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questions and probes to facilitate discussion and ensure the participants’ views were explored in depth. Participants were encouraged to freely express their views in as much detail as possible and the facilitator did not ask the next question until she felt that all participants had voiced their opinions. Example questions include: “How do you think risks are portrayed in CS media” and “Do you think CS media may influence girls your age? How?” Procedure Interviews were carried out at a higher education college. After the study was approved by the University research ethics board and the college, students voluntarily signed up to the study in the time slots available. We gave participants an information sheet which explained the procedure of the study, and assured participants anonymity and confidentiality, while also noting that should they decide to withdraw from the study, it would be difficult to remove their individual contribution due to the nature of the methodology. Participants then signed the consent form and read one of the two articles, followed by discussion around it. All participants were given time to finish reading the article before discussion was initiated. The same was repeated for the second article. The order in which the articles were presented was counter-balanced across groups to ensure subsequent opinions were not influenced by the order in which they were read. Following this, there was a more general discussion on CS and participants’ personal opinions. The first author facilitated all the focus groups, which took an average of 35 minutes. Analysis Interviews were analysed using systematic thematic analysis. This involves interpreting and categorising linguistic data into theme-based groupings. The categorisation process was inductive and continual in the sense that pieces of text categorised as falling within a specific theme may be adjusted and placed in relation to other pieces. Interviews were analysed in two phases. To begin with, the first author read through the first wave (2010) of transcribed focus group interviews, RUNNING HEAD: Adolescents’ views on cosmetic surgery 8 identifying themes and commonalities within and between interviews, and then placing them in higher-order categories or themes. Four main themes emerged from this analysis of the first wave interviews. The same process was carried with the second wave of interviews (2011). The original four main themes remained, although some further information emerged. Reliability of coding (Boyatzis, 1998) was checked through an independent rater coding approximately 25% of participants’ comments and indicating which of four themes the comments fell within. There was a 90% agreement between the author’s coding and the independent rater. Any minor disagreements were resolved through discussion. Results Four themes were identified of girls’ (1) dissatisfaction with their appearance, (2) acceptability of CS, (3) personal feelings about undergoing CS, as well as perceptions of peers’ feelings and opinions towards surgery, and (4) CS in the media. Theme 1. Dissatisfaction with our appearance: “Everyone is self-conscious” This theme summarises how adolescent girls felt about their appearance and perceived pressures to look good. Participants believed the majority of girls are dissatisfied with their appearance and that this is due to pressure from peers, media and society to look good. Participants argued that girls their age are almost invariably dissatisfied and unhappy with their appearance with comments such as ‘I don’t really know a single girl that’s completely happy with her body’ and ‘If you’re a girl everyone, however good looking, however thin, whatever, everyone’s self- conscious.’ Girls perceived various pressures to look good, the most prominent source being the media. This was mentioned by the majority of girls as influencing how they felt about their body image. ‘I think the majority of everyone being unhappy with themselves is down to the media. If you didn't see these perfect people and you saw them normally, you wouldn't be half as bad. I think everyone would be much happier if we weren't so focused on the way you look, and... images in magazines and stuff.‘ RUNNING HEAD: Adolescents’ views on cosmetic surgery 9 Interestingly, girls were aware of airbrushing and image manipulations that occur within the media, but still felt negatively influenced by them. Many stated that the image of how they could potentially look is now so engraved in their mind that it is hard to remind themselves that what they are looking at and comparing themselves to is not real. ‘I think the problem is that you see so many people in magazines and on TV so airbrushed and trimmed in..., so therefore you almost compare it to yourself, and no matter how hard you try, you still have an image in your head of what you could look like.’ Other sources of pressure to look good came from peers and comparison with peers. One participant even argued that peer pressure was more important than media pressure: ‘I don't really know if we get it off the media, I think we probably get it more from friends 'cos I compare myself to them, I don't really compare to really stick thin people because it's not realistic is it?’ Finally, girls went on to say that they thought there was more pressure to look good when you are younger, and that
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