UPFRONT

Volume 8, Number 1
January-February 2003

Vol. 8, Num. 1: Contents | Editorial | Up Front | Abstracts

From This Issue | Upcoming Conferences and Events | Announcements | Prescriptions

Vital Data

From This Issue

The impact of Alzheimer’s disease (AD) in terms of its prevalence and cost to society is widely recognized as a public health issue. Despite the growing awareness of the disease, specific knowledge about AD among the public remains limited. People with AD are unlikely to seek information or professional help for themselves, due in part to their
cognitive deficits and the stigma of the disease. Instead, family members, friends, and neighbors may notice symptoms in a loved one and seek help. Thus, efforts to increase knowledge and awareness among the public may play a major role in health decisions made on behalf of people with dementia. In the first article of this issue of the Journal of Health Communication, the authors developed an AD module for an innovative educational outreach initiative, the Michigan Interactive Health Kiosk Project, to disseminate information about Alzheimer’s disease to the public. This project provides the general public with access to health information via kiosks located throughout the state using interactive multimedia software. After an overview of the project, the steps involved in developing the AD module and strategies designed to promote and monitor its use are described. Finally, the implications of this initiative for disseminating information about
AD are discussed. Connell, C.M., Shaw, B.A., Derry, H.A., Holmes, S.B., Hudson, M.L., Strecher, V.J. The Development of an Alzeimer’s Disease Channel for the Michigan Interactive Health Kiosk Project. (pgs. 11–22)

Agenda setting is regarded as a key process in policymaking, since only issues with agenda status are generally picked up for discussion as problems to be solved, either by legislators or administrators. The mass media is a key institution in this process: It can create awareness of the health problem, which is then accompanied by additional intervention components, such as policy changes and implementation. However, the efficacy of the mass media in health policy-making, namely its effects on legislators and administrators, has rarely been examined quantitatively. The second article of this issue first examines the trends in newspaper articles on smoking and health and the debates on the issue in the Diet in Japan for the period 1945–1990. Articles and debates are classified into several categories by their contents. Then, relationships of those articles and debates with national administrative actions are analyzed. Analysis disclosed that the focuses of media reports changed considerably over time: In the early period, scientific reports predominated, while in the later period, the focus shifted to non-governmental activities and the restriction of smoking in public places, as well as to increasing numbers of articles on smoking control in other countries. The media first helped set the agenda in the Diet, but it no longer did so after the emergence of the nonsmokers rights movement. On the other hand, a few media agenda items continued to be associated with administrative actions throughout the study period. Effects of mass media on agencies were regarded as largely independent of the debates in the Diet. It was also noted that simple scientific reports on the health hazards of smoking had no association either with agency action or with Diet debates. Retrospectively, the mass media, or the non-governmental advocacy activities reported therein, effectively mobilized administrative agencies for tobacco control, while the Diet remained politically immobilized. For scientific facts to be dealt with by policymakers,
issue building, which consists of creating a package of ideas about the facts, the causal theories, the responsibilities, and the feasible solutions, is especially important. Sato, H. Agenda Setting for Smoking Control in Japan, 1945–1990.
(pgs. 23–40)

The third article examines the role that celebrities have in drawing attention to health-related issues—one of the growing influences in the field of health communication. When Mark McGwire broke Roger Maris’s home run record in September of 1998, he was instantly declared an American hero and held up as a positive role model for teenagers and young adults. The extensive media attention focused on McGwire made the general public aware of his use of a muscle-building dietary supplement, Androstenedione. It also increased the public’s awareness of McGwire’s organized efforts to prevent child abuse. To explore McGwire’s influence, Brown, Basil and Bocarnea studied people’s involvement with McGwire through the processes of parasocial interaction and identification. They then assessed the effects of that involvement on audience knowledge of and attitudes toward Androstenedione and child abuse prevention. Results indicate parasocial interaction with McGwire led to identification with him, which in turn increased public concern for child abuse prevention. In
addition, involvement with McGwire was strongly associated with knowledge of Androstenedione and intended use of the supplement. The researches concluded that popular sports celebrities can have an significant influence on health beliefs and behavior. Brown, W.J., Basil, M.D., Bocarnea, M.C. The Influence of Famous Athletes on Health Beliefs and Practices: Mark McGwire, Child Abuse Prevention, and Androstenedione. (pgs. 41–57)

Journalistic reporting on Presidential health has increased since the 1950s and 60s. While a few articles and books have dealt with the subject over the past 25 years from an historical and/or medical ethics perspective, there has been very little systematic discussion of the professional–ethical issues involved from the point of view of the journalist—especially regarding situations in which such medical information is not disclosed voluntarily and/or the public official is someone other than the President. The fourth article in this issue raises and discusses several issues within the general frame-work
of press freedom vs. the right to privacy, in light of relevant laws, judicial rulings, legal scholarship and especially journalistic professional ethics. Specifically, these are the questions that reporters should take into account when considering whether to publish unauthorized medical information about public officials: 1) Do officials have
any right whatsoever to medical privacy? 2) If so, is such a right relevant before, during, and/or after political service? 3) Should journalists relate differently to non-disclosure as opposed to false disclosure by the public official? 4) Are there journalistic limits to informed speculation based on indirect (but nor hard) medical evidence? 5) What types and degree of ill health justify reporting—specifically, from the journalist’s standpoint is there a difference between public officials’ physical and mental illness? 6) Should ill-health reporting extent to mid/lower level representatives or even to
appointed officials? The article also briefly raises other ancillary questions: A) What kinds of ill-health newsgathering are legitimate? B) When does previous ill-health of an official become ‘‘non-news’’ (if ever)? C) Are there any extenuating circumstances that might justify not publishing news of serious ill-health? D) Can a candidate’s low IQ be
considered a legitimate (health) problem? E) If and when law or custom enables reporters to have access to privileged medical information of elected officials, who is to be considered a ‘‘journalist’’? F) What are appropriate sanctions for someone reporting confidential medical information of public officials? Finally, the article concludes with
a short discussion regarding the issue of ill health reporting of public officials in the future, predicting that it will become even more problematic in the coming years as a result of easier access to confidential information through the Internet as well as from DNA residue ‘‘left behind’’ by public officials (e.g., palm sweat on a drinking glass). Regarding the complex of questions raised, the author suggests that no overarching reporting algorithm can be determined a priori, but rather that in each case the journalist and/or editor must carefully weigh the sundry questions involved in an attempt to strike a legitimate balance between the public’s right (and need) to know about its leader’s ill-health and the need (and right) or elected officials to maintain some semblance of medical privacy. In the final analysis, the decision must be based on the
potential severity of the illness’s consequences for the body politic and society as a whole. Lehman-Wilzig, S.N. Political Ill-Health Coverage: Professional-Ethical Questions Regarding News Reporting of Leaders’ Ailments. (pgs. 59–77)

The most recent literature on the prevention of problematic drinking on the college campus includes a growing controversy about approaches to the reduction of college drinking. Putting aside temporarily the question of the effectiveness of one particular prevention strategy versus another, there is certainly no disagreement that college campuses are plagued by drinking and drinking-related problems. Furthermore, there can be little disagreement that many of the college students who drink do so in ways that are more problematic than they themselves comprehend. In the Forum of this issue, the authors argue that students’ thinking about their drinking needs to be taken into account if we want them to personalize messages. It is by understanding their attitudes and behaviors through their own ways of seeing that we can become more effective in the language we use to frame what we say to them about their drinking and in creating ways of communicating that will resonate with them. Rutgers University is presented as a case study of on-going data collection designed to reveal what students themselves think. This paper describes an innovative initiative at Rutgers, CHI, and its
development of ‘‘dangerous drinking’’ as an alternative to the term ‘‘binge drinking.’’ We argue that using the term ‘‘dangerous drinking’’ places the focus on the type of drinking that needs to be addressed, that which is dangerous, in an arena that most students, researchers, and health educators can agree. Lederman, L.C., Stewart, L.P.,
Goodhart, F.W., Powell, R., Laitman, L. A Case Against ‘‘Binge’’ as the Term of Choice: Convincing College Students to Personalize Messages about Dangerous Drinking. (pgs. 79–91)

Upcoming Conferences and Events

The Society of Behavioral Medicine will hold its 24th annual meeting on March 19–22, 2003 in Salt Lake City, Utah. For registration and meeting information please visit http://www.sbm.org/annualmeeting/index.html

‘‘World Congress on Risk’’ is an International Conference to be held June 22–25, 2003 at the Sheraton Brussels in Belgium. This is the first of a series of World Congresses on Risk that will be important, logical steps to further develop the field of risk analysis and its applications. In partnership with other professional societies and organizations, the Society for Risk Analysis is launching the first of this series in 2003. The unifying theme for the First World Congress is ‘‘Risk and Governance,’’ which reflects the worldwide trend toward making better use of risk-oriented concepts, tools, and processes (derived from both research and practice) in public decision-making and risk management. The Society for Risk Analysis is co-sponsoring the Congress with other scientific and professional organizations interested in risk. For more information visit www.sra.org

Announcements

The U.S. Agency for International Development has selected a team consisting of the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs, The Alan Guttmacher Institute, and Analytical Sciences Inc. to carry out a new $33 million, 5-year global reproductive health information project. The information and Knowledge for Optimal Health project, or ‘‘INFO,’’ will collect, synthesize and make widely available information on family planning and reproductive health. The project also will collect and disseminate best practices related to reproductive health from an
array of partners in both the developed and the developing world. INFO plans to use a variety of technologies to enable health professionals and policy-makers to communicate with each other and to contribute to a comprehensive base of knowledge. For more information visit the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs website at www.jhuccp.org.

Prescriptions

Connell, Shaw, Holmes, Hudson, Derry, and Strecher developed an Alzheimer’s disease module for an innovative educational outreach initiative, to disseminate information about Alzheimer’s disease to the public. Practical messages from their research include:

Soliciting feedback directly from the intended target audience is a critical step in tailoring an educational component for interactive media to specific needs, interests, and priorities. Recruiting a recognized and respected public figure to ‘‘host’’ the channel increased its appeal and usage. Because scientific advances and treatment options are changing rapidly in the field of Alzheimer’s disease, disseminating information about the disease via interactive media may be especially appropriate because it can be updated more easily and frequently than print materials. To increase usage among the target audience most likely to access information about Alzheimer’s disease (i.e., adults and older adults), kiosks should be placed in locations that serve this group (e.g., libraries, senior centers, local chapters of the Alzheimer’s Association, retirement communities). Additional research is needed to further examine the potential of this type of interactive media for disseminating information to hard-to-reach groups (e.g., residents of rural areas, people without home computers or computer experience). Despite the potential of kiosks for disseminating user-tailored health information to the general public, substantial resources are needed to evaluate their impact on the knowledge and behavior of users. –C.M.Connell ;B.A.Shaw ;S.B.Holmes ; M.L.Hudson ;H.A.Derry,V.J.Strecher

Sato examined trends in Japanese newspaper articles on smoking and health and the debates on the issue for the period 1945–1990. Relationships of those article and debates with national administrative actions were then analyzed. Messages from the research include:

For the media to be effective in agenda setting, a package of ideas that includes an account of the causes and consequences of undesirable circumstances as well as a theory about how to improve them should be prepared, instead of just scientific reports on health hazards. With the help of mass media, tobacco control activists can propel the involvement of administrative agencies in their action against tobacco, even when legislators remain politically immobilized. Mass-media health communication could both affect and reflect the mobilization of social interests, and health advocacy groups might be able to advance their efficacy in policy change by the strategic use of the media. –H.Sato

The powerful influence of celebrities on health beliefs and behaviors is an important concern of health communication scholars and health providers. Brown, Basil, and Bocarnea assessed the influence of Mark McGwire on the public’s concern about child abuse and on people’s interest in taking the steroid Androstenedione. They make the following recommendations based on their findings:

Health communication practitioners and public health officials should continue to seek opportunities to use popular sports celebrities in health communication campaigns. Professional sports organizations should provide relevant information to educate professional athletes about the potential influence they can have on health-related beliefs and behavior. Parents and educators should discuss with children and young people the powerful ways in which they are influenced through their involvement with celebrities. Health communication scholars should explore the ‘‘branding’’ of certain diseases by certain celebrities advocating prevention, research, and cures. –W.J.Brown ;M.D.Basil ;M.C.Bocarnea

Lehman-Wilzig discusses several questions facing reporters who wish to report on public officials’ ill health. Some of his main recommendations are the following:

While overall the need for such reporting is greatest regarding a candidate for office (as opposed to a serving official), the potential personal damage to the candidate is so great that the journalist must be absolutely sure of the facts as well as convinced that the illness could seriously impair the future functioning of the candidate, if elected. False disclosure by an official gives a journalist carte blanche to report any and all true medical information; in cases of ill-health non-disclosure, the journalist must weigh the pros and cons. If the reporter does not have hard evidence of a leader’s ill-health, then a decision whether to report speculatively should be based on the relative conclusiveness of the indirect ‘‘information’’ and the serious implications of such ‘‘facts.’’ From a journalistic perspective, how an ailment affects the short-to-mid term functioning of a public official is more important than the illness’s seriousness (long-term threat to life). Thus, in most cases, mental illness is ethically more ‘‘reportable’’ than physical illness, although the journalist must also consider the problem of ‘‘stigma’’ and the greater difficulty of a clear diagnosis regarding mental illness. It is not necessarily the hierarchical job status that determines whether to report on ill-health but rather the sensitivity of the officials’ job and the level of potential public harm if and when the sick person fails on the job. –S.N.Lehman-Wilzig

Lederman, Stewart, Goodhart, Powell and Laitman describes an innovative initiative at
Rutgers, CHI, and its development of ‘‘dangerous drinking’’ as an alternative to the term
‘‘binge drinking.’’ From their research they suggest:

Use a term such as ‘‘dangerous drinking’’ that focuses on outcomes and consequences rather than solely upon the number of drinks a student drinks. To get students to personalize messages, we need to use language with which they can identify. Be aware that the word ‘‘binge’’ in describing college drinking may be both inflammatory, creating an image far worse than what is happening; and at the same time easy for students to deny, seeing it as what happens to others. –L.C.Lederman ;L.P.Stewart ;F.W.Goodhart ;R.Powell ;L.Laitman

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The Up Front section is edited by Wendy Meltzer, Managing Editor, Journal of Health Communication: International Perspectives.