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CHAPTER Copyright 2014. Routledge. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 13 Media Effects and Health Adam J. Parrish, Sarah C. Vos, and Elisia L. Cohen In a New York Times op-ed, Angelina Jolie announces that she’s had her breasts removed to avoid cancer, resulting in a media frenzy. On television, commercials promote the use of prescription drugs to supposedly improve our mental and physical well-being. In the medical drama Grey’s Anatomy, doctors are portrayed as sexy superheroes, making decisions based on gut-instinct and bravado before stealing away to the utility closet for some romance. Each of these examples represents areas in which mass media and health intersect and where media have the potential to inÀuence our knowledge about health, attitudes toward diseases and preventive behaviors, and beliefs about what causes diseases and how to cure them. Media can even inÀuence our beliefs about who is responsible for illness—the individual or society as a whole—and who can make changes that inÀuence health outcomes. For the purposes of this chapter, we de¿ne mass media broadly: newspaper stories, televised sitcoms and dramas, newscasts, websites, commercials, YouTube videos, video games, magazine articles, Twitter feeds, and more. Such a broad de¿nition makes conceptualizing mass media inÀuence dif¿cult, but it also underscores the multiple ways in which media have the potential to converge with health communication. Scholars who use a scienti¿c perspective to conceptualize media effects on health emphasize mass media’s role in transmitting health information and are often concerned with the accuracy of the information being presented. In contrast, commu- EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY AN: 841321 ; Nancy Grant Harrington.; Health Communication : Theory, Method, and Application Account: wviruniv.main.eds Media Effects and Health nication scholars who use an interpretive perspective focus on the audience’s role in understanding that information. Scholars who use a critical–cultural perspective focus on the social structures that shape media coverage and the ways in which public issues and individual health concerns intersect. Each of these perspectives emphasizes different aspects of the relationship between media and health, and each has different underlying assumptions about the agency of individuals and the structural role of media systems in society. These paradigms also illuminate the different pathways through which scholars examine the relationship between media and health. In this chapter, we ¿rst discuss some of the most common theoretical perspectives that consider the effects of media on individual and societal health. We then examine in more detail three ways in which media inÀuence health through news reporting, advertising, and entertainment. THEORETICAL PERSPECTIVES Scholars from various health-related backgrounds use several prominent communication theories to understand the inÀuence of the news media on health. Some theories stem from the scienti¿c social–psychological tradition of media effects, originally developed to explain the role of media in politics. These theories include agenda setting, priming, and framing. Other theories stemming from the interpretive and critical–cultural traditions examine the social determinants of health. They look at ways social structures such as workplaces, neighborhoods, and schools inÀuence health and the ways that media systems reinforce these structures, ultimately solidifying social and individual understandings of health. Traditional Theories of Media Effects Agenda setting. Agenda setting focuses on ways media coverage makes certain issues more prominent by covering them more often than others (McCombs & Shaw, 1972). More speci¿cally, according to agenda setting theory, media set the public agenda by covering and drawing attention to certain news stories. Take, for example, EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 365 366 Chapter 13 Angelina Jolie’s double mastectomy. From an agenda setting perspective, the news coverage of this event raises awareness about genetic testing for breast cancer. It places the issue of breast cancer and its prevention on the public agenda. McCombs and Shaw (1972) argued that media tell audiences what issues to think about but not how to think about them. In their seminal 1972 study, the researchers examined how the number of news stories about different political issues during a campaign matched people’s views on what issues were most important. The issues that undecided voters thought were most important were also the issues that were written about most often in the newspapers. This line of research has important implications for health policies and the implementation of healthcare-related legislation. When editors select health-related news stories for publication or broadcast, they are making choices that can affect the relevance and importance of health information for the public. For example, Wang and Gantz (2010) found that local news media frequently broadcast stories about the causes of and treatments for speci¿c physical illnesses (e.g., cancer, heart disease, diabetes) and chose stories about mental illness and aging less often. The researchers also discovered that health news accounted for eight percent of all televised news coverage and stories averaged one minute in length. This type of content analysis highlights the importance of health in local news and reveals the need for further examination of the content of health stories. That is, if a health issue will receive only one minute of coverage on the local news, what information should journalists attempt to include in that minute? Studies of newspaper coverage of health-related stories also accent the importance of the agendasetting function of media. Content analyses indicate that cancer is one of the most frequently covered health topics (Wang & Gantz, 2010). Breast cancer is overrepresented in American newspapers when compared to the actual incidence of the disease, whereas more common cancers such as lymphoma, thyroid, and prostate cancer are underreported (Cohen et al., 2008; Jensen, Moriarty, Hurley, & Stryker, 2010). Breast cancer may EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health receive more attention than other cancers because of the political power and media presence of breast cancer nonpro¿ts such as the Susan G. Komen for the Cure© organization. However, Cohen at al. (2008) noted that newspapers targeted to AfricanAmerican readers might consider health disparities when selecting stories for publication. Black newspaper journalists, for example, may write a story that considers how their readers will understand or evaluate the story from their socio-cultural perspective. African-Americans experience higher rates of breast and prostate cancer mortality and are diagnosed with later stage disease than non-Hispanic Whites, potentially creating a greater need for stories that provide information about prevention, diagnosis, and treatment of illnesses that affect diverse populations disproportionally. Priming. Priming theory has been used to show how news coverage of health issues inÀuences our knowledge of those issues. Priming may be considered as an extension of agenda setting (Scheufele & Tewksbury, 2007). Like agenda setting, priming focuses on the ways media coverage makes certain issues and ideas more accessible by covering them more often (Weaver, 2007). For example, Stryker, Moriarty, and Jensen (2008) investigated the relationship between what people knew about cancer risks and coverage of those same cancer risks in American newspapers. The study found that the modi¿able cancer risks most often covered in the news media were tobacco use and diet, whereas exercise and sun protection were covered less often. Not surprisingly, people who reported reading cancer-related stories in newspapers knew signi¿cantly more about tobacco avoidance and healthy eating than they did about exercise and protection from the sun. These ¿ndings suggest that media primed consumers to think about certain aspects of cancer prevention (e.g., tobacco and food) rather than others (e.g., exercise and sun protection). Unlike agenda setting, which focuses on the importance attributed to issues, priming focuses on how mass media content inÀuences the evaluation of issues (Scheufele & Tewksbury, 2007). Priming also considers the short-term effect of media exposure (Roskos-Ewoldsen, Roskos-Ewoldsen, & Carpentier, 2009). As such, much priming research examines how exposure to media violence primes aggressiveness in viewers. Another line of research investigates how media portrayals activate stereotypes, inÀuencing how people perceive others. A related line of health media research examines how representations in media inÀuence public understanding of diseases, including the stigma associated with representations of mental illness in media (also see Chapter 10). Framing. Framing examines the ways in which issues are presented in media and how those presentations inÀuence the way viewers understand those issues (Scheufele & Tewksbury, 2007). In agenda setting theory, media inÀuence what we think about. In framing theory, media inÀuence how we think about issues. Entman (1993) argued EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 367 368 Chapter 13 that frames “diagnose, evaluate, and prescribe” (p. 52). By this, he meant the way an issue is presented makes certain aspects of it more relevant than others and, as a result, the presentation, or frame, inÀuences the way we understand that issue. The public debate on obesity provides an opportunity to examine how attributions of blame identify the causes and cures of this epidemic. Lawrence (2004) used a scienti¿c perspective to examine how this issue was framed in news coverage between 1985 and 2003. Setting out to conduct a content analysis, she collected New York Times articles about obesity that appeared on the frontpage of the paper or in the editorial section. She and a colleague coded the New York Times articles deductively. Then they examined news coverage of obesity on television, using abstracts of prime-time news stories. Finally, they searched 10 major newspapers for articles containing key words related to the obesity debate. Before beginning the analysis, Lawrence identi¿ed three competing frames for the obesity epidemic from previous studies of the problem: biological, individual, and environmental. In the biological disorder frame, obesity was portrayed as a medical problem that would be cured by a pill, presumably developed and sold by pharmaceutical companies. In the individual behavior frame, obesity was described as an individual problem that would be cured when people individually made choices to eat healthier food and exercise more. In the environmental frame, obesity was presented as resulting from an “unhealthy food and activity environment created by corporate and public policy” (p. 62). After analyzing the data sets, Lawrence found that there was a “vigorous frame contest” going on between the environmental and individual behavioral frames surrounding the obesity epidemic (p. 56). She concluded from her analysis that the obesity epidemic was being reframed from an individual behavioral problem to an environmental problem. Each frame identi¿es a different cause of the problem and therefore a different solution. For example, when the obesity epidemic is identi¿ed by the news media as a matter of personal responsibility, obese people are responsible for their weight and are at fault if they don’t lose weight. The solution is for obese individuals to eat healthier foods and exercise. If they fail, then it is a personal failure. Conversely, if the obesity EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health epidemic is described as an environmental problem, then society is responsible, and policy issues (like subsidies for corn, food advertising, portion sizes, walkable communities, the availability of healthy foods, and physical education in schools) become part of the solution. With a frame emphasizing the social environment, the solution to the obesity problem isn’t that people should make personal changes but that policies should be changed to encourage healthier eating and active lifestyles. What a particular frame leaves out is just as important as what it highlights. Entman (1993) argued that frames often direct attention away from alternative and conÀicting explanations of reality. In the example above, the frame of obesity as an individual problem directs attention away from public policies that contribute to obesity. Niederdeppe, Shapiro, and Porticella (2011) have begun to explore how attributions of responsibility for obesity affect public opinion and whether individual differences such as political beliefs inÀuence people’s willingness to accept that societal actors (e.g., government and employers) are responsible for addressing the epidemic. Theories of Media Learning A second line of research on media and health investigates the ways we learn about health from the media. Cultivation theory and social cognitive theory guide this research and examine how we learn by acquiring and retaining information about health from media. These theories are also rooted in the scienti¿c tradition of communication research. Cultivation theory. Cultivation theory proposes that the stories told by media, on television in particular, shape the way we view the world (Gerbner, 1990). Much early cultivation research focused on televised portrayals of violence and attempted to measure the cumulative effect of television watching on public perceptions of violence (Shanahan & Morgan, 1999). Essentially, this research demonstrated that people who watched a lot of television perceived the world around them to be more violent than people who did not watch a lot of television. In effect, television exposure was “cultivating” attitudes and beliefs. In health communication research, scholars have used this theory to examine how portrayals of health on television affect psychosocial health. For example, Hammermeister, Brock, Winterstein, and Page (2005) examined whether people who watched less than two hours of TV a day (the EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 369 370 Chapter 13 recommendation of the American Academy of Pediatrics) reported fewer attributes of poor psychosocial health (e.g., loneliness, hopelessness, shyness) than people who watched more than two hours of television per day. Traditionally, scholars engaged in cultivation theory research use a two-step process to understand the effects of television. First, they conduct a content analysis of the television show(s) being examined; second, they survey viewers and non-viewers about television exposure and outcome variables. Hammermeister et al. did not analyze television content ¿rst, however. Instead, they assumed that the type of content would not matter; it was the act of television-watching itself that created differences in psychosocial health. Hammermeister et al. (2005) recruited 430 participants through national media outlets to take an online survey. The majority of participants were White (76%) and were women (75.6%). Participants were asked to report the average number of minutes of television they watched in a day, and they completed several measurement scales to assess their psychosocial health. The researchers then completed a statistical analysis to compare the psychosocial health of people who watched less than two hours of TV a day and those who watched more. Hammermeister et al.’s (2005) results con¿rmed that women who watched more than two hours of television had a signi¿cantly lower score on the measurements of psychosocial health than women who watched less than two hours of television. However, this relationship was not apparent for men. These results are incongruent with previous studies, which have found that men who were frequent viewers of television were shyer, lonelier, more hopeless, more dissatis¿ed with their appearance, and had a higher tendency toward eating disorders than did their peers who watched less television (Page, Hammermeister, Scanlan, & Allen, 1996; Williams, Sallis, Calfas, & Burke, 1999). The inconsistency with previous research could be due to the small sample size of men in Hammermeister et al.’s study. The Hammermeister et al. (2005) study also illustrates a dif¿cult issue for cultivation theory: the issue of causation. The method of analyzing survey research cannot prove that watching more television causes psychosocial problems. This method can only show that there is a correlation, or relationship, between the two variables. Researchers do not know whether people who are already shy, lonely, depressed, etc., tend to watch more television or whether people who watch more television become more shy, lonely, and depressed. Whether or not television viewing predisposes people to psychosocial risks or, conversely, whether psychosocial conditions prompt television viewing is uncertain. Most previous research in this area has identi¿ed health risks associated with frequent viewing (Dittmar, 1994; McCreary & Sadaca, 1999; Page et al., 1996; Williams et al., EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health 1999). Researchers also do not know how much television watching might be too much and under what conditions frequent viewing might be harmful. These distinctions need to be made if research is to determine clearly that (a) the time spent with media displaces other time people could spend in more meaningful activities and (b) inÀuential media content shapes individual attitudes and beliefs. Time spent watching television illustrates another dif¿culty with cultivation research: How do researchers measure this media exposure variable? In the Hammermeister et al. (2005) study, researchers asked participants to report the number of minutes they spent watching television per day and then divided the sample into two groups, those who watched television for more than two hours a day and those who watched for less than two hours a day. This is traditionally how television viewing is measured in cultivation research (Signorielli & Morgan, 2009): The amount of television watched is measured and then the participants are divided into groups based on their televisionwatching habits. Researchers often divide the sample into three groups (heavy, medium, light) based on reported television watching. As a result, the amount of time constituting a “large amount” of television watching varies from study to study. This practice is important because how researchers group participants can inÀuence results, as challenges to the cultivation theory have demonstrated (Hirsch, 1980). The current media landscape also poses dif¿culties for researchers seeking to measure television watching. When George Gerbner ¿rst developed cultivation theory in the late 1960s, television was a different medium than it is today. Gerbner (1990) conceived of television as unique because unlike the other mass media of the day (radio, newspapers, and ¿lm), television combined visual and auditory messages and sat in a prominent place in the home; the limited number of channels back then also limited what was available to watch. Today television includes a plethora of cable channels and local news. It competes with Internet entertainment and home movie-viewing systems. It also appears online. For the purposes of measurement, these changes raise questions about what watching television actually means. For example, are people watching television while using NetÀix to watch old episodes of a particular show? What if they watch YouTube videos of a show on their iPhone? Or, worse yet, what if they watch YouTube videos while watching television? EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 371 372 Chapter 13 Should researchers measure that multitasking time twice? Clearly, there are many challenges in this kind of research. Social cognitive theory. Another theory that conceptualizes the inÀuence of the media through learning is Bandura’s social cognitive theory (SCT), a theory that focuses on how we learn by observing others. SCT proposes that media inÀuence our values, thinking, and behavior by modeling behaviors that prompt observational learning (Bandura, 2009). For example, when we watch a sitcom character discuss condom use (or fail to discuss condom use) with a casual sex partner, we acquire information about the role of condoms in casual sex. We might retain that information and remember a useful way to bring up condom use in conversation. Although this type of learning occurs every day in non-mediated interactions, Bandura argued that modeling occurs via media when individuals learn vicariously through the process of identifying with mass media characters. In this way, media portrayals show us what is possible (or what is impossible) and how a task might be accomplished. SCT is part of the socio-psychological tradition of communication research, and it has a post-positivistic, scienti¿c perspective, meaning it assumes that researchers can observe and measure the world around them. Four constructs critical to understanding SCT are human agency, human capabilities, vicarious learning, and self-ef¿cacy. SCT assumes that we have agency, which means that we can exercise control over our thoughts, feelings, and actions (Bandura, 1986). Our abilities to symbolize, provide forethought to action, and engage in self-regulation and self-reÀection provide the cognitive means by which we act. Additionally, by observing the behavior of others, we can learn vicariously and develop rules to guide our behaviors. Bandura also argued that vicarious learning will not be suf¿cient to prompt behavior unless we also have self-ef¿cacy. Self-ef¿cacy, essentially, is the belief that you can do something. According to SCT, observing other people who are similar to you can enhance your beliefs about your capacity to engage in a behavior (self-ef¿cacy beliefs). In this way, SCT is similar to social comparison theory, which suggests that we can determine our relative success or failure in any given domain by comparing ourselves to others interpersonally or through media. For example, if you want to gauge your long-distance running abilities, you might enter a marathon. At the end of the race, you will know where you placed in comparison to other competitors (assuming you are still breathing). Knobloch-Westerwick and Romero (2011) noted that upward social comparisons (i.e., comparing yourself to others who are superior in some domain) can have positive or negative effects. When you believe that you can be just as good as or better than other people, you might be more motivated to engage in behaviors that will lead to a higher level of achievement. However, if you believe that the superior goal is unattainable, you might avoid EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health making positive changes. As Vince Vaughn noted in Dodgeball: “I found that if you have a goal, that you might not reach it. But if you don’t have one, then you are never disappointed. And I gotta tell ya, it feels phenomenal.” Mr. Vaughn’s advice aside, our point here is that in relation to health, positive upward social comparison can potentially improve health outcomes. So researchers should strive to learn more about that media effect. Indeed, researchers have investigated the ways in which we use media for vicarious learning and social comparisons in relation to health. Sohn (2009) used a social comparison framework to examine how men and women perceived their own bodies when they compared them to television and magazine representations of idealized body types. Results indicated that women believed their bodies were different from the women they saw on television; men believed that their bodies were similar to the men they saw on television. However, both men and women thought their bodies were different from the images they saw in magazines. Overall, women were more dissatis¿ed with their bodies after social comparison with media than were men. Sohn noted that differences in these entertainment media might explain the results. For example, television may present more accurate images of men than of women. However, magazines, especially those with a health and wellness focus, often portray idealized images of the human form, thus increasing perceived differences between the real and ideal for both sexes. Our existing beliefs about our bodies also can affect the social comparison process. For example, Knobloch-Westerwick and Romero (2011) found that people who reported dissatisfaction with their bodies spent less time reading magazine articles with general interest content that included photographs of ideal body images than they did reading body improvement articles that included similar pictures. This ¿nding indicates that although some images may have negative psychological effects on readers, if the content of the messages accompanying body-ideal images promotes positive and upward social comparison, these effects may be lessened. Media Power and Inequalities Several theories argue that mass media reinforce existing power structures that preserve patterns of social inequality. A focus on communication and inequality is important. Research has demonstrated that “differences in health outcomes across social groups result more from social, economic, institutional, and political factors than from access to or quality of medical care or unhealthy decisions EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 373 374 Chapter 13 by socially disadvantaged groups” (Niederdeppe, Bigman, Gonzales, & Gollust, 2013, p. 9). This means that even more than the individual decisions we make, the environments in which we live inÀuence our health. Another way to think about this is that the environments we live in inÀuence the choices we have. Research has shown that people who are poor, discriminated against, or part of marginalized subgroups suffer from higher rates of disease and death than people who are economically secure, not discriminated against, and members of privileged subgroups. Learning how media can make a positive impact on these social determinants of health is very important. This type of research may help identify ways that communication can shape public support and collective action to reduce health disparities. Knowledge gap hypothesis. Social inequalities and health disparities can produce differences in the knowledge or information we retain about health-related issues. The knowledge gap hypothesis (Tichenor, Donohue, & Olien, 1970) predicts that people with more education and ¿nancial means gain and/or retain more from information they encounter in the media. People with less education retain less information, creating a growing gap between the information rich and the information poor. The access that we have to news and other health information is shaped by the environments in which we live and the media choices that are available to us. As a result, health communication in the media may contribute to and even expand health disparities, as the knowledge required to positively change health behavior grows among people with more education and means, while it remains the same among people with less education and means. Communication inequality. Viswanath and Emmons (2006) argued that the same structural factors that contribute to health disparities also contribute to communication inequality, or the differences in the ability of social groups to generate, manipulate, and distribute information. For example, empirical studies show that structural factors, such as journalistic practices and values, shape the content and viability of EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health health news stories (Gandy, Kopp, Hands, Frazer, & Phillips, 1997; Hinnant, Oh, Caburnay, & Kreuter, 2011). Although the media-effects tradition focuses on individual psychological factors to explain differences in our uptake of information, other scholars have taken a more sociological approach. Viswanath and Emmons (2006), for example, called attention to social factors like living conditions, access to a good education, and exposure to environmental factors (e.g., violence) that may affect our ability to obtain and retain information. Beyond information access, these social factors are considered more broadly as social determinants of health. From a social scienti¿c perspective, communication ecology theory identi¿es and explains the “array of interpersonal, mediated, and organizational communication options available to an individual to achieve everyday goals” (Katz, Ang, & Suro, 2012, p. 438). In the communication ¿eld, this tradition explores how the ecologies in which people live vary by communities and ethnic groups and inform their health communication ecologies (inclusive of both formal and informal communication channels, such as doctors and friendship networks; Katz et al., 2012; Wilkin, Ball-Rokeach, Matsaganis, & Cheong, 2007). From an ecological perspective, Katz et al. have asked whether “a rich set of informal health communication connections—to friends, family, radio, television, Internet, newspapers, magazines, churches, and community organizations—can compensate, even partially for not having access to doctors” (p. 437). The researchers examining responses to the Pew Hispanic Center/Robert Wood Johnson Latino Health Survey found no such compensatory mechanism. However, analysis revealed that “diversi¿ed informal health communication ecologies related to health care access (regular doctor visits, uninterrupted health insurance, and regular health care location) and favorable health outcomes (self-ratings of general health, health-related ef¿cacy, and knowledge of diabetes symptoms)” (p. 437). Thus, this line of research con¿rms that the communication ecology in which individuals reside is related to health outcomes. From a critical paradigmatic perspective, the conceptualization of communication inequality offers a critical lens to examine the relationship between media and health. Such a perspective—one that examines issues of power, social structures, and social class—is rare in the health communication literature. A review of 22 years of scholarship in the ¿eld’s de¿ning journal, Health Communication, found only nine articles (or 1.4% of the total) that employed a critical paradigm (Kim, Park, Yoo, & Shen, 2010). One notable exception is an article that analyzes the symbolic power of an online game designed to promote sugary cereals. Thomson (2011) used a critical semiotic approach to closely examine the marketing rhetoric EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 375 376 Chapter 13 of Millsberry.com, an online game website created by General Mills to promote its breakfast cereals like Lucky Charms and Trix to children (but not rabbits). A critical semiotic approach meant that Thomson focused on the way in which symbols operated in the game and how those symbols (boxes of cereal, cereal characters) undermined the purported health messages of the site. To play the Millsberry game, kids created avatars. The avatars earned money by playing games at the arcade and then used this money to buy clothes, decorate houses, and buy food. The object of the game was to keep the avatars healthy in terms of the types of food they ate, the amount of food they ate, and the activities in which they engaged. In order to conduct the study, Thomson created her own avatar, Kidsresearch, and played the game herself for multiple years. Her nine-year-old daughter also played the game, as Jake Spongebob. Thomson’s analysis was based on her experiences in the game and her daughter’s insights. Thomson (2011) found that, at a surface level, Millsberry promoted two health messages: (a) Eat from multiple food groups, and (b) eat only until full. However, these messages were undermined by the logic of the game, which encouraged players to eat entire boxes of sugary cereal in one sitting and labeled Fruit Roll-Ups, a product that contains added sugar and food dyes, as fruit. Thomson labeled this type of rhetoric commodity healthism (p. 325). Commodity healthism, she explained, “names the way corporations pull a semiotic sleight of hand as they pay lip service to health ideals in order to increase the value of their commodities, making the brands appear ‘healthy’ without even having to make speci¿c health claims about their products” (p. 325). Although Thomson’s study focused on only one advergame, it shows how insidious these messages can be. In effect, the game was encouraging children to eat a cereal that provides more than 25% of its calories from sugar. Thomson’s study demonstrates the need to regulate child-targeted food marketing. EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health PARADIGMATIC PERSPECTIVES ON MEDIA AND HEALTH Communication theories guide much research about media and health. Scholars from the scientific paradigm often investigate how media messages about health set the public agenda, frame information, prime attitudes, and cultivate perceptions of health. Scholars from the interpretive and critical traditions are more interested in how social determinants of health reinforce inequalities and support institutions that disproportionally affect access to accurate health information, which in turn maintains or increases health disparities. HEALTH REPORTING IN MEDIA As we established in the previous section, media representations of health and disease have the potential to exert a substantial inÀuence on health knowledge, attitudes, and even behavior. As a result, researchers and professionals in health communication, journalism, medicine, and public health have dedicated much time to examining how health information is developed and disseminated through media channels. They’ve paid particular attention to the accuracy of health reporting and how information inÀuences public perceptions and health-related behaviors. Developing Health-related Stories How a news story is developed plays a role in what it communicates. Viswanath et al. (2008) noted that media outlets generally follow a four-step process in the creation of news. In the ¿rst step, journalists decide if a story is interesting, exciting, or unique enough to be told. The second step involves research, which includes selecting sources of accurate and reliable information and translating that information so that it can be understood by laypeople. The third step includes gathering additional information that might make a story appealing, such as personal testimonies and analogies, which leads to the fourth step of news-making: dissemination. Unfortunately, there is not yet a set of rigid journalistic standards that guides this four-step process, and existing standards are not applied uniformly. National surveys suggest that journalists’ education, experience, and the size and type of media organization for which they work inÀuence story selection and development (Viswanath et al., 2008; Wallington, Blake, Tayor-Clark, & Viswanath, 2010). For example, Wallington et al. found that reporters working for national media organizations were more interested in novel and entertaining health news than were EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 377 378 COMMUNICATON MATTERS Chapter 13 Al Cross, Director, Institute for Rural Journalism and Community Issues, University of Kentucky There is no “health beat” at most U.S. newspapers, because most are weeklies— small papers that lack the staff, skills, and/or the inclination for aggressive coverage of health problems and disparities. But most readers of these newspapers in rural areas don’t read any other newspaper. As larger newspapers have shrunk as a result of the economic recession, their circulation areas—the geographic reach of their newspapers—have also shrunk. This has also meant less coverage. Helping rural news media pick up that slack, especially on health coverage, is part of the mission of the Institute for Rural Journalism and Community Issues. That’s partly because we’re based at the University of Kentucky, in a state with chronically low health status. I’m a former state political writer and weekly newspaper editor/ manager, and it’s clear to me that many rural weeklies’ tendency to shy away from “negative news” extends to health coverage. For example, the counties where most Kentucky papers publish stories about their place in the annual County Health Rankings are in the top two quintiles of the rankings. Others avoid, consciously or unconsciously, making the county “look bad.” One of our advisers, cancer specialist Gil Friedell, M.D., says, “If there’s a problem in the community, the solution is in the community.” To encourage more news coverage that will help communities face up to their health problems and help people make better decisions that affect their health, we have two online publications, one for the state and one for the nation. Kentucky Health News, funded by the Foundation for a Healthy Kentucky, is updated almost daily with excerpts of, and links to, stories about health topics relevant to Kentucky. It’s at www.kyhealthnews.blogspot.com. We also do our own stories, because few Kentucky newspapers have a health beat, and we cover health topics extensively on The Rural Blog, a daily digest of events, trends, issues, ideas and journalism from and about rural America. It’s at http://irjci.blogspot.com We sponsor and speak at seminars that help rural journalists cover health topics and post resources for them on our website, www.RuralJournalism.org. We also present research and other presentations at health conferences, to help providers understand how to work with rural journalists. Our research has found that much rural newspaper health “coverage” is advertorial articles, in which a message promoting a product or service is embedded in what appears to be a news story. We oversaw a project to provide authoritative, independent health articles to rural Appalachian newspapers for use in special health sections and encouraged the papers to use their sample-copy postal powers to send the edition containing the sections to every household in its core area, to reach people with low health literacy. The papers doing that reported a highly positive response. EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health local reporters, who preferred to focus on health education and decision making for their publics. Furthermore, more educated and experienced journalists cited public education as a priority in story selection, whereas their less-experienced counterparts cited entertainment value as important when selecting stories. In addition, research has demonstrated that newspaper coverage is inÀuenced by the community the paper serves. For example, Pollock and Yulis (2004) found they could accurately predict a paper’s position on assisted suicide on the basis of the characteristics (age, education, income, and other factors) of people who read that paper. Choosing the sources that will inform a story also varies according to education, experience, and type of media organization. Wallington et al. (2010) found that experienced journalists from national organizations were more likely to use information from scienti¿c journals and independent scientists, whereas less-seasoned reporters from smaller organizations were more likely to rely on information from government agencies, local healthcare providers, and press releases when developing stories. The size and scope of media organizations can also inÀuence journalists’ decision-making process regarding story development. Large-scale media outlets may have the ¿nancial resources to employ one or more full-time reporters who focus solely on health-related stories (Wallington et al., 2010). These journalists are likely to have more education and expertise in the realms of both health and journalism than are reporters who work for local media outlets. This can affect their abilities to access information from scienti¿c sources, as well as allow for more time and consideration in story development. Local reporters may have to cover a variety of news “beats” and thus have less time to devote to researching and developing health-related news. The economy has also impacted the quality of health reporting. As a result of the economic downturn that began in 2007 and changing revenue streams, the newspaper EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 379 380 Chapter 13 industry underwent drastic changes. In the two years following the initial economic crisis, eight major newspaper chains ¿led for bankruptcy (Kirchhoff, 2010). Major newspapers, like Rocky Mountain News in Denver, shut down, and some papers, like the Seattle Post-Intelligencer, moved to web-only publications (Westphal, 2009). Thousands of reporters and editors were laid off (Kirchhoff, 2010). According to a survey of health reporters by the Kaiser Family Foundation and the Association for Health Care Journalists (2009), the ¿nancial strain has hurt the quality of health news, as reporters have less time to write in-depth stories and less space to print those stories. In addition, fewer reporters have time to specialize in health coverage (and thus gain expertise), and more experienced reporters have been laid off or moved to other beats. At the same time that these changes have been occurring in newsrooms, foundations have begun funding projects to ¿ll the gap in reporting (Westphal, 2009). The Kaiser Family Foundation began the Kaiser Health Service Project to provide national reporting on health news. Several other nonpro¿t projects, like the Center for Investigative Reporting and ProPublica, focus on investigative journalism, and their projects regularly include health-related stories. Whether these nonpro¿ts can ¿ll the gap that has resulted from the structural changes in the news industry is not yet known. As a result of the economic changes, journalists, especially at smaller news organizations, may rely more often on “information subsidies” packaged by advocacy organizations and industry for story ideas. Len-Rios et al. (2009) noted that public relations (PR) materials (e.g., press releases) often present compact and easily understood information. However, press releases may also contain pre-framed information that is favorable to the entity publishing the release. Therefore, a journalist who uses PR materials as a primary source may not be delivering a story free from bias. Conversely, the ability to translate scienti¿c information varies from reporter to reporter (Forsythe et al., 2012). Wallington et al. (2010) argued that although peer-reviewed journals are considered highly credible and less biased than other potential sources, they contain scienti¿c jargon that can be dif¿cult to render understandable for laypersons. Reporting Health-related Stories The way journalists frame news stories can sometimes create inaccurate perceptions of health-related matters. For example, one study found that local television news stories about cancer focused more on the causes of and treatments for cancer than they did on cancer prevention methods (Niederdeppe, Fowler, Goldstein, & Pribble, 2010). The researchers noted that by highlighting many possible causes of cancer and the varying success of treatment options, local TV stories were cultivating fatalistic perceptions concerning viewers’ abilities to prevent cancer. That is, if people learn EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health that cancer develops because of genetic, behavioral, and environmental factors, they might think that getting cancer is nearly inevitable and avoid making lifestyle changes that could reduce their risk for cancer. However, if they learn that they can prevent cancer through simple behavioral changes, they may develop healthier attitudes and lifestyle changes. There are no universal standards that delineate what information should be highlighted in health-related news stories. Some argue that stories in local markets should focus on local sources of information, others call for social justice concerns to guide story and content selection, and still others note that there is illness-speci¿c information that should or should not be included in all mediated health messages (Anhang, Stryker, Wright, & Goldie, 2003; Caburnay et al., 2003; Kim, Kumanyika, Shive, Igweatu & Kim, 2010). However, research indicates that newspapers targeted to minority populations are often primary sources of health information and that locally relevant content can have a powerful impact upon reducing health disparities (Cohen et al., 2008; Len-Rios, Cohen, & Caburnay, 2010). Future research concerning how the roles of national and local media inÀuence health behaviors could provide insight about possible best practices for health journalists. Media Misinformation Given the number of factors that can inÀuence how a news story is written and selected for publication, it is no surprise that inaccurate or incomplete health information sometimes reaches large audiences. Journalists, medical professionals, and public health personnel have raised serious concerns regarding the effects of misinformation on public perceptions and health behaviors (Schwitzer et al., 2005). One notable example of media misinformation occurred in 1998 when the British medical journal The Lancet reported a link between the measles, mumps, and rubella (MMR) vaccine and autism in children. Before numerous physicians and national and international health organizations could refute the claims made in the report, the damage was done: Media coverage of the report spurred the creation of an organized antivaccination movement that is still prevalent today (Gross, 2009). In fact, EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 381 AHCJ Statement of Principles COMMUNICATON MATTERS Statement of Principles of the Association of Health Care Journalists The Association of Health Care Journalists displays its principles for professionalism, content, and accuracy in health news reporting on its website. The principles are abbreviated here. You can find the full version at http://healthjournalism.org/ secondarypage-details.php?id=56 1. Be vigilant in selecting sources. 2. Investigate and report possible links between sources of information (studies or experts) and those (such as the manufacturers) who promote a new idea or therapy. 3. Recognize that most stories involve a degree of nuance. 4. Understand the process of medical research. 5. Preserve journalistic independence by avoiding the use of video news releases or the use of quotes from printed news releases. 6. Be judicious in the use of television library or file footage. 7. Recognize that gathering and reporting information may cause harm. 8. Show respect. Illness, disability and other health challenges facing individuals must not be exploited merely for dramatic effect. 9. Remember that some sick people don’t like to be called “victims." 10. Avoid vague, sensational language (cure, miracle, breakthrough, promising, dramatic, etc.). 11. Make sure anecdotes are appropriately chosen to serve the interests of fairness and balance. 12. Quantify the magnitude of the benefit or the risk in the story. 13. Report the complete risks and benefits of any treatment. 14. Clearly identify and explain the meaning of results. Remember: association is not cause. 15. Clearly define and communicate areas of doubt and uncertainty. Explain what doctors don’t know as well as what they do know. 16. Seek out independent experts to scrutinize claims and evaluate the quality of evidence presented by sources. 17. Strive to include information about cost and insurance coverage in any reporting of new ideas in medicine. 18. Ensure that the total news package (headlines, teases, graphics, promotional material) does not oversimplify or misrepresent. 19. Consider public interest the primary criterion when choosing which stories to report. Follow up on those stories that serve a wider public interest. 20. Distinguish between advocacy and reporting. There are many sides in a health care story. It is not the job of the journalist to take sides, but to present an accurate, balanced and complete report. 21. Be original. Plagiarism is untruthful and unacceptable. EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health following a 2011 Republican presidential primary debate, Minnesota Congressperson Michelle Bachmann mistakenly and irresponsibly claimed that the HPV vaccine caused “mental retardation” in a supporter’s daughter (Weiner, 2011, para. 6). Even though the link between vaccines and autism has been widely discredited (10 of the 13 authors of the original Lancet article retracted their opinions in 2004), research indicates that MMR vaccination rates decreased signi¿cantly in both the United States and England between 1995 and 2004, shortly after this now-discredited research study received media attention (Smith, Ellenberg, Bell, & Rubin, 2007). Given the potentially life-threatening consequences of media misinformation, researchers and ethicists have called for changes in professional and academic standards for health news reporting. THE CHALLENGE OF MISINFORMATION Journalists and researchers interested in health reporting face economic and structural obstacles to creating and disseminating accurate health information. These challenges should be addressed systematically by communication scholars and media professionals to develop effective strategies for gathering, interpreting, and reporting on health-related news stories. Future research is needed in this area to avoid the spread of misinformation to the public. DIRECT-TO-CONSUMER ADVERTISING So far, we have focused on the inÀuence of news organizations’ storytelling practices on health knowledge, attitudes, and behaviors. However, another important source of mediated health information is direct-to-consumer advertising (DTCA). DTCA is the practice of promoting prescription medications to lay audiences through print and electronic media. DTCA began in 1981, when Merck advertised a pneumonia vaccine in the pages of Reader’s Digest. Today, DTCA spending averages $5 billion a year, making it one of the most proli¿c and pro¿table forms of health communication (Lee, 2009; Ventola, 2011). The Food and Drug Administration (FDA) provides oversight of the DTCA industry, regulating DTCA to only three forms: “product claim ads,” “reminder ads,” and “help-seeking ads” (FDA, 2010, para. 13). The FDA requires print ads to provide ¿ne print describing potential drug risks. Televised advertisements must inform potential consumers where they can learn more information about medications. EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 383 384 Chapter 13 FDA Regulations for DTCA Content COMMUNICATON MATTERS The FDA explicates the three types of DTCA content on its website. Product Claim Ad Reminder Ad Help-Seeking Ad A product claim ad names a Reminder ads give the drug’s Help-seeking ads describe a disease drug, says what condition it name but not the drug’s use. or condition but do not recommend or treats, and talks about both The assumption behind suggest specific drugs. For instance, its benefits and its risks. An reminder ads is that the this ad describes seasonal allergy ad must present the benefits audience knows what the symptoms, such as runny nose, and risks of a prescription drug is for and does not need sneezing, and itchy, watery eyes. drug in a balanced fashion. to be told. A reminder ad People with these symptoms are Balance depends on both does not contain risk encouraged to talk to their doctor. the information in the ad information about the drug Help-seeking ads may include a drug itself and how the because the ad does not company’s name and may also information is presented. In discuss the condition treated provide a telephone number to call for this ad, the benefits and or how well the drug works. more information. FDA does not risks are presented to give a Reminder ads are not regulate lawful help-seeking ads. balanced impression of the appropriate for drugs whose They are regulated by the Federal drug. labeling has a “boxed Trade Commission. However, if an warning” about certain very apparent help-seeking ad references serious drug risks. a particular drug, it is no longer a help-seeking ad, and FDA regulates it. Quoted from http://www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising/default.htm Although the FDA asserts that its “comprehensive surveillance and enforcement program” attempts to protect consumers from false or misleading advertising, the agency has come under ¿re from the Government Accountability Of¿ce for a lack of prompt and thorough reviews of DTCA materials (U.S. GAO, 2006). This is potentially problematic, as some televised advertisements spend more time highlighting a drug’s bene¿ts than they do describing potential health risks in an understandable manner (Kaphingst, Dejong, Rudd, & Daltroy, 2009). Indeed, DTCA is a global controversy. The United States and New Zealand are the only developed nations that allow extensive drug advertising with few regulations; many developed nations have banned the practice ouright (Ventola, 2011). Supporters of DTCA note that it provides patients with important health information that empowers them to initiate communication with their healthcare providers, thus enhancing patient–provider communication. These conversations may in turn promote EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health adherence to medical regimens, leading to improved health. For example, researchers discovered that people with stigmatized illnesses (e.g., social anxiety disorder, erectile dysfunction) felt less embarrassment discussing treatment options with their physicians after being exposed to DTCA for drugs that could treat their symptoms (Khanfar, Polen, & Clausen, 2009; Myers, Royne, & Deitz, 2011). Opponents of DTCA are found mostly in the medical community. Practitioners suggest that the primary purpose of DTCA is to boost corporate pro¿ts, which may lead to unethical practices such as using misleading information in ads (Donohue, Cevasco, & Rosenthal, 2007; Frosch, Kreuger, Hornik, Conbolm, & Barg, 2007). This in turn may prompt inaccurate perceptions of illnesses and treatment options, giving patients false hope (An, 2008). In addition, DTCA could increase dissatisfaction with healthcare providers who refuse to grant their patients’ requests for advertised medications (Gilbody, Wilson, & Watt, 2005). Research suggests that DTCA affects patient–provider communication in some interesting ways. For example, Lee (2010) used the two-step Àow model to guide a secondary data analysis of a 2002 survey by the FDA. The survey had been administered to 762 U.S. adults and measured participants’ information-seeking behaviors relevant to DTCA (e.g., print advertisements, Internet and toll-free phone numbers, and interpersonal communication), inÀuence variables (i.e., asking for drugs from healthcare providers), and response variables (i.e., how healthcare providers responded to requests and how patients reacted to those responses). The two-step Àow model suggests that mass media inÀuence people to think about a certain topic (step one) and then seek out more information interpersonally from others whom they deem to be opinion leaders (step two). In this case the ¿rst step involves exposure to DTCA from media, and the second step involves talking with healthcare providers as opinion leaders. Statistical analysis of survey data revealed that patients who encountered DTCA most frequently sought more information about prescription drugs from their primary physicians but also consulted pharmacists, nurses, and physicians who were not their primary care providers about speci¿c drugs. Furthermore, EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 385 386 Chapter 13 patients who consulted pharmacists and other physicians were more likely to receive prescription drugs from their primary care providers after citing other medical personnel as sources of information. This may indicate that primary care providers are more willing to capitulate to patients’ requests provided those patients have received endorsement from others within the medical establishment. In other words, the opinion leaders also have opinion leaders! If physicians refused to prescribe pharmacistendorsed medications, patients reported a desire to switch primary care physicians. Lee’s (2010) study is important for at least two reasons. First, the study supports and adds complexity to the two-step-Àow model. DTCA did prompt some participants to ask their providers for advertised medications directly. However, these patients frequently left without the requested medications, feeling dissatis¿ed with the experience. In contrast, those patients who engaged in interpersonal communication with other medical opinion leaders were the only patients able to sway the prescribing behaviors of their primary care physicians. Second, it seems that both supporters and detractors of DTCA make valid points. DTCA does in fact lead to increased information-seeking behaviors and the initiation of communication with healthcare providers. However, the patient–provider relationship can be affected negatively if these informed consumers do not receive the medications they request. It should be noted that skilled healthcare providers are able to maintain positive relationships with patients even after denying them treatments highlighted in DTCA (Blose & Mack, 2009; Paterniti et al., 2010). The ultimate effects of DTCA upon physician-prescribing behaviors and patient health outcomes remain unknown. However, given the controversial nature of DTCA, health practitioners have suggested certain reforms to federal policies regarding the industry. For example, Ventola (2011) recommended including quantitative information about drug effectiveness in DTCA and speci¿cally mentioning drug costs in every ad. Only time will tell if these changes become implemented. DIRECT-TO-CONSUMER ADVERTISING (DTCA) The United States and New Zealand are the only developed nations that have not banned the controversial practice of direct-to-consumer advertising. Proponents of DTCA believe that it can empower patients, decrease stigma surrounding illness, and increase patient-provider communication. Detractors believe that because DTCA regulations are lax, powerful drug companies misrepresent their products, misinforming patients and affecting the patient-provider relationship negatively. Research about DTCA paints a more complex picture, wherein patients seek out information about advertised drugs from multiple opinion leaders. EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health 387 ENTERTAINMENT-EDUCATION Beyond advertisements embedded in broadcast media, a number of entertainment media are relied upon as a vehicle for health education. Entertainment-education (E-E) is the process of embedding health-related information into popular media narratives with the goal of changing knowledge, attitudes, and behaviors (Beacom & Newman, 2010; Movius, Cody, Huang, Berkowitz, & Morgan, 2007). E-E occurs when health professionals work with writers and producers to create original storylines for well-known programs and characters. For example, Movius et al. (2007) discussed consulting writers from the popular crime drama Numb3rs in the development of an episode about black-market organ trade in the United States. In truth, there is no market for illegally harvested organs in America; therefore, health communication specialists at The Norman Lear Center (NLC) collaborated with writers to include some accurate information in the imaginary tale. Although the ¿ctional organ-harvesting plot drove the drama behind the episode, writers also included facts and statistics concerning the number of people waiting for organs in the United States in various scenes. Furthermore, the episode included a subplot in which a main character was convinced by others to become an organ donor himself. A follow-up survey conducted by the NLC found that viewers of this episode were more likely than viewers of other dramas featuring storylines about organ donation to think about the importance of organ donation, sign up to become an organ donor, and encourage others to become donors. It seems, then, that presenting medically reliable information The Norman Lear Center Named after the prolific Hollywood producer and creator of classic television programs such as All in The Family and The Jeffersons, the University of Southern California Annenberg School of Communication’s Norman Lear Center, “probes the meaning of entertainment as a discourse, an industry, and a key component of contemporary life.” The Hollywood Health and Society program at the Center has worked with entertainment professionals from popular television shows like Bones, Law and Order SVU, and Grey’s Anatomy to help integrate medically accurate information into fictional storylines and conduct research concerning a host of entertainment and health matters, such as examining representations of disabled individuals in primetime programming, developing effective entertainment-education processes, and promoting national and international diplomacy about health crises. Visit the Center’s website for more information: http://hollywoodhealthandsociety.org EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use COMMUNICATON MATTERS 388 Chapter 13 through ¿ctional narratives can produce pro-social effects. However, a host of factors might inÀuence whether or not an E-E narrative is educational, entertaining, or both. Accuracy of health information should be a primary concern for people interested in E-E because media can become powerful sources of information about health-related phenomena for us, especially when we have limited knowledge about certain health issues. For example, Yoo and Tian (2011) noted that people who are uninformed about organ donation can be negatively affected by narratives that portray organ donation as dangerous. Imagine if you tuned in late to Numb3rs and saw only the violent black-market organ harvesting scene of the episode discussed above. Would you sign a donor card or tell your friends to become organ donors? It is important, therefore, that messages in E-E provide accurate information and boost self-ef¿cacy to engage in healthy or pro-social behaviors. Research indicates that accurate information is important in E-E, but so too is the entertainment value of E-E efforts. For example, one study found that adolescents were more interested in theatrical plays with anti-drug messages when those plays contained authentic messages, characters, and plots (Guttman, Gesser-Edelsburg, & Israelashvili, 2008). Teens receive an overwhelming number of health messages from interpersonal and media sources. Guttman et al. warned that because teens are inundated with so much information, stories that do not seem at least potentially relatable could be rejected and perhaps even engender a boomerang effect (i.e., when a persuasive message incites the exact opposite behavior that was advocated). For example, consider the overthe-top emotional tone of the “This is Your Brain on Drugs” PSA, which spawned numerous parodies, or the typical anti-drug educational ¿lms shown in high school health classes. The PSA relied on metaphor to convey spurious information (i.e., ANY drug making your brain immediately go all sunny-side up), whereas the ¿lms, although EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Media Effects and Health likely more accurate, typically were so poorly acted and produced that they detracted from the overall message. One interesting line of E-E research considers the effects of repeated exposure to similar messages. For example, researchers found that women who watched analogous breast cancer-related storylines on both Grey’s Anatomy and ER were more likely to have increased knowledge about the topic, more favorable attitudes toward screening, and increased screening-related behaviors than were women who watched only Grey’s Anatomy or ER (Hether, Huang, Beck, Murphy, & Valente, 2008). In other words, repeated exposure to similar E-E messages can positively affect healthrelated outcomes for populations (e.g., women) who frequently receive similar messages about speci¿c health issues (e.g., breast cancer). Most researchers seem to agree that learning occurs in E-E because of two similar constructs, involvement and transportation. Involvement describes the level of personal identi¿cation we have with a speci¿c character in a story. Transportation is the degree to which we are engrossed in a general narrative. Moyer-Gusé, Chung, and Jain (2011) found that identi¿cation with characters from Sex in the City was related positively to self-ef¿cacy and negatively to generating counter-arguments, which led to increased discussion of sexual health with others. Viewers who perceived themselves to be like certain characters from Sex in the City were more likely to believe that they could act like their favorite characters and were less likely to question the behaviors of those characters. Murphy, Frank, Moran, and Patnoe-Woodley (2011) studied the effects of transportation, identi¿cation, and emotion on cancer-related knowledge, attitudes, and behaviors among regular viewers of the television show Desperate Housewives. For two seasons on the show, Lynette Scavo’s storyline depicted her diagnosis, treatment, and recovery from non-Hodgkin’s lymphoma. Transportation proved to be the strongest predictor of knowledge, attitudes, and behaviors (e.g., information-seeking and talking about cancer). However, the authors argued that transportation and identi¿cation are likely interrelated concepts. That is, people who identi¿ed strongly with Lynette may have become more engrossed with the show, or people who were already engrossed in the general narrative of Desperate Housewives may have become more involved with Lynette’s story. This study seems to reconcile the exposure/ overexposure dilemma. Lynette dealt with cancer for multiple episodes over two seasons. Viewers likely received many messages about cancer. However, because they identi¿ed with the character and the show overall, they did not lose interest in the story and the messages did not create a boomerang effect. It seems that the key to E-E is a well-planned mix of science and spectacle. EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use 389 390 Chapter 13 ENTERTAINMENT-EDUCATION Entertainment-education is the multidisciplinary process in which health professionals, communication researchers, and entertainers work together to embed health messages in popular entertainment media. Research indicates that accurate information needs to be portrayed in ways that engage audiences so that they connect with characters, stories, and fictional environments. If people are transported into a story and identify with it, they will likely accept health messages and learn new information even upon repeated exposure. However, if the story and characters are not compelling, audiences may have negative reactions to health information. FUTURE DIRECTIONS Future studies of mass media and health should focus upon narrowing the theoretical and methodological gaps discussed in the ¿rst section of this chapter. Researchers will need to work together to create sophisticated measures and study designs that can more accurately capture how mass media affect our understanding of health. Journalists and communication researchers should continue to work to overcome structural and economic challenges that affect the development and reporting of health news. Collaborative research among professionals and academics could improve strategies for gathering and interpreting medical information, which might minimize the negative effects of media misinformation. Considering the controversy surrounding DTCA, more research is necessary to understand how this form of advertising affects patient–provider communication. Similarly, researchers and professionals from the entertainment industry should continue to measure how E-E efforts affect knowledge, attitudes, and behaviors. Given the ever-changing media landscape, new media such as health-related websites (e.g., WebMD and Yahoo! Health), video games that promote exercise (e.g., Wii Fit), YouTube videos demonstrating disease screening processes or offering medical advice, Facebook wellness communities like Healthyshare, and cellphone applications that track weight, food intake, and exercise regimens will become important topics and contexts for future studies of media and health communication. EBSCOhost - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use Health Information Processing Reacting to health messages • When studying health communication, we need to consider how people “process” messages • Process = how you think about, read, and make sense of the information • Also, what you prioritize or rely on when making a decision • In health communication, we want to always think about how a message is influencing beliefs about health and risk, what features of a message are the cause of that influence, and what aspects of health beliefs should be targeted with a health message Information processing The Heuristic Systematic Model • A leading account of how we process and respond to messages comes from the “Heuristic Systematic Model” • Whether and how a message or piece of information persuades us to think or act a certain way depends on how you think about it and what you pay attention to in the message • Heuristic processing of information versus systematic processing Information processing The Heuristic Systematic Model • Systematic Processing • Attempts to thoroughly understand all information available • Careful attention to the text and overall message, deep thinking, and careful reasoning • Thinking through each argument, considering it against past knowledge and beliefs, and the person who is communicating the information • Requires time and energy, and the desire to actually put the effort into it Information processing The Heuristic Systematic Model • Systematic Processing • Persuasion and change happens in this mode when arguments are convincing and presenting in preferred formats and trusted sources • Systematic processing is what most HOPE for in people’s response to health messages Information processing The Heuristic Systematic Model • Heuristic Processing • Less demanding of mental energy • Involves focusing on easy-to-notice and easily understood cues (or, heuristics) • Like credential (doctor, expert, etc.), group membership (Republican vs. Democrat, WVU student, or other identity), how long the messages is and how many points/arguments are made, and how others react to the message • Occurs when there is no time, less motivation, or not seen as particularly worth the effort Information processing The Heuristic Systematic Model • Heuristic Processing • Persuasion via heuristic processing occurs when a heuristics/cues indicate the message is “good” or “to be trusted” – will follow along or ignore based on how heuristics line up • This is likely what happens for most people • Do not care, do not understand the topic, do not see the importance Information processing Information Sufficiency • Outside of time or ability, motivation is key to processing • For a person to be motivated to exert cognitive effort, they must have a sufficient amount of confidence in the amount of information they have • This is called the “sufficiency principle” How much you know How much you WANT to know Information processing Information Sufficiency • As the gap between how much you know and how much you want to know (the “confidence gap”), the more effort is exerted to understand information • As the gap widens, the individual will look for more information and scrutinize that information more Gap in confidence How much you know How much you WANT to know Information processing Motivations Affecting Sufficiency • The level of confidence desired in a specific health domain is shaped by a number of motives • Extent of confidence/information desired is affected by: • Defense motivation • Impression motivation Information processing Motivations Affecting Sufficiency • Defense Motivation • When presented with information, we may unconsciously assess it is is relevant to our sense of self and will respond accordingly • If health information we received confirms how we view ourselves (such as, “I am a healthy person” or “I take good care of myself”), we will uncritically accept that information • But, if information is contrary to how we view ourselves (such as a health care provider indicating we need to alter our diet or exercise more), we will pay close attention to what they are saying and work to undermine their argument (“this is a rude doctor,” or “there must be something wrong with their tests,” Information processing Motivations Affecting Sufficiency • Impression Motivation • When presented with health information, we may also try to balance our goals in developing relationships and being accepted by others • If we believe other people who are important to us know or care a lot about a health topic, we will seek out and try to understand additional information about it • So, if my friends seem knowledgeable about COVID-19, I will spent more time looking for information from them and media sources to stay up-to-date on what is happening so I can be seen as “in-the-know” by my peers Communication Information processing What Message Content Should Include • Health messages need to take into account different ways of processing • Just “coming from a doctor or public health official” is not enough • What other cues come from the message that might affect how people respond? • For example, the COVID-19 response has been to put a leading public health official (Dr. Fauci) at the head of many announcements, assuming everyone will use an ”experts know best” heuristic • But, people selectively react to and process these messages – if they are motivated to think COVID-19 is a hoax, they will find things wrong with Fauci • If they are motivated to ”believe in science,” then they will take it at face-value Information processing What Message Content Should Include • Content has to then focus on persuading the patient/audience to act in a health promoting or risk-reducing way • Informed by behavior change theories • As seen in following slides, it is not just about “raising awareness” or teaching • We need to think about how messages influence or address specific types of beliefs and perceptions • And if ”behavior change” is really a reasonable goal Stages of Change Theories of health behavior • Last time: health messages (mediated or interpersonal) need to take into account how people’s behavior is shaped • Leading behavior change theories in health communication: • Stages of Change • Theory of Planned Behavior • Extended Parallel Process Model • Psychological Reactance Theory Stages of change • When tasked with “changing behaviors” or persuading someone, most focus just on “raising awareness” or educating • But, knowledge is a necessary but not sufficient aspect of changing behavior and persuading • And it matters when basic knowledge is addressed • The “stages of change” model can help us determine Stages of change • Originally for counseling and one-on-one motivating for change, but has been used in many large-scale campaigns • Generally: behavior change unfolds over time and across 5 stages • Precontemplation • Contemplation • Preparation • Action • Maintenance • Plan to change associated with values, beliefs, and behavior Stages of change • To change behavior, a person has to move sequentially through each stage • Can move forward, stay in a stage, or fall back (“relapse”) • “Change” does not occur until the “Action” phase Stages of change Precontemplation • Not intending to take action in foreseeable future • The “starting point” for many health issues • Don’t recognize problem or need to make a change • Usually unaware that their behavior puts them at risk, or • Refuse to acknowledge they are at risk • Avoid reading, talking, thinking about the risky behavior Stages of change Precontemplation • To change, messages should encourage evaluation of current behaviors and start to consider alternatives • Low motivation, so action-orientated suggestions are ignored • Should increase knowledge of the risky/unhealthy behavior and expected benefits • Emphasize positive attributes of the new behavior (gain frame) • General awareness raising messages • Gain frame, informative, one-sided Stages of change Contemplation • Thinking about problem behavior & intending to change soon (next 6 months) • Consideration of problem/behavior & possibility of change • Generally aware of the pros & cons of changing, but don’t act • People often stay in this stage • Difficult to evaluate costs & benefits of change • May be ambivalent or uncertain • *Not ready for action-oriented programs Stages of change Contemplation • Messages should encourage serious consideration of changing something about oneself • Continue promoting positive evaluation of behavior • Dispute commonly believed negative consequences Suggest ways to minimize real negative consequences • Identify how to overcome perceived barriers to change • Persuasive or informative, two-sided, gain or loss frame Stages of change Preparation • Serious planning, intending to take action in immediate future (next month) • Committed to change & taking steps to prepare • Typically taken some significant action in past year to “get ready” for change • A “trial period” can be an important part • Ready for action-based programs Stages of change Preparation • Messages should help maintain motivation to eliminate risk • While also building repertoire of safer alternative behaviors • Skills for change are important at this step • Must prepare for situations that might jeopardize change efforts and work out strategies to cope with them • Instruct on skills or encourage “environmental restructuring” by building cues for new behavior Stages of change Action • Some specific overt modifications in lifestyle made recently (last 6 months) • A successful modification of behavior • This is usually the “behavior change” we talk about • This change is not necessarily permanent Stages of change Maintenance • Continuing to behave in the “changed” way • Solidifying and routinizing the behavior • Working to prevent relapse, but do not need to exert as much effort as in previous stages • Some say 6 months to 5 years, or it never ends • Typically less tempted to relapse and more confident in continuing with their change(s) Stages of change Action & Maintenance • Messages should aim to maintain motivation & build habit • Help cope with new obstacles, set-backs, & slip-ups • Encourage positive feelings when making progress toward goals • Reiterate concrete long-term positive consequences for change • Hard to do on a mass scale (good for individual interventions) Stages of change • Campaign messages tailored to one stage are inappropriate for people at other stages • Helps explain why awareness campaigns are sometimes good, but often not • Goals of intervention should reflect movement from one stage to the next, instead of “solving” the problem • If your patient, population, or other audience is not immediately ready to change, you cannot expect any intervention to actually make that person/group change their behavior The Theory of Planned Behavior Theory of planned behavior • Another leading theory in understanding how behaviors are shaped and what types of beliefs ought to be addressed in health messages is the “theory of planned behavior” • Rather than specifically thinking about behavior, we instead want to focus on people’s plans to do certain things (call their “behavioral intention”) • And our intention is shaped by how positively or negatively we think that behavior is (called our “attitude” toward the behavior), our perception of what others do or think about that behavior (“social norms”), and how easy or feasible we think that behavior is (“perceived behavioral control” or “self-efficacy) Theory of planned behavior Behavior is planned and shaped by: • Attitude toward behavior Attitude • Subjective evaluation of a behavior • Is it good or bad? • Norms around behavior • Perception of what others expect you to do Norm • What do other people do (and support)? • Perceived behavioral control • Confidence & perceived capacity to act • Can I actually do it? Perceived Control Behavioral Intention Behavior Theory of planned behavior Behavior is planned, and shaped by: • Attitude toward behavior • Subjective evaluation of a behavior Attitude • Messages target expected outcomes (valence and likelihood) • Norms around behavior • Perception of what others expect you to do • Perceived behavioral control • Confidence & perceived capacity to act • Messages target things that facilitate or get in the way of doing the behavior Norm Perceived Control Behavioral Intention Behavior Theory of planned behavior Attitude • Subjective evaluation (+/-) of the behavior • Is doing the behavior good or bad? Will I enjoy it? Will the outcome be positive or negative? • As attitude increases, likelihood of acting increases • Shaped by behavioral beliefs • Expected outcomes or experiences associated with doing a behavior • Messages promote expected positive outcomes (or downplay negative ones) • Probability that a behavior will result in an experience/outcome • Messages boost perceived likelihood of good, downplay likelihood of bad Theory of planned behavior Social Norms • Perceived social pressure to do (or not do) a behavior, from important others • Reference group’s beliefs/opinions (or perceived beliefs/opinions) about a behavior • The stronger the norm, the more likely you will act in accordance with it • Formed through social interaction • Most powerful in novel situations • Can be about frequency (descriptive) or approval/expectation (injunctive) Targeting motivation Theory of Planned Behavior • Descriptive norm • Belief about whether most people perform the behavior (Prevalence of the behavior) • Messages inform on (or correct) how important others act • Injunctive norm • Belief about whether others (dis)approve of the behavior (Acceptability of behavior) • Messages promote idea that a behavior is acceptable (or, try to make it acceptable) Targeting motivation Theory of Planned Behavior • Power of social norms shaped by… • Normative beliefs: • Perceived behavioral expectations of important others • Other’s actual behavior, or actual (dis)approval • Motivation to comply: • How much do you want to (or care to) follow what others want Theory of planned behavior Perceived behavioral control: • Self-efficacy • Perceived confidence to enact a behavior • Perceived ability to cope with consequences of the behavior • Shaped by control beliefs: • Perceived presence of things that facilitate or impede the performance of the behavior • Messages highlight resources or try to boost confidence (or, build resources) Theory of planned behavior Vaping is good (overall) My friends all vape I can afford vaping (and it’s discreet) I plan on vaping I vape Theory of planned behavior Pacing my drinks is a good idea My friends expect me to pace my drinks Keeping track of my drinks is easy I plan on pacing how much I drink I pace how much I drink Theory of planned behavior [attitude] [social norm] [perceived control] [intention] [behavior] Theory of planned behavior In health information interventions: • Address attitude, norms, and/or perceived control in messages • Assess which one is causing a problem (or is most influential in the problem behavior) • Find out which is easiest to target • Goal should be to change intention (not necessarily behavior, yet) Risk Communication and the Extended Parallel Process Model Risk in health communication • Risk: • The possibility of danger, or the possibility of loss, injury, or other negative outcomes • Health risks: things that can potentially diminish our health and well-being • Risk communication: • Strategic communication and information, • to provide realistic and accurate information, • about the risks to one’s health and well-being Risk and emotion • Many risk messages use “fear appeals” or “scare tactics” • Motivational appeal designed to increase drive to undertake some course of action • Persuasive message that scares people • Describes bad things that will happen if they don’t do what is recommended • Usually use vivid language, personal language, and gory details/pictures Risk and emotion • Focus of message is to imply some sort of risk (to self or others) • Inherently fear-arousing • Goal is to channel fear in proper direction (action or change) • Most theorizing comes from the “extended parallel process model” or EPPM Fear appeals and the EPPM Components to fear appeals 1. Fear 2. Threat 3. Recommended response Fear appeals and the EPPM Threat components • Threat determines whether and how intense the response • Threat severity • How severe or harmful a risk and its consequences are • Threat susceptibility • How likely or probably a risk is to affect you • These responses usually prompt fear, anxiety, or discomfort Fear appeals and the EPPM Efficacy components • Efficacy determines the direction of the response • Self-efficacy • Perceived ability to enact a recommended response • Response efficacy • Belief that the recommended response works Fear appeals and the EPPM Four types of outcomes • **High threat, high efficacy • High threat, low efficacy • Most “scare tactics” • Low threat, high efficacy • Low threat, low efficacy Fear appeals and the EPPM Three possible processes: • 1. Danger control processes (threat & efficacy) • Primarily cognitive; attitude, intention, behavior change • What most messages want; changing to deal with fear; ”adaptive response” Fear appeals and the EPPM Three possible processes: • 2. Fear control processes (low threat & low efficacy) • Reject the persuasive health messages • Instead of being convinced to act toward better health or less risk, the individual will minimize for much fear/concern they experience • Outcomes: it must not be that big of a deal, the message was poorly designed, the source of the message is untrustworthy, etc. Fear appeals and the EPPM Three possible processes: • 3. Nothing! • The message and risk are just ignored Fear appeals and the EPPM Threat & Efficacy Risk Information Message • Some threat • Some efficacy • Attention • Adopt message Threat, No Efficacy • Attention, fear! • Reject message Efficacy, No Threat No Threat, No Efficacy • No attention • No response • No attention • No response Fear appeals Coronavirus example • Goal: motivate risk-reduction for coronavirus • Risk/threat: the coronavirus • Recommended response: washing hands • Can use the EPPM to think of persuasive messages Fear appeals Coronavirus example (message) • The threat • Severity of coronavirus • Symptoms, death rate, lack of vaccine • Susceptibility • Local outbreak is likely, easy to transmit, people are gross • The behavior • Response efficacy of handwashing • Washing hands for 20 seconds (regularly) prevents virus spread • Self-efficacy for hand washing • Sing the ABCs while you wash your hands, clean your nails in your palm Fear appeals Coronavirus example (audience analysis) • Severity • How bad of a disease do they think COVID-19 actually is? • Susceptibility • How likely do they actually believe they are to come in contact with coronavirus? • Response efficacy • Can anything actually prevent COVID-19? Does handwashing really help? • Self-efficacy • Do they feel like they can (or want to) wash their hands well enough? Is that possible in their situation? Fear appeals Coronavirus example (downplaying the risk) • Severity • Some are saying it’s not that bad (ONLY a 5% death rate!) • Susceptibility • Only the old and already sick are really at risk (or, I’m not traveling anywhere with it) • Response efficacy • We don’t know enough about it to prevent it • Self-efficacy • Washing my hands is a pain Fear appeals • “Fear” is loosely applied • Most probably just make someone “worried” or “concerned” • Dynamic and audiovisual fear appeals: • Fear is an “orienting response” • Present information succinctly once fear is created • Most appeals are just posters or text • Or, videos are gross/scary, but don’t give any information • Most “scare tactics” do not work • They are memorable… but that’s it Emotions in health communication Main points: • Must have a recommended response • Efficacy is necessary for success • Faith in self, faith in the response • But also enough information to be threatening • Fear alone will lead to avoiding thoughts about threat Book: Harrington, N. G. (2014). Health Communication: Theory, Method, and Application. Hoboken, NJ: Routledge. [ISBN: 9780415824545] Writing 1: What factors or reasons shape a person’s decision to do or not do a given health behavior (meaning, something that either makes them healthier, less at risk, or otherwise promotes well-being and avoids disease/harm)? (1-2 pages) Format: APA Writing 2: Use concepts from Chapter 13 regarding the effect of media on learning, motivation, and beliefs to make sense of how COVID-19 beliefs may have been shaped by the type of media people consume. (1-2 pages) Format: APA Material: Chapter 13 document attached Writing 3: Many COVID restrictions have been lifted and the vaccine is widely available. Some might argue that COVID-19 is not a pressing health issue anymore. What do you think? Use concepts from at least two of the theories discussed this week to explain how media influences the public’s perception of the severity of COVID-19 in the months after vaccine availability and the lifting of most restrictions. How have health behaviors and social norms changed and evolved over time? Feel free to explore who is (or has been) influenced/persuaded to change their behavior and in what ways, if at all. ( 2-3 pages) Format: APA Quiz QUESTION 1 Relying on easy-to-remember cues in a message to make judgments is what kind of message process? ◼ ◼ ◼ Heuristic processing ◼ ◼ ◼ Sufficient processing ◼ ◼ ◼ Systematic processing QUESTION 2 “Communication inequality” refers to what? ◼ ◼ ◼ Disparities in the type of information people have available to them or that they can produce and otherwise work with ◼ ◼ ◼ The unequal effectiveness of messages that are aimed at educating others and messages that are meant to persuade others to act ◼ ◼ ◼ Strategic information to educate others on the presence of inequalities in society in order to prompt action to alleviate those inequalities QUESTION 3 When someone experiences a reactance response (i.e., psychological reactance), they are… ◼ ◼ ◼ likely to be persuaded by a message. ◼ ◼ ◼ experiencing guilt. ◼ ◼ ◼ unlikely to be persuaded by a message. QUESTION 4 “Agenda setting” in media effects for health refers to which of the following? ◼ ◼ ◼ The health topics covered in the news and other media determine what topics we think about ◼ ◼ ◼ The health topics covered in the news and other media shape the ways we think about those topics ◼ ◼ ◼ We are gravitated toward news and other media content that reflects how we already think about health topics QUESTION 5 According to Psychological Reactance Theory, what causes people to resist health recommendations? ◼ ◼ ◼ Believing their personal right to choose is being taken away ◼ ◼ ◼ Believing that there is no feasible way to enact the recommendations ◼ ◼ ◼ Believing they are personally immune to the health issue QUESTION 6 According to Cultivation Theory, media shapes our health beliefs in which way? ◼ ◼ ◼ The more media we consume, the more our health beliefs reflect health images in media ◼ ◼ ◼ Lessons about health are presented in an entertaining format ◼ ◼ ◼ The frequency that content is covered by media impact how important we think certain health topics are QUESTION 7 The “knowledge gap” hypothesis refers to what? ◼ ◼ ◼ People who already know more about health information will find and learn more information than those who know less ◼ ◼ ◼ People of lower socioeconomic status know less about their health than people of higher socioeconomic status ◼ ◼ ◼ The best way to change behavior is to reduce the gap between how much someone knows and how much they ought to know QUESTION 8 If a message is targeting a descriptive norm around a behavior, what is being addressed? ◼ ◼ ◼ How many other people do that behavior ◼ ◼ ◼ How easy a behavior is perceived to be to enact ◼ ◼ ◼ Whether other people approve or disapprove of you doing that behavior QUESTION 9 To change behavior, some theories say a person has to perceive a great enough threat. This means a health risk has to do what? ◼◼ ◼ Have serious consequences and be likely to affect them personally ◼◼ ◼ Be fear-inducing and seem dangerous ◼◼ ◼ Affect enough other people the individual trusts and identifies with QUESTION 10 According to the Stages of Change model, it is most appropriate to simply raise awareness when? ◼ ◼ ◼ Never ◼ ◼ ◼ When the health topic is entirely unknown ◼ ◼ ◼ When behavior change is the direct goal CHAPTER Copyright 2014. Routledge. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 13 Media Effects and Health Adam J. Parrish, Sarah C. Vos, and Elisia L. Cohen In a New York Times op-ed, Angelina Jolie announces that she’s had her breasts removed to avoid cancer, resulting in a media frenzy. On television, commercials promote the use of prescription drugs to supposedly improve our mental and physical well-being. In the medical drama Grey’s Anatomy, doctors are portrayed as sexy superheroes, making decisions based on gut-instinct and bravado before stealing away to the utility closet for some romance. Each of these examples represents areas in which mass media and health intersect and where media have the potential to inÀuence our knowledge about health, attitudes toward diseases and preventive behaviors, and beliefs about what causes diseases and how to cure them. Media can even inÀuence our beliefs about who is responsible for illness—the individual or society as a whole—and who can make changes that inÀuence health outcomes. For the purposes of this chapter, we de¿ne mass media broadly: newspaper stories, televised sitcoms and dramas, newscasts, websites, commercials, YouTube videos, video games, magazine articles, Twitter feeds, and more. Such a broad de¿nition makes conceptualizing mass media inÀuence dif¿cult, but it also underscores the multiple ways in which media have the potential to converge with health communication. Scholars who use a scienti¿c perspective to conceptualize media effects on health emphasize mass media’s role in transmitting health information and are often concerned with the accuracy of the information being presented. In contrast, commu- EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 6/18/2022 9:03 AM via WEST VIRGINIA UNIVERSITY AN: 841321 ; Nancy Grant Harrington.; Health Communication : ...
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Writing Two

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COVID-19 Beliefs and Media Consumption
In the context of the COVID-19 pandemic, mass media has positively and negatively
influenced peoples' perceptions, beliefs, and attitudes towards the pandemic. According to
Parrish, Vos & Cohen (2014), the social cognitive theory entails learning by observing others.
This explanation is relatable to the numerous adverts, news articles, interviews, and
documentaries that have flooded radio and television channels and newspapers since the onset of
the pandemic. Through such initiatives, people have undoubtedly gained vital knowledge on the
best practices required to tackle the virus. At the same time, these informative programs played
crucial roles in swaying the beliefs and perceptions of the public from dismissing health
guidelines to embracing and practicing them. However, the same is not true for social media.
Popular social media channels like Twitter, Facebook, and YouTube have been the primary
culprits in spreading disinformation regarding the Coronavirus. In this case, the social cognitive
theory has influenced some people to develop negative behavior and beliefs about COVID-19
due to misinformation and rumors.
The knowledge gap hypothesis asserts that socioeconomic factors determine people's
access to news and ability to gain and retain information (Parrish, Vos & Cohen, 2014). This
theory is relatable to economic inequalities between the White majority and minority Black,
Hispanic and Latino communities. In this case, Whites have access to real-time, accurate
information about the pandemic. As a result, their beliefs about Coronavirus rely on scientific
data, a factor that also influences how they behave in response to health guidelines provided by
authorities. On the other hand, most Blacks, Hispanics, and Latinos might not be privileged to
have real-time access to accurate and updated information about the pandemic. In this case,
income disparities hinder the ability of minority communities to consume news from premium

channels and publications that tend to contain the latest and most accurate info. As a result, most
members of these communities rely on inaccurate information, rumors, and stereotypes about the
pandemic. This phenomenon probably explains why most Blacks and Hispanics would instead
seek alternative interventions to the virus instead of scientific ones.
Meanwhile, it's undeniable that health disparities contribute to information disparities
(Parrish, Vos & Cohen, 2014). This statement is particularly true concerning journalistic
attitudes. Due to several decades of racial health disparities, the focus and priorities of AfricaAmerican and White health journalists are somehow different. In the COVID-19 scenario, White
journalists are primarily focused on reporting about infection control practices and medical
interventions. Interestingly, their reports are likely to find their way to national publications
inaccessible to the majority of minority ethnic races living on a low income. On the other hand,
Black journalists targeting African-American readers are likely to report the burden of the virus
on the Black community and its ties to...


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