UPFRONT

Volume 8, Number 4
July-August 2003

Vol. 8, Num. 4: Contents | Editorial | Up Front | Abstracts

From This Issue | Prescriptions

Vital Data

From This Issue

The news media function as a source of health information for the general public, patients, doctors, and the medical community, as well as policymakers and funders. Given the wide scope of media influence, there are numerous pathways through which news coverage may affect health behaviors. Longitudinal analyses of news media effects on health behaviors are a promising tool for uncovering macro-level media effects that are respectful of the multi-level diffusion process that accompanies substantial health behavior change. Evidence is slowly accumulating that news media messages affect secular trends in health behaviors, mediated in part by factors including public beliefs about performing the behavior, social norms, funding for medical research, and legislation. As a case study, the first article of this issue of the Journal of Health Communication tested the longitudinal impact of news messages on the prevention of marijuana
use among adolescents, using two distinct methods: time-series regression and non-linear modeling. It also tested two intervening variables, personal disapproval and perceived harmfulness of marijuana, that existing research has identified as significant predictors of adolescent marijuana use at the aggregate level. Spanning 23 years (1977–1999), media
coverage was operationalized as news stories appearing in The Associated Press that mentioned negative (PRO) or positive (CON) consequences of marijuana use. It was hypothesized that PRO stories would positively influence decisions to abstain from marijuana use, while CON stories would negatively influence behavior. Similar associations were predicted for the relationship between media coverage and the two intervening variables. Ultimately, it was hypothesized that the relationship between media coverage and marijuana abstinence would be mediated by adolescents’ personal disapproval
and perceived harmfulness of marijuana. Results from the analysis suggested that media coverage explained a significant portion of the variation in adolescents’ abstinence from marijuana use over time. It also explained a significant portion of the variation in personal disapproval of marijuana. Personal disapproval was found to partially mediate the relationship between media coverage and marijuana abstinence. These results provide support for the claim that news media messages impact health outcomes, offer information about mechanisms of media influence, and suggest the utility of media advocacy strategies. Stryker, J.E. Media and Marijuana: A Longitudinal Analysis of News Media Effects on Adolescents’ Marijuana Use and Related Outcomes, 1977–1999. (pages xx).

Television plays a constant and major role in the daily lives of millions of children in the U.S. Consequently, television must be recognized as a major source of health information and an influence on health practices. Its role as an ersatz health educator makes it imperative that health professionals be aware of the health education that is occurring via television and develop opportunities for students to more effectively and accurately evaluate the health messages embedded therein. Thus, the purpose of the second paper in this issue was to identify, content analyze, and describe the health-related content (HRC) presented in 26 top-ranked prime-time network television programs for the age 2 to 11 year-old category. The programs yielded a total sample of 397 HRC containing scenes, 116 of which addressed more than one type of HRC. By a wide margin, the most prevalent type of HRC was food/nutrition, which accounted for two-thirds
of all HRC. The least common types of HRC focused on drug abuse, smoking, mental health, and promiscuous sex. The images and actions broadcast on television programs present detailed instructions on how to live—they teach people how to dress, how to resolve conflict, what foods to eat, and what health behaviors to practice. Indeed, they provide instructions to viewers who would not otherwise seek them or who might not realize the impact the instructions have on them. These instructions on how to live are potentially important because they provide viewers with valuable information on
recommended lifestyle behaviors, like anti-alcohol messages for teens, sexual responsibility and birth control, and AIDS prevention measures. At the same time, these instructions can be detrimental if they encourage poor health habits, such as onset of alcohol use in adolescence, distorted body images and eating disorders, drug overdose, or not using contraception due to lack of planning. The findings of this study help to increase our awareness of how health behaviors are presented on television and can enable health professionals to more fully understand children’s beliefs and attitudes
towards health behaviors. Byrd-Bredbenner, C., C.B., Finckenor, M., Grasso, D. Health Related Content in Prime-Time Television Programming. (p. xx).

Kim and Shanahan studied the process through which changing social norms and public sentiment may have impacts on health behaviors. Examining cigarette smoking and relevant public opinion, they looked into the idea that strong antismoking sentiment in the U. S. may have discouraged cigarette smoking by creating a social atmosphere where smoking is stigmatized as a socially unacceptable behavior. Their state-level analyses indicated that smoking rates are lower where the public holds relatively unfavorable sentiment toward cigarette smoking. This relationship was significant even after controlling for the effects of regulatory measures, such as state cigarette taxes and smoking restrictions in private workplaces and restaurants. An individual-level analysis revealed that smokers who have experienced unfavorable public sentiment are more willing to quit smoking than those who have not. The authors conclude that unfavorable
public sentiment and its normative influences may have been responsible at least partly for the decrease in the smoking population in the U. S. Kim, S.-H., Shanahan, J. Stigmatizing Smokers: Public Sentiment Toward Cigarette Smoking and Its Relationship to Smoking Behaviors. (pages 343–367).

Stroke is a major cause of death and disability, especially among African Americans. Yet research on stroke knowledge and barriers to stroke prevention are limited. In the fourth article of this issue, Pratt et al., analyzed responses from 379 African American adults, 50 years or older. The mean stroke knowledge score was 10.9; maximum possible
was 27. Stroke knowledge was significantly related to family histories of stroke, hypertension, heart disease, and diabetes. College education was significantly associated with older respondents’ knowledge of stroke. Younger respondents who were college educated had more knowledge about the risk behaviors that lead to stroke than those with less education. Respondents preferred hospitals as the site for receiving stroke information and for learning about stroke from their physicians. Stress and poor financial status were the two factors most frequently recognized as barriers to stroke prevention. Those findings have implications for communicating stroke prevention strategies with African Americans. Pratt, C.A., Ha, L., Levine, S.R., Pratt, C.B. Stroke Knowledge and Barriers to Stroke Prevention Among African Americans: Implications for Health Communication. (p. XX ).

In the final article of this issue, Barker describes how organizational dynamics can affect the ability of communication programs to achieve behavior change objectives. Organizational relationships play a central role in health communication activities. However, rarely has the influence of organizational relationships on the success (or failure) of health communication programs been evaluated. The development and implementation of the National Information, Education and Communication (IEC) Strategy for Health in Mali provides a case study showing the importance of successful coordination and negotiation among various institutions working in IEC. This article describes the process of development and implementation of the national IEC health strategy in Mali, a process that resulted in the creation of integrative structures through which IEC specialists throughout that nation now work with greater effectiveness. The case study shows how the highly successful application of the strategy development and implementation process in Mali enabled IEC
technicians to do ‘‘good’’ IEC. The process of implementing the strategy created a system that combined the best aspects of hierarchy or vertical control, with heterarchy, or open horizontal communication. Barker, K. Order from Chaos: Organizational Aspects of Information, Education and Communication (a Case Study from Mali). (p. 369).

Prescriptions

Stryker conducted a longitudinal analysis of news media effects on adolescent marijuana use. Results from the 23-year span of analysis suggest the following:

News coverage of marijuana use may have impacted high school seniors’ decision to abstain from marijuana use at the aggregate level. One of the strongest established predictors of aggregate adolescent marijuana use, personal disapproval of marijuana, may have mediated the relationship between media coverage and marijuana abstinence. Longitudinal analyses of news media effects on health behaviors are a promising tool for future research on health behavior change. Evidence of news media effects on health behaviors suggest the potential efficacy of media advocacy approaches. —J. Stryker

Byrd-Bredbenner, Finckenor, and Grasso studied health related content in prime-time television programming. From their research they offer these findings:

Scenes from top-ranked prime-time television programs that contained health-related content (HRC) occurred on average of 23 times per hour, accounting for approximately one-quarter of program time. The least frequent types of HRC focused on drug abuse, smoking, mental health, and promiscuous sex. The most prevalent type of HRC was food/nutrition, which accounted for two-thirds of all HRC. HRC was directly related to the main point of the scene less than 40 percent of the time. Food/nutrition, smoking, and alcohol HRC tended to be in the background whereas body image, exercise/fitness, medical treatment, mental health, promiscuous sex, physical health, safety, and drug abuse HRC were more likely to be directly related to the main point of the scene. The characters involved in HRC-containing scenes almost always were white, male, and slender. Portrayals of recommended health behaviors were nearly evenly matched with negative, non-recommended behaviors. The findings of this study help to increase our awareness of how important health behaviors are presented on television and can enable health professionals to more fully understand the children’s beliefs and attitudes towards health behaviors. Television programs are an important vehicle for conveying health messages. —C. Byrd-Bredbenner, M. Finckenor, D. Grasso

Kim and Shanahan examined the idea that strong antismoking sentiment in the U. S. may have contributed to the decrease in the smoking population by creating a social atmosphere unfavorable to cigarette smokers. Their findings suggest the following:

Massive assaults on cigarette smoking have given rise to strong antismoking sentiment among the public, creating a social norm in which smoking is considered not only risky but also socially unacceptable. Modification of social norms, as well as passage of regulative measures, may play an important role in discouraging unhealthy behaviors, such as cigarette smoking. Public health campaigners, however, should be concerned about an unintended consequence of intervention efforts: ‘‘stigmatization of unhealthy behaviors.’’ Those who fail to comply with changing health norms can be socially rejected, isolated, and embarrassed. —S.-H. Kim and J. Shanahan

Pratt, Ha, Levine and Pratt examine stroke knowledge, barriers to stroke prevention, and preferred approaches to stroke education among African American adults. Their recommendations for educating African Americans about stroke prevention are as follows:

Clinicians and health educators must communicate stroke prevention messages that include the role of lifestyle behaviors, such as nutrition and physical activity, in the prevention of stroke. Health professionals should use hospitals, clinics, and group instruction in stroke education programs for African Americans. Stroke prevention campaigns should consider age, literacy level, and family or personal history of stroke of their audiences. —C.A. Pratt, L. Ha, S.R. Levine, and C.B. Pratt

Barker describes how organizational dynamics can affect the ability of communication programs to achieve behavior change objectives, and offers the following insights:

‘‘Vertical chaos’’ is created where weak leadership within a hierarchy results in confusion and lack of vision and direction. In communication programs, vertical chaos is created when the system lacks a mechanism or institution to assure the development and use of high-quality, standardized, and technically correct messages and materials. ‘‘Horizontal chaos’’ is characterized by a lack of communication between the organizational units at each horizontal stratum of a network due to the absence of a mechanism to coordinate and channel communication, information and resources among the various actors in a system. This can lead to a duplication of effort and dissipation of resources, with little resulting impact. Implementation of a sound national communication strategy, with full participation of all interested stakeholders, can remedy a situation of vertical and horizontal chaos by creating a system of functional heterarchy. Heterarchy combines the best elements of visionary leadership with a forum for horizontal communication and coordination, to assure maximum efficiency of an organizational system and achievement of results. —K.Barker

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