The news media are an important source of health information, not just for the general public, but also for patients, for doctors and the medical community, for entertainment producers in search of story ideas, and for policymakers and funding organizations. Journalistic practices favor the use of established sources, so public health and medical journals are one of the principal sources for health reporting. Fundamental differences between the institutional norms of journalism and public health and medicine create potential sources of misunderstanding and confusion among news consumers. Nonetheless, studies have demonstrated the effects of news media on knowledge, health behavior, medical practice, and public policy.
Patterns Of News Selection On Health Issues
Journalistic practices facilitate the routine construction of news, and affect how medical and health information is presented. For example, journalists favor established sources because their credibility can easily be confirmed, and because they can provide a steady flow of information to the journalist, which is useful for the continuous development of new stories. Medical and public health journals are an important established source for journalists because certain rules and practices of the journals have facilitated their use as sources for reporters. These journals are peerreviewed publications, which takes the onus of establishing source credibility away from the reporter.
Additionally, certain practices ensure the “newsworthiness” of a medical story. For example, most prominent medical journals have what is known as “the Ingelfinger rule.” Established in 1969 by the New England Journal of Medicine, the Ingelfinger rule posits that a given journal will not publish any article whose content has been previously reported. Enacted in part to increase the journals’ profitability via advertising, the Ingelfinger rule also assures journalists that the information about which they are reporting is timely, and that no other journalist has the opportunity to “out-scoop” them. Similarly, many medical journals have a policy of a “news embargo,” under which journalists receive advanced copies of the journal with the promise that nothing will be reported until the journal’s release date.
Another mechanism that enhances journalists’ reliance on medical journals is the use of the press release. Typically, press releases are written for several of the journal articles in each issue. A press release aids the reporter because it highlights “important” issues, and saves the journalist the trouble of translating what can often be difficult medical language. Journalists have reported that the availability of a press release does increase the likelihood of their reporting medical research, and research has shown that journal articles for which press releases have been written receive more news coverage than those without.
Tensions Between Medicine And Journalism
There is a documented tension between medicine or public health and the media that is due in large part to the disparity of norms between the two institutions. In the book Selling science: How the press covers science and technology, Dorothy Nelkin (1995) chronicled the tension that stems from differences in the production process. Epidemiologic findings, and the scientific process more generally, are based on replication over time; journalism is based on timeliness of the news event. The need for drama in news stories often results in emphases on aberrant findings, scandals, individuals of public notoriety, or misleading headlines. A reliance on short narrative structures and “newsworthiness” criteria (which include timeliness and the need for novelty and drama) govern the ultimate selection and framing of news stories.
The factors affecting story selection and format often hinder optimal presentations of science and medicine in the news media. In particular, journalists oversimplify medical research, often omitting important contextual information. There tends to be a lack of follow-up in news reporting, such that the reporter, and by extension the media consumers, may not know how much importance should be placed on one particular study. Inaccuracies resulting from the decontextualized and sensationalized manner in which stories are reported are known as “errors of omission”. Faced with reporting on new medical research that does not place it in the proper historical context, the public often feels confused because so many recommendations, often contradictory, appear in the news. Hence, health news reporting potentially creates a knowledge gap (Tichenor et al. 1970; Gaziano 1997) whereby individuals with greater education are better equipped to sift through and interpret seemingly contradictory information from health news stories. Accordingly, individuals with less education may become frustrated with health information in the news, and the gap between the health knowledge of high-and low-health-education individuals becomes exacerbated.
Errors of omission are conceptually distinct from, and tend to occur with greater frequency than, factual errors, known as “errors of commission.” For example, a study assessing the accuracy of breast cancer research reported in the news media found that 17 percent of stories contained erroneous information, while 38 percent contained errors attributed to misleading or decontextualized information (Moyer et al. 1995). Errors of any kind contribute to potential misunderstanding of medical information reported by the news media.
Effects Of Media Coverage
Despite distortions in news coverage of health issues, there is an abundance of evidence to suggest that news coverage influences health knowledge, beliefs, and behaviors. Research to date suggests that frequent media users are more informed about health issues than their counterparts who do not have the same levels of media exposure. Beyond the informative dimension, media may also influence health behaviors. There are numerous pathways through which news coverage may affect health behaviors.
The news media are a primary source of health information for the general public. An individual effects model suggests that individuals exposed to news messages gain knowledge about or change attitudes toward the behavior, with enough people exposed that changes can be seen at the population level (Hornik 1991). Alternatively, exposed individuals may share the information with others in their social network, who subsequently change their behavior. There is also a variety of other audiences for news messages: physicians and other health-care workers, policymakers responsible for passing laws and allocating funding for health, and entertainment producers in search of story ideas. Each of these audiences may indirectly influence health behaviors. Policymakers, for example, may be prompted by news messages about the dangers of drunk driving to introduce legislation for stricter drunk driving laws, which subsequently reduces the prevalence of drunk driving in the US (Yanovitzky & Bennett 1999).
Evidence regarding the impact of news coverage on health behaviors can be separated into shortand long-term effects. A compelling event, such as a celebrity diagnosis of cancer, can generate substantial news coverage capable of producing temporary changes in health behaviors. For example, Katie Couric’s public crusade to educate the public about colon cancer after her husband’s death, including her on-air colonoscopy on The Today Show in 2000, resulted in increased colonoscopy rates after the program aired (Cram et al. 2003). Similar effects were demonstrated for mammogram rates following Betty Ford’s and “Happy” Rockefeller’s surgeries for breast cancer in 1974 (Fink et al. 1978), and for colorectal screening rates after Ronald Reagan underwent surgery to remove an intestinal tumor (Brown & Potosky 1990). In most cases, population changes in health behavior increase while media attention to celebrity illness is high, but decrease after the media spotlight wanes; i.e., celebrity effects on health behaviors tend to be of limited duration.
The second conceptualization of news effects on health behavior entails more gradual and cumulative effects of exposure to health news. Comparable to agenda-setting research, the basic causal mechanism is that the quantity of news coverage about a health behavior produces changes in population-level behavior. However, in contrast to agenda-setting research, which posits that the amount of media attention influences perceptions of salience, some models of media effects on health behavior suggest that specific media “frames,” albeit simplistic ones, produce different persuasive effects (Framing Effects; Framing of the News). For example, David Fan’s ideodynamic model proposes that that the population at any one point in time consists of adopters and non-adopters of beliefs, attitudes, and opinions with respect to a particular health behavior (Fan 2002). While the majority of individuals’ beliefs, attitudes, or behaviors will only be reinforced by media messages, there is presumably a small population that would be induced to change because of news coverage. This persuasive force is a function of the ratio of messages supportive of healthy behaviors to messages advocating the unhealthy behaviors, which can function as deterrents to behavior change.
Studies of media effects on correlates of health behaviors include funding for AIDS research, public opinion regarding AIDS and illegal drugs, and beliefs about AIDS transmission. Others studies have moved into the realm of health behavior and health outcomes, testing effects on breast cancer incidence, drunk driving, mammography utilization, cocaine use, marijuana use, and binge drinking. Slowly, evidence is accumulating that news media messages affect secular trends in health behaviors. Mediating pathways through which behavior change may occur include public beliefs about performing the behavior; social norms; funding for medical research; and legislation.
Garnering Media Attention To Health Issues
The news media have the lofty goal of packaging and re-presenting medical and public health information to their audiences. There are different audiences among those affected, including “average” citizens, policymakers, and individuals in funding agencies. Even those individuals in the medical profession reading medical journals are not exempt from being affected by the news media telling them what to think about regarding medical knowledge.
Journalists look for newsworthy medical research that will appeal to their readers. In so doing, the news media over-represent certain medical issues that conform to the normative necessities of journalism. For example, stories about prevention tend to receive less media attention than stories about treatment. It may be that prevention does not conform to journalists’ conceptions of newsworthiness, including the need for novelty and drama. While there is no conceivable way to reconcile the conflicting norms between medicine and the media that contribute to imbalanced representations of illness and health, it is critical that public health practitioners keep a watchful eye on news producers by forging lasting relationships and taking steps to help shape the content of health behavior coverage.
In light of the growing body of evidence supporting news media effects on health behavior, the utility of media-advocacy approaches must be considered (see Wallack et al. 1993). While media advocacy traditionally focuses on the strategic use of news media to advance a social or policy initiative, the term can be more broadly applied to include any purposive effort to help shape news coverage to positively impact health.
There are numerous obstacles to garnering and sustaining media attention to an issue over time. There is a limited amount of time and space for health news, hence health issues must compete with each other for room on the media’s agenda. For example, while there has been an extraordinary amount of news attention to breast cancer, it has come at the cost of attention to other cancers. Moreover, the media tend to exhibit what has been termed the “issue-attention cycle,” whereby any given issue tends to receive substantial media attention for a limited time only, because journalists are motivated to constantly introduce new issues in an effort to maintain the interest of their audiences. While the successful implementation of media advocacy efforts often proves difficult, the potential for improving the public’s health provides a powerful incentive.
- Brown, M. L., & Potosky, A. L. (1990). The presidential effect: The public health response to media coverage about Ronald Reagan’s colon cancer episode. Public Opinion Quarterly, 54, 317–329.
- Cram, P., Fendrick, A. M., Inadomi, J., Cowen, M. E., Carpenter, D., & Vijan, S. (2003). The impact of a celebrity promotional campaign on the use of colon cancer screening: The Katie Couric effect. Archives of Internal Medicine, 163(13), 1601–1605.
- Fan, D. P. (2002). Impact of persuasive information on secular trends in health-related behaviors. In R. C. Hornik (ed.), Public health communication: Evidence for behavior change. Mahwah, NJ: Lawrence Erlbaum, pp. 251–264.
- Fink, R., Roeser, R., Venet, W., Strax, P., Venet, L., & Lacher, M. (1978). Effects of news events on response to a breast cancer screening program. Public Health Reports, 93(4), 318 –327.
- Gaziano, C. (1997). Forecast 2000: Widening knowledge gaps. Journalism and Mass Communication Quarterly, 74(2), 237–264.
- Hornik, R. C. (1991). Alternative models of behavior change. In J. N. Wasserheit, S. O. Aral, & K. K. Holmes (eds.), Research issues in human behavior and sexually transmitted diseases in the AIDS era. Washington, DC: American Society for Microbiology, pp. 201–217.
- Moyer, A., Greener, S., Beauvais, J., & Salovey, P. (1995). Accuracy of health research reported in the popular press: Breast cancer and mammography. Health Communication, 7(2), 147–161.
- Nelkin, D. (1995). Selling science: How the press covers science and technology, rev. edn. New York: W. H. Freeman.
- Tichenor, P. J., Donohue, G. A., & Olien, C. N. (1970). Mass media flow and differential growth in knowledge. Public Opinion Quarterly, 34, 159 –170.
- Wallack, L., Dorfman, L., & Makani, T. (1993). Media advocacy and public health: Power for prevention. Newbury Park, CA: Sage.
- Yanovitzky, I., & Bennett, C. (1999). Media attention, institutional response, and health behavior change: The case of drunk driving, 1978 –1996. Communication Research, 26(4), 429 – 453.