
 No
Q28 If you answered "Yes" to the previous question, what is your occupation? (Skip if
you answered "No" to the previous question)
Q29 Do any other adults in your household have a job?
 Yes
 No
 There are no other adults in my household
Q30 If you answered "Yes" to the previous question, what jobs do these adults have?
(Skip if you answered "No" or "There are no other adults in my household" to the
previous question)
Q31 How many children do you have?
Q32 How old are your children?

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Q33 What school(s) do your children attend? Select all that apply.
 Berney Elementary
 Blue Ridge Elementary
 Edison Elementary
 Green Park Elementary
 Prospect Point Elementary
 Sharpstein Elementary
 Garrison Middle School
 Pioneer Middle School
 Lincoln High School
 Walla Walla High School
 Other ____________________
Q34 What is your highest level of education completed?
 Less than High School
 High School or GED
 Some College
 2-Year College Degree (AA/AS)
 4-Year College Degree (BA/BS)
 Master's Degree
 Doctoral Degree
 Professional Degree (MD/JD)
Q35 Please use the space below to provide any other comments or questions you may
have.
Thank you for your participation in this research. All answers will be kept confidential,
and none of the personal information you disclosed will be seen by anyone aside from my
professors and myself. If you have any further questions or concerns, feel free to contact
me or my thesis chair, Michelle Janning. The results of my research will be made
available to school administrators upon completion.
Stefani Paladino
Senior, Whitman College
Department of Sociology
[email protected]
(253) 880-4759
Michelle Y. Janning
Professor of Sociology
Whitman College
[email protected]
(509) 527-4952

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WWPS Parent Head Lice Survey
Estimados participantes,
Gracias por participar en mi estudio. Por favor, lea la siguiente información y si usted
entiende y está de acuerdo, entonces por favor firme abajo. Deje me saber si usted tiene
alguna pregunta sobre el estudio o la informacion abajo.
¿Quién es la investigadora? La investigadora es Stefani Paladino, una estudiante de
ultimo grado del Departamento de Sociología de la Universidad Whitman, está llevando a
cabo este estudio para su tesis de graduación.
¿Cuál es el objetivo de esta investigación? Este estudio es sobre la estigmatización de los
piojos de la cabeza y cómo estos estigmas se transmiten y se perpetúan. La Junta de
Revisión Institucional de la Universidad de Whitman (un comité que protege los derechos
de los participantes en la investigación ) aprobó este proyecto. La información obtenida
de esta investigacion sera parte de mi tesis de graduación.
¿De qué consiste la participación? Usted tendrá que llenar una encuesta que durará 5-10
minutos. Las preguntas son acerca de sus experiencias con los piojos de la cabeza, y
algunas preguntas son personales.
¿Es voluntaria y confidencial? La participación en este estudio es completamente
voluntaria y confidencial. No hay penalidad si decide no participar, si usted deja de
participar, si usted elige no contestar ciertas preguntas, o si retira la información que
usted dio. Sus respuestas son completamente confidenciales y anónimas. No se le pedirá
que presente su nombre con su encuesta y el acceso a sus respuestas sólo seran
compartido con los profesores de mi comité de tesis y yo.
¿Cuáles son los beneficios y los riesgos? Su participación puede ayudarnos a comprender
mejor la estigmatización de los piojos de la cabeza. Hay algunos riesgos mínimos para
usted como participante. Usted se puede sentir incómodo/a sobre sí mismo o sobre
situaciones que ocurrieron en el pasado. Sin embargo, la mayoría de la gente encuentra
estas preguntas fáciles de responder. Si una pregunta te hace sentir incómodo/a , es
possible evitar la pregunta. También puede terminar la encuesta en cualquier momento.
¿Qué pasa si tengo preguntas o inquietudes? Si usted tiene preguntas sobre el estudio o
sobre sus derechos como participante, por favor póngase en contacto con Stefani
Paladino: Whitman College, 280 Boyer Ave, Walla Walla, WA 99362, mi teléfono es:
253-880-4759, o por correo electrónico: [email protected] Si usted tiene
preocupaciones acerca de esta investigación, puede comunicarse con la profesora
Michelle Janning en [email protected], o por teléfono: 509-527-4952, o puede
escribir a la Presidenta de la Junta de Revisión Institucional de la Universidad de
Whitman ([email protected]; 345 Boyer Ave., Walla Walla, WA 99362).
Si usted completa la encuesta, a continuación, usted estara aceptando que usted entiende
esta información, acepta que usted es mayor de 18 años, y se compromete a participar en

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la investigación. Si usted está listo/a y dispuesto a participar en la investigación, por
favor, siga adelante con la encuesta.
Las siguientes preguntas le preguntará acerca de la salud general de sus estudiantes.
Conteste las siguientes preguntas al mejor de su capacidad.
Q1 ¿Con qué frecuencia su hijo visite a su proveedor de atención médica cada año?
(Responda con en el número de visitas por año)
Q2 ¿Qué crees que es el mayor problema de salud para los niños de la misma edad de su
hijo?
Q3 ¿Habla de la salud con su hijo? (Marque Sí o No)
 Sí (1)
 No (2)
Q4 Si respondió "Sí" a la pregunta anterior, ¿qué temas de salud en específico discute con
su hijo/a? (Ignora esta parte si contestó "No" a la pregunta anterior)
Para cada una de las siguientes preguntas, por favor responda el grado en que está de
acuerdo o en desacuerdo con estas declaraciones "Acuerdo," "Algo de acuerdo,"
"Neutral," "Algo en desacuerdo," "En desacuerdo," o "No estoy seguro."
Q5 La mayoría de los niños que tienen piojos vienen de familias pobres.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)
Q6 La mayoría de los niños que tienen piojos vienen de familias que no son limpios.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)

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Q7 Ciertos grupos étnicos son más propensos que otros a tener piojos.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)
Q8 Cualquier persona que entra en contacto con una persona infestada de piojos de la
cabeza debe ser tratada.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 Desacuerdo (5)
 No estoy seguro (6)
Q9 Usted puede tener piojos de sus mascotas.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)
Q10 Usted puede tener piojos (liendres) de la suciedad.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)
Q11 Los niños por lo general se contagion con piojos en la escuela.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)

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Q12 El mejor tratamiento para los piojos de la cabeza es el champú insecticida que se
compra en la tienda.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)
Q13 Es fácil contraer piojos de la cabeza, por que son capaces de volar, saltar o
brincar.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)
Q14 Los piojos son un problema mas grande hoy de lo que eran hace 25 años.
 De acuerdo (1)
 Algo de acuerdo (2)
 Neutral (3)
 Algo en desacuerdo (4)
 En desacuerdo (5)
 No estoy seguro (6)
Para cada una de las siguientes preguntas, por favor, seleccione todas las opciones que se
aplican a usted.
Q15 ¿Dónde recibe información acerca de los piojos?
 La enfermera escolar (1)
 Maestro del niño (2)
 Medios de comunicación (radio, televisión, etc ) (3)
 Médico del niño (4)
 Internet (5)
 Periódico (6)
 No he recibido instrucciones sobre los piojos de la cabeza (7)
 Otro (8) ____________________

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Q16 Si usted se entera de que su hijo tiene piojos en la cabeza, ¿qué medidas tomaría
usted?
 Visita al médico (1)
 Limpie su casa (2)
 Mantenga a su niño fuera de la escuela (3)
 Comprar champú contra los piojos (4)
 Infórmese sobre las últimas investigaciones de piojos (5)
 Obténer consejos de otras familias que de los piojos de la cabeza (6)
 Cuidar de los piojos sin decirle a nadie fuera de su casa (7)
 Otro (8) ____________________
Las siguientes preguntas son acerca de su experiencia en general con los piojos. Si usted
no se siente cómodo respondiendo a una pregunta, puede ignorar. Como recordatorio,
todas las respuestas son confidenciales y no serán accesibles al público.
Q17 ¿Alguna vez ha tenido piojos en la cabeza?
 Sí (1)
 No (2)
Q18 ¿Alguna vez ha vivido con alguien que haya tenido piojos en la cabeza?
 Sí (1)
 No (2)
Q19 ¿Alguno de sus hijos ha tenido piojos en la cabeza?
 Sí (1)
 No (2)
Q20 ¿Habla de los piojos de la cabeza con su hijo(s)?
 Sí (1)
 No (2)
Q21 ¿Sus padres hablaron de los piojos con usted?
 Sí (1)
 No (2)
Q22 ¿Habla de los piojos de la cabeza con los adultos en la escuela de su hijo?
 Sí (1)
 No (2)
Las siguientes preguntas son acerca de su información personal. Ninguna de de su
información individual será compartida.

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Q23 ¿Cuál es su sexo?
 Masculino (1)
 Femenino (2)
Q24 ¿Cuántos años tienes?
Q25 ¿Cuántas personas (incluido usted) viven en su hogar?
 1 (1)
 2 (2)
 3 (3)
 4 (4)
 5 (5)
 6 (6)
 7 (7)
 8 (8)
 9 (9)
 10 (10)
 Prefiero no responder (11)
Q26 ¿Cuál es el idioma principal que se habla en su casa?
Q27 ¿Usted tiene un trabajo remunerado?
 Sí (1)
 No (2)
Q28 Si respondió "Sí" a la pregunta anterior, ¿cuál es el oficio? (Ignora este parte si
contestó "No" a la pregunta anterior)
Q29 ¿Los otros adultos en su hogar tienen un trabajo?
 Sí (1)
 No (2)
 No hay otros adultos en mi casa (3)
Q30 Si respondió "Sí" a la pregunta anterior, ¿qué trabajos tienen estos adultos? (Ignora
este parte si contestó "No" o "No hay otros adultos en mi casa" a la pregunta anterior)
Q31 ¿Cuántos hijos tienes?
Q32 ¿Qué edad tienen sus hijos?

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Q33 ¿A qué escuela(s) asisten a sus hijos? Seleccione todas las que apliquen.
 Berney Elementary (1)
 Blue Ridge Elementary (2)
 Edison Elementary (3)
 Green Park Elementary (4)
 Prospect Point Elementary (5)
 Sharpstein Elementary (6)
 Garrison Middle School (7)
 Pioneer Middle School (8)
 Lincoln High School (9)
 Walla Walla High School (10)
 Otro (11) ____________________
Q34 ¿Cual es su nivel más alto de educación?
 Menos de la Escuela Secundaria (1)
 Escuela Secundaria o GED (2)
 Algo de universidad (3)
 2 años de grado de la universidad (AA / AS) (4)
 4 años Título universitario (BA / BS) (5)
 Master (6)
 Doctorado (7)
 Título Profesional (MD / JD) (8)
Q35 Utilice el siguiente espacio para proveer cualquier otro comentario o pregunta que
pueda tener.

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Gracias por su participación en esta investigación. Todas las respuestas serán
confidenciales y ninguno de los datos personales serán vistos por cualquier persona
aparte de mis profesores y yo. Si tiene alguna duda o pregunta, no dude en ponerse en
contacto conmigo o con mi profesora de tesis, Michelle Janning. Al finaliar mi estudio
los resultados de mi investigación se harán disponibles para los administradores de la
escuela.
Stefani Paladino
Estudiante, Whitman College
Departamento de Sociología
[email protected]itman.edu
(253) 880-4759
Michelle Y. Janning
Profesor de Sociología
Whitman College
[email protected]
(509) 527-4952

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APPENDIX B:
Tables and Figures
In this appendix, you will find a collection of tables and figures from the surveys
distributed to parents and educators at Green Park Elementary School in Walla Walla,
WA.

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Parent-Child Communication
Parent responses to “What health topics do you talk to your child(ren) about?”
Topics Parents Discuss with Children
healthy eating and physical activity
de todo, cuando se requiere. (all, when it is required)
Any and all that arise is day to day life, why keep health from the person your trying to
keep healthy
washing hands. passing on cold germs
Importance of a healthy diet and exercise
eatting right and exercising
Nutrition, the value of exercise, cleanliness, hand washing, and more.
Eating healthy, washing hands
washing hands, brushing teeth, menstruation, healthy diet, hygiene, exercise
Healthy food choices Prevention of spreading germs/diseases.. Exercise
I talk to her about how important it is took take care of her mind body and spirit. To not
let stress overcome her life. No no touches. And be aware of how she feels...
Hand washing
body hygyne
hand washing, anything that comes up
handwashing, teeth brushing, rest, drinking water not other options, being out in
"nature"
nutrition, hygiene, illness

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Parent Head Lice Knowledge
Top three questions parents answered wrong, or didn’t know, about head lice. The
correct answer for each is “Disagree.”
Q: You can get head lice from your pets.
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
0
1
1
0
8
5
15

Q: Children usually get head lice at school.
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
5
8
1
1
0
0
15

Q: It’s easy to contract head lice because they are able to fly, jump, or hop.
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
5
3
0
0
6
1
15

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Educator Head Lice Knowledge
Educator responses to the same three questions answered most incorrectly by parents.
Again, the correct answer for each is “Disagree.”
Q: You can get head lice from your pets.
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
0
1
0
0
2
1
4

Q: Children usually get head lice at school.
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
1
0
1
0
2
0
4

Q: It’s easy to contract head lice because they are able to fly, jump, or hop.
Answer
Agree
Somewhat
Agree
Neutral
Somewhat
Disagree
Disagree
Not sure
Total

Response
0
0
0
4
0
0
4

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Parent Occupations and Education Level
Parent self-reports of education level and occupation
Level of
Education
Less than High
School
High School or
GED
Some College
2-Year College
Degree (AA/AS)
4-Year College
Degree (BA/BS)
Master's Degree
Doctoral Degree
Professional
Degree (MD/JD)
Total

Response
0

Parent Occupations
Vet. tech.
Registered Nurse
Customer service manager
IT Management
Administrative Assistant
Teacher
Tutor
Teacher
clerical
gardener/ farmer/ teacher

1
5
3
4
2
0
1
16

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APPENDIX C:
Questions from Kirchofer, Price, and Telljohann’s (2001) study “Primary Grade
Teachers’ Knowledge and Perceptions of Head Lice”
In this appendix, you will find the list of questions that I used from Kirchofer et al.’s
2001 study in my own survey. As you will find, they only offered true/false answer
options for respondents. My study used a Likert scale to allow for more precision in
respondents’ answers. I also divided their questions into two categories: stigma questions
and knowledge questions.

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Question Set from Kirchofer et al. 2001:

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APPENDIX D:
Interview Questions
In this appendix, you will find an outline of the questions I asked my interview
participants. While there was variation between the interviews due to the semi-structured
design of the interviews, the following questions were fairly standard in each interview.

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Walla Walla Community College Student Interview Questions
RESEARCH QUESTION: What are the current stigmas associated with head lice
in Walla Walla? How are perceptions about head lice transmitted to people?
The following interview questions attempt to answer my research question. The student
interviews will be semi-structured, but will not deviate far from these questions. I will
keep students on track and will only ask questions that serve to clarify students’ answers.
These interviews should only take about 15 minutes each.
What do students know about head lice (and student health in general)?


Have you ever missed school because of an illness?



Do you go to the doctor when you are sick?



Have you ever visited the school nurse before?



Do you wash your hair every day?
o If yes, do you think that protects you from head lice?



Do you know what head lice are?
o If yes, what are they?
o How do people get head lice?
o How do people get rid of head lice?



Compared to your classmates, do you think you know more, less, or equal about
head lice?

Where did students learn this information?


Did you talk about health in your class?
o If yes, what?



Did you talk about head lice with your parents?



Have you talked about head lice with your teachers?



Have you talked about head lice with your school nurse? Your doctor?



Did you talk about head lice with other kids?



Do you know anyone who has had head lice?



Have you had head lice?



Have you ever lived with somebody who had head lice?

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Have you ever seen head lice talked about on a tv show? In a movie? On the
internet?

What are students’ perceptions about head lice?


What are the first words that come to mind when you hear the words “head lice”?



Do you think most kids get head lice?



Where do people get head lice?



Do you think head lice are hard to get?



(Show picture of magnified head lice) How would you describe this picture?



If you had head lice, would you care if your classmates knew that you did?

Demographic Questions:


How old are you?



Did you attend school in Walla Walla Public Schools?
o If yes, for how long?



Growing up, how many people lived in your house?



What language did you speak at home as a kid?



Do you have any siblings?
o If yes, how many?



Growing up, did any of the adults in your house have jobs?
o If yes, what?

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APPENDIX E:
Letters
In this appendix, you will find the emails I wrote when originally contacting Dr. Linda
Boggs at Walla Walla Public Schools and Principal Gina Yonts at Green Park
Elementary School. They were critical players in helping set up my research, and
therefore I thought it appropriate to include the information that was communicated to
them at the beginning of the research process.

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October 21, 2014

Dr. Linda Boggs,

I am a senior Sociology student at Whitman College. I am writing to you in regards to my
thesis research. I have an interest in education and health, and my thesis topic is the result
of those two interests. I met with Walla Walla Public School’s Director of Health
Services, Jennifer Douglas, over the summer and we discussed some of the top health
issues in the school district. One that caught my attention was the concern with head lice.
For my research, I hope to look into the stigmatization of head lice in Walla Walla's
public schools. There is limited research on the topic of head lice, and it is my hope to
uncover what students’ perceptions of head lice is, what they know about head lice, and
where they learned that information in order to understand what stigmas about head lice
are circulating among students, as well as uncover why these stigmas exist. I plan to
ground my research in Ecological Systems Theory, and hope to not only investigate
children’s perceptions and attitudes towards head lice, but also those of teachers, parents,
and the broader society.
In order to accomplish this goal, I need to take the proper steps that come along with
studying students. For my research, I am hoping to gain access to at least two different
age groups (preferably elementary school and middle school students). I am still at the
planning stages of my methodology, but I know for sure I would like to conduct personal
interviews with students. I will be going through the Institutional Review Board at
Whitman College in order to get my research design approved to ensure my research is as
ethical as possible. Once I have my methodology, including the exact interview questions
I wish to use, I will share that information with you. My question for you is what steps
should I take in order to gain access to research students in the Walla Walla Public
Schools? I know that when studying minors, parental consent can be an issue. I’ve
spoken to my advisor, Michelle Janning, about parental consent options, and she
mentioned either the “opt in” consent or the “opt out” consent. Do you prefer one over
the other? Are there other considerations I should be aware of when researching students
in the WWPS?
I appreciate any guidance you are able to offer me as I navigate through the proper
protocol for researching students. If you have any questions or need more clarification
about my thesis, feel free to call or email me. I know you are very busy, but I am also
available to meet in person to discuss the next steps. Thank you for your time, and I look
forward to working together in the future.
Sincerely,
Stefani Paladino
Senior, Whitman College
Department of Sociology
[email protected]
253-880-4759

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January 22, 2014

Ms. Yonts,

I am a senior Sociology student at Whitman College and am hoping to conduct research
in the Walla Walla Public Schools for my thesis project in Spring 2014. I have received
approval from Dr. Boggs at the district level and now I am reaching out to your school,
Green Park Elementary, to assist me in my endeavor. My research will revolve around
uncovering stigmas about head lice within the Walla Walla Public schools. I will not only
be asking what head lice stigmatization exists, but also exploring why such perceptions
exist. I will be taking an Ecological Systems approach, looking at current college
students’ knowledge and perceptions about head lice, as well as interactions with parents,
teachers, and the larger society that might form and shape these perceptions. It is my
hope that my research will provide a platform upon which to expand and supplement
head lice information in schools in order to reduce—and hopefully eventually eradicate—
stigmas associated with head lice.
As part of this research, I will need to gain access to parents and teachers in the Walla
Walla Public Schools. I am hoping to reach out to Parent-Teacher Associations in order
to distribute surveys regarding knowledge and perceptions about the head lice problem in
the district. I would like to have access to parents and teachers of two different age
groups, such as elementary-middle school or elementary-high school. I would like to
request for Green Park Elementary to be the elementary school I collect data from. I plan
to conduct all surveys using an online program such as SurveyMonkey. I would also be
open to using Zoomerang, the survey program the district uses. It is my hope that by
distributing online questionnaires, these surveys will be accessible to a wide range of
respondents, and can be completed when most convenient for them. All answers will be
kept anonymous and confidential, and no names or personal information of the
participants will be released. These surveys will augment interviews I hope to conduct
with current students at Walla Walla Community College.
The results of my research have several intentions. First, and foremost, the research is
going to be used to fulfill my graduation requirements with the Department of Sociology
at Whitman College, wherein I need to complete a thesis prior to graduation. Therefore,
any results from my study will be shared with my professors, but confidential information
will not be shared with anyone outside of the appropriate professors or myself. Second,
my research will hopefully serve as a tool for the Walla Walla Public Schools to better
understand the stigmatization of head lice among students, as well as to understand what
misinformation parents have and are transmitting to their students. By knowing what the
stigmas are and where they are originating from, the district will be able to create
curriculum and instructional materials that serves to dispel these mistruths and stigmas.
While the intended audience of my research is primarily my professors, I am also hoping
to make the results accessible to educators and parents in the district. Upon completion of
the research, I will provide copies of the results to the district and the schools at which I
conduct my study. I am also more than willing to provide copies of the results to any
party that desires them.

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It is my hope that with your consent, I will be able to continue moving forward with my
research in order to provide information about a school health topic that is currently
underrepresented in academic research. Below I have provided an outline of my research
process, as well as a projected timeline for the various goals in my research project.
Please note that this timeline is an estimation and is subject to change. Please let me
know if you have any questions or concerns. Thank you for your time, and I look forward
to working together in the future.

Research Methods




Distribute online surveys to Green Park Elementary’s Parent Teacher Association
and teaching staff
Distribute online surveys to teaching staff and (if possible) parents at Walla Walla
High School
Conduct interviews with current students at Walla Walla Community College

Projected Timeline for Research
Now through early February:
• Submit proposal to Walla Walla Public Schools
• Receive approval from Whitman College’s Institutional Review Board
• Solidify survey and interview questions
• Reach out to Walla Walla Community College to set up student interviews
Mid February through Early March:
• Meet with PTAs and/or send out emails introducing my project
• Distribute online surveys to parents and teachers
• Receive completed surveys by the end of February/beginning of March
• Conduct personal interviews with students at Walla Walla Community College in
February
March through April:
• Organize and analyze results from interviews and surveys
• Write results into thesis document
• Present published results to district, schools, and any necessary party
Sincerely,
Stefani Paladino
Senior, Whitman College
Department of Sociology
[email protected]
(253) 880-4759

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