Print media coverage of research on passive smoking

30+ years of media analysis of relevance to chronic disease: a scoping review

BACKGROUND

Chronic, non-communicable diseases are a significant public health priority, requiring action at individual, community and population levels, and public and political will for such action. Exposure to media, including news, entertainment, and advertising media, is likely to influence both individual behaviours, and attitudes towards preventive actions at the population level. In recent years there has been a proliferation of research exploring how chronic diseases and their risk factors are portrayed across various forms of media. This scoping review aims to map the literature in this area to identify key themes, gaps, and opportunities for future research in this area.

METHODS

We searched three databases (Medline, PsycINFO and Global Health) in July 2016 and identified 499 original research articles meeting inclusion criteria: original research article, published in English, focusing on media representations of chronic disease (including how issues are framed in media, impact or effect of media representations, and factors that influence media representations). We extracted key data from included articles and examined the health topics, media channels and methods of included studies, and synthesised key themes across studies.

RESULTS

Our findings show that research on media portrayals of chronic disease increased substantially between 1985 and 2016. Smoking and nutrition were the most frequent health topics, and television and print were the most common forms of media examined, although, as expected, research on online and social media channels has increased in recent years. The majority of studies focused on the amount and type of media coverage, including how issues are framed, typically using content analysis approaches. In comparison, there was much less research on the influences on and consequences of media coverage related to chronic disease, suggesting an important direction for future work.

CONCLUSIONS

The results highlight key themes across media research of relevance to chronic disease. More in-depth syntheses of studies within the identified themes will allow us to draw out the key patterns and learnings across the literature.

Regulating the Fast-Food Landscape: Canadian News Media Representation of the Healthy Menu Choices Act

With the rapid rise of fast food consumption in Canada, Ontario was the first province to legislate menu labelling requirements via the enactment of the Healthy Menu Choice Act (HMCA). As the news media plays a significant role in policy debates and the agenda for policymakers and the public, the purpose of this mixed-methods study was to clarify the manner in which the news media portrayed the strengths and critiques of the Act, and its impact on members of the community, including consumers and stakeholders. Drawing on data from Canadian regional and national news outlets, the major findings highlight that, although the media reported that the HMCA was a positive step forward, this was tempered by critiques concerning the ineffectiveness of using caloric labelling as the sole measure of health, and its predicted low impact on changing consumption patterns on its own. Furthermore, the news media were found to focus accountability for healthier eating choices largely on the individual, with very little consideration of the role of the food industry or the social and structural determinants that affect food choice. A strong conflation of health, weight and calories was apparent, with little acknowledgement of the implications of menu choice for chronic illness. The analysis demonstrates that the complex factors associated with food choice were largely unrecognized by the media, including the limited extent to which social, cultural, political and corporate determinants of unhealthy choices were taken into account as the legislation was developed. Greater recognition of these factors by the media concerning the HMCA may evoke more meaningful and long-term change for health and food choices.

Evaluation of a Public Awareness Campaign to Prevent High School Dropout

Many advocacy organizations devote time and resources to increasing community awareness and educating the public in an effort to gain support for their issue. One such effort, the Dropout Prevention Campaign by America's Promise Alliance, aimed to increase the visibility of the high school dropout problem and mobilize the community to take action. The objective of this paper is to evaluate the framing of the Dropout Prevention Campaign in television news media. To evaluate this campaign, television news coverage about high school dropout in 12 U.S. communities (N = 982) was examined. A content analysis of news transcripts was conducted and coded to determine the definition of the problem, the reasons for dropout and the possible solutions. Findings indicated that the high school dropout problem was most often framed (30 % of news segments) in terms of the economic and societal implications for the community. Individual student factors as well as broader societal influences were frequently discussed as possible reasons for dropout. The most commonly mentioned solutions were school-based interventions. News segments that mentioned America's Promise Alliance were more likely to frame the issue as a crisis and to use statistics to illustrate that point. Solutions that were more likely to appear in America's Promise segments promoted community and cross-sector involvement, consistent with the messages promoted by the Dropout Prevention Campaign. The findings suggest that a media content analysis can be an effective framework for analyzing a prevention campaign.

Advocacy coalitions involved in California's menu labeling policy debate: Exploring coalition structure, policy beliefs, resources, and strategies

Advocacy coalitions often play an important role in the state health policymaking process, yet little is known about their structure, composition, and behavior. In 2008, California became the first state to enact a menu labeling law. Using the advocacy coalition framework, we examine different facets of the coalitions involved in California’s menu labeling policy debate. We use a qualitative research approach to identify coalition members and explore their expressed beliefs and policy arguments, resources, and strategies by analyzing legislative documents (n=87) and newspaper articles (n=78) produced between 1999 and 2009. Between 2003 and 2008, six menu labeling bills were introduced in the state’s legislature. We found the issue received increasing media attention during this period. We identified two advocacy coalitions involved in the debate—a public health (PH) coalition and an industry coalition. State organizations acted as coalition leaders and participated for a longer duration than elected officials. The structure and composition of each coalition varied. PH coalition leadership and membership notably increased compared to the industry coalition. The PH coalition, led by nonprofit PH and health organizations, promoted a clear and consistent message around informed decision making. The industry coalition, led by a state restaurant association, responded with cost and implementation arguments. Each coalition used various resources and strategies to advance desired outcomes. PH coalition leaders were particularly effective at using resources and employing advocacy strategies, which included engaging state legislators as coalition members, using public opinion polls and information, and leveraging media resources to garner support. Policy precedence and a local policy push emerged as important policymaking strategies. Areas for future research on the state health policymaking process are discussed.

Why media representations of corporations matter for public health policy: a scoping review

Background

Media representations play a crucial role in informing public and policy opinions about the causes of, and solutions to, ill-health. This paper reviews studies analysing media coverage of non-communicable disease (NCD) debates, focusing on how the industries marketing commodities that increase NCD risk are represented.

Methods

A scoping review identified 61 studies providing information on media representations of NCD risks, NCD policies and tobacco, alcohol, processed food and soft drinks industries. The data were narratively synthesized to describe the sample, media depictions of industries, and corporate and public health attempts to frame the media debates.

Results

The findings indicate that: (i) the limited research that has been undertaken is dominated by a focus on tobacco; (ii) comparative research across industries/risk-factors is particularly lacking; and (iii) coverage tends to be dominated by two contrasting frames and focuses either on individual responsibilities (‘market justice’ frames, often promoted by commercial stakeholders) or on the need for population-level interventions (‘social justice’ frames, frequently advanced by public health advocates).

Conclusions

Establishing the underlying frameworks is crucial for the analysis of media representation of corporations, as they reflect the strategies that respective actors use to influence public health debates and decision making. The potential utility of media research lies in the insights that it can provide for public health policy advocates about successful framing of public health messages and strategies to counter frames that undermine public health goals. A better understanding of current media debates is of paramount importance to improving global health.

The Development and Validation of a Coding Protocol to Measure Change in Tobacco-Control Newspaper Coverage

The national ASSIST newspaper coding protocol model was used as a template to adapt a system for measuring tobacco-related newspaper coverage in Colorado newspapers. Over a 3-month period, tobacco-related articles were clipped from 180 daily and weekly newspapers. Variables coded included adaptations of the original ASSIST categories. During development and testing, additional variables were added to make the protocol more comprehensive and sensitive to tobacco policy media coverage. Intercoder reliabilities were calculated for all nonstatic variables using Cohen’s kappa. Disagreements were resolved through group discussions. Two rounds of testing achieved ratings above .70 for all variables. The protocol improves dramatically upon the ASSIST model by providing greater breadth and depth of analysis and more sensitivity to the nuances of newspaper coverage of tobacco-related issues. Given its simplicity, the protocol could also prove valuable for antitobacco advocacy groups who wish to track the changes in public and media opinions.

Smokeless Tobacco Risk Comparison and Other Debate Messages in the News

OBJECTIVES

Public health professionals have debated the use of smokeless tobacco (SLT) over cigarettes for harm reduction. This article describes SLT and cigarette risk comparisons and other SLT "debate" messages potentially reaching the public through news stories.

METHODS

We conducted a content analysis of SLT-related 2006-10 articles from top newspapers and selected news wires.

RESULTS

About 16% of articles (N = 677) referred to SLT as less harmful than smoking, attributing these messages to public health professionals as frequently as to tobacco company representatives. About 29% of articles included an "anti" SLT message, including variously phrased warnings that SLT is not a safe smoking alternative, or other potential consequences such as youth uptake.

CONCLUSION

Professionals should begin developing and using more consistent messages about SLT's risks.

Making News: The Appearance of Tobacco Control Organizations in Newspaper Coverage of Tobacco Control Issues

Purpose.

To characterize the presence of advocacy groups in media coverage about tobacco issues.

Design.

A content analysis of tobacco-related newspaper articles.

Setting.

Australia.

Sample.

All 12 national and state capital daily newspapers published in Australia between 2004 and 2007.

Measures.

We coded each article for explicit mentions of any of 16 major national or state tobacco control advocacy groups; for the article type, prominence, and topic; for the tone of the event; and for the author's opinion.

Analysis.

A series of 2 × 2 χ2 analyses assessed the extent to which advocacy groups were more or less likely to be mentioned in articles of each type, prominence, topic, event impact, and opinion orientation.

Results.

Of the 4387 tobacco-related articles published over this period, 22% mentioned an advocacy group. There was a greater-than-expected proportion of advocacy groups mentioned in news articles with very high prominence (44%; χ2 [1, N = 3118] = 27.4, p < .001), high prominence (34%; χ2 [1, N = 3118] = 10.9, p < .001), and medium prominence (30%; χ2 [1, N = 3118] = 7.3, p = .007), and in articles covering events with mixed (30%; χ2 [1, N = 4387] = 10.0, p = .002) or positive (24%; χ2 [1, N = 4387] = 26.1, p < .001) implications for tobacco control.

Conclusions.

Australian tobacco control advocacy groups have a reasonable presence within the news discourse on tobacco control issues and so are likely to contribute to generating and shaping this discourse, particularly in relation to evolving and controversial issues.

Knowledge and use of folic acid in women of reproductive age

Folic acid reduces the risk of neural tube defects. As approximately 50% of pregnancies are unintended, women of reproductive age should be aware of the importance of folic acid. We reviewed the existing literature on these women's knowledge of folic acid and neural tube defects. Databases searched were PubMed, CINAHL, and Health Reference Center Academic. We used terms such as "folic acid knowledge" and "folic acid awareness" to search articles published from 1998 to 2010. Awareness of the benefits of folic acid before conception and during pregnancy was low, although knowledge levels were associated with education and household income. Women who were already knowledgeable about folic acid cited health care professionals, magazines and newspapers, and radio and television as common sources of information. Effective knowledge translation is needed to ensure that women are informed about the benefits of folic acid during the reproductive years. This knowledge will allow them to make informed decisions about folic acid consumption. Health care professionals play an influential role in promoting folic acid knowledge among women of childbearing age. Lower levels of knowledge among women with lower levels of education and/or household income must be addressed.

The nature, scope, and development of the global tobacco control epistemic community

Over the past 50 years, tobacco control has been transformed from a national to a global issue, becoming institutionalized in the World Health Organization (WHO) Framework Convention on Tobacco Control, the first international public health treaty negotiated under the auspices of the WHO. The global tobacco control epistemic community, a worldwide network of professionals with a common interpretation of the science in tobacco use and control, has contributed to this transformation. We investigated the development, structure, and function of this community through interviews and archival documents. Professionals in the community are bound by values and consensual knowledge developed after years of contentious debates undergirded their activities. Although these professionals play multiple roles, they recognize that scientific evidence should inform advocacy and policy activities. Public health professionals should continue to strengthen the links between science and advocacy for policy while being vigilant against industry efforts to undermine the scientific evidence on tobacco use and control.

Tobacco advertising and press coverage of smoking and health in 10 years of Argentinean newspapers

OBJECTIVE

To describe the extent and content of tobacco-related images, advertising and articles published in the largest Argentinean newspapers before and after a voluntary advertising ban implemented in 2001.

METHODS

Issues from four months of each year of the four main national newspapers were examined from 1995 to 2004. We recorded the number of tobacco images (advertisement or not), tobacco-focused articles, space used, and placement within the newspaper. Regression analyses evaluated time trends.

RESULTS

We identified 1800 images and articles from 4828 different issues. Non-advertisement images were the most frequent (71.2%), followed by articles (20%) and advertisement images (8.8%). Advertisements only appeared in the two best selling newspapers with a majority (57%) in the Sunday magazine and 21% in the sports sections. Non-advertisement images were published in the sports and entertainment sections (55%) and showed a public figure in 88%. Of 336 articles, 39% focused on health topics and 55% emphasized the negative effects of tobacco on health. Regression models showed that prior to 2001 there were significant time-related decreases in ad images and articles and significant increases in non-ad images. The trend of each outcome changed direction beginning in 2001 and the magnitude of the change in trend was significant for ad images and non-ad images. The number of non-ad images dropped significantly in 2001 from a model-predicted value of 178 per year to 103 non-ad images and remained constant thereafter.

CONCLUSIONS

Tobacco images exceeded information about tobacco hazards in Argentinean newspapers over this period. Advertisement increased from 2001 to 2005, following the voluntary advertisements ban. Partial advertisement bans are ineffective and a total ban is imperative.

Sources and coverage of medical news on front pages of US newspapers

Background

Medical news that appears on newspaper front pages is intended to reach a wide audience, but how this type of medical news is prepared and distributed has not been systematically researched. We thus quantified the level of visibility achieved by front-page medical stories in the United States and analyzed their news sources.

Methodology

Using the online resource Newseum, we investigated front-page newspaper coverage of four prominent medical stories, and a high-profile non-medical news story as a control, reported in the US in 2007. Two characteristics were quantified by two raters: which newspaper titles carried each target front-page story (interrater agreement, >96%; kappa, >0.92) and the news sources of each target story (interrater agreement, >94%; kappa, >0.91). National rankings of the top 200 US newspapers by audited circulation were used to quantify the extent of coverage as the proportion of the total circulation of ranked newspapers in Newseum.

Findings

In total, 1630 front pages were searched. Each medical story appeared on the front pages of 85 to 117 (67.5%–78.7%) ranked newspaper titles that had a cumulative daily circulation of 23.1 to 33.4 million, or 61.8% to 88.4% of all newspapers. In contrast, the non-medical story achieved front-page coverage in 152 (99.3%) newspaper titles with a total circulation of 41.0 million, or 99.8% of all newspapers. Front-page medical stories varied in their sources, but the Washington Post, Los Angeles Times, New York Times and the Associated Press together supplied 61.7% of the total coverage of target front-page medical stories.

Conclusion

Front-page coverage of medical news from different sources is more accurately revealed by analysis of circulation counts rather than of newspaper titles. Journals wishing to widen knowledge of research news and organizations with important health announcements should target at least the four dominant media organizations identified in this study.

Philip Morris's health information web site appears responsible but undermines public health

Many people may search for information about tobacco use, the largest cause of preventable mortality in the United States, on the Internet. In 1999, Philip Morris U.S.A. (PM), the country's biggest cigarette manufacturer, posted a Web site and launched a campaign to encourage people to obtain information about tobacco and health issues there. The company asserted that its goal was to deliver the messages of the public health community about tobacco. However, internal tobacco company documents reveal that the site was a public relations effort intended to help the company avoid punishment and regulation. Examination of the language on the Web site reveals many contradictions and omissions that may undermine public health messages. Among these are vague and confusing information about addiction, tar, and nicotine, a lack of motivators to quit smoking, and silence about tobacco-related mortality. By appearing to join with public health organizations in disseminating "responsible" messages about tobacco, PM may improve its image, thus facilitating its ability to continue to sell its lethal products. Public health nurses should be prepared to examine health information on the Internet for subtle biases, to counter PM's specific language about smoking to patients, and to challenge PM's larger corporate goals.

"Accommodating" smoke-free policies: tobacco industry's Courtesy of Choice programme in Latin America

OBJECTIVE

To understand the implementation and effects of the Courtesy of Choice programme designed to "accommodate" smokers as an alternative to smoke-free policies developed by Philip Morris International (PMI) and supported by RJ Reynolds (RJR) and British American Tobacco (BAT) since the mid-1990s in Latin America.

METHODS

Analysis of internal tobacco industry documents, BAT "social reports", news reports and tobacco control legislation.

RESULTS

Since the mid-1990s, PMI, BAT and RJR promoted Accommodation Programs to maintain the social acceptability of smoking. As in other parts of the world, multinational tobacco companies partnered with third party allies from the hospitality industry in Latin America. The campaign was extended from the hospitality industry (bars, restaurants and hotels) to other venues such as workplaces and airport lounges. A local public relations agency, as well as a network of engineers and other experts in ventilation systems, was hired to promote the tobacco industry's programme. The most important outcome of these campaigns in several countries was the prevention of meaningful smoke-free policies, both in public places and in workplaces.

CONCLUSIONS

Courtesy of Choice remains an effective public relations campaign to undermine smoke-free policies in Latin America. The tobacco companies' accommodation campaign undermines the implementation of measures to protect people from second-hand smoke called for by the World Health Organization Framework Convention on Tobacco Control, perpetuating the exposure to tobacco smoke in indoor enclosed environments.

Tobacco images and texts in Norwegian magazines and newspapers

BACKGROUND

Print media may influence smoking behaviour through tobacco advertisements and editorial use of tobacco pictures and texts. In Norway tobacco advertising has been banned for many years. The authors studied the coverage of tobacco promotion and tobacco and health in some general Norwegian magazines and newspapers. The findings were related to the publications' policy as stated by their editors.

METHODS

During three months in 1998-99 all pictures of tobacco and smoking situations were registered, plus the coverage on health aspects of tobacco in all consecutive issues of 7 newspapers and 19 magazines. The editors were asked about their attitudes regarding indirect tobacco advertisement and editorial use of people smoking.

RESULTS

All editors for men's magazines and the majority of newspaper editors had no restrictions on displaying both indirect tobacco advertisements and images of people smoking. In total, 610 texts or pictures on tobacco were found in the 624 issues of magazines and newspapers. Only 26 items were indirect tobacco advertisements. Items promoting smoking were more common than coverage of tobacco and health (71% vs 29%), and occurred most frequently in men's magazines (2.1 per issue) and least frequently in local newspapers (0.3 per issue). The proportion of tobacco and health coverage compared with the total tobacco coverage was significantly lower in men's than in family magazines and local newspapers.

CONCLUSION

Editors should be encouraged to increase the coverage of tobacco and health in print media. This may be an important factor in helping their readers to give up or not to take up smoking.

'We will speak as the smoker': the tobacco industry's smokers' rights groups

INTRODUCTION

The tobacco industry usually keeps its commercial and political communications separate. However, the images of the smoker developed by the two types of communication may contradict one another. This study assesses industry attempts to organize 'smokers' rights groups,' (SRGs) and the image of the smoker that underlay these efforts.

METHODS

Searches of the Legacy Tobacco Documents Library, the British American Tobacco documents database, and Tobacco Documents Online.

RESULTS

1100 documents pertaining to SRGs were found, including groups from across Europe and in Australia, New Zealand, and Hong Kong. From the late 1970s through the late 1990s they were active in numerous policy arenas, particularly the defeat of smoke-free laws. Their strategies included asserting their right to smoke and positioning themselves as courteous victims of tobacco control advocates. However, most SRGs were short-lived and apparently failed to inspire smokers to join in any significant numbers.

CONCLUSION

SRGs conflated the legality of smoking with a right to smoke. SRGs succeeded by focusing debates about smoke-free policies on smokers rather than on smoke. However, SRGs' inability to attract members highlights the conflict between the image of the smoker in cigarette ads and that of the smokers' rights advocate. The changing social climate for smoking both compelled the industry's creation of SRGs, and created the contradictions that led to their failure. As tobacco control becomes stronger, the industry may revive this strategy in other countries. Advocates should be prepared to counter SRGs by exposing their origins and exploiting these contradictions.

Pictures worth a thousand words: noncommercial tobacco content in the lesbian, gay, and bisexual press

Smoking prevalence in the lesbian, gay, and bisexual (LGB) community is higher than in the mainstream population. The reason is undetermined; however, normalization of tobacco use in the media has been shown to affect smoking rates. To explore whether this might be a factor in the LGB community, we examined noncommercial imagery and text relating to tobacco and smoking in LGB magazines and newspapers. Tobacco-related images were frequent and overwhelmingly positive or neutral about tobacco use. Images frequently associated smoking with celebrities. Text items unrelated to tobacco were often illustrated with smoking imagery. Text items about tobacco were likely to be critical of tobacco use; however, there were three times as many images as text items. The number of image items was not accounted for by the number of text items: nearly three quarters of all tobacco-related images (73.8%) were unassociated with relevant text. Tobacco imagery is pervasive in LGB publications. The predominant message about tobacco use in the LGB press is positive or neutral; tobacco is often glamorized. Noncommercial print images of smoking may normalize it, as movie product placement does. Media advocacy approaches could counter normalization of smoking in LGB-specific media.

Nursing's involvement in tobacco control: historical perspective and vision for the future

There is little evidence that nursing organizations have played a major leadership role in addressing tobacco control at the political level, and none have addressed collectively, in any sustained way, the role of the tobacco industry, the primary vector of the tobacco disease epidemic. The aims of this article are (a) to explore what accounts for organized nursing's relative quiescence about tobacco industry and (b) to elucidate why a nursing voice would be especially effective in addressing the industry as a vector of the tobacco disease epidemic. Drawing on the internal tobacco industry documents research, and incorporating a critical theoretical perspective on education, research, and practice, it is argued that tobacco cessation cannot be viewed solely as an individual problem but must be understood in a sociopolitical context and promoting a nursing agendum on cessation research and practice requires educating (and energizing) nurses on the sociopolitics of tobacco. Because of nurses' numbers, class status, political capital, and moral authority in society, they are the group of health professionals whose voices are needed urgently at this historical moment to help avert the global tobacco epidemic. The Nightingales is an example of a nursing group involved in activism against the tobacco industry, applying findings from research on the industry to engage nurses in tobacco control activism, research, and education. The cessation research agenda should include research on the tobacco industry and how its activities influence cessation, how political activism influences cessation, and how critical education may advance cessation research, policies, and practices.

German tobacco industry's successful efforts to maintain scientific and political respectability to prevent regulation of secondhand smoke

OBJECTIVE

To examine the tactics the tobacco industry in Germany used to avoid regulation of secondhand smoke exposure and to maintain the acceptance of public smoking.

METHODS

Systematic search of tobacco industry documents available on the internet between June 2003 and August 2004.

RESULTS

In West Germany, policymakers were, as early as the mid 1970s, well aware of the fact that secondhand smoke endangers non-smokers. One might have assumed that Germany, an international leader in environmental protection, would have led in protecting her citizens against secondhand smoke pollution. The tobacco manufacturers in Germany, however, represented by the national manufacturing organisation "Verband" (Verband der Cigarettenindustrie), contained and neutralised the early debate about the danger of secondhand smoke. This success was achieved by carefully planned collaboration with selected scientists, health professionals and policymakers, along with a sophisticated public relations programme.

CONCLUSIONS

The strategies of the tobacco industry have been largely successful in inhibiting the regulation of secondhand smoke in Germany. Policymakers, health professionals, the media and the general public should be aware of this industry involvement and should take appropriate steps to close the gap between what is known and what is done about the health effects of secondhand smoke.

Philip Morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke

BACKGROUND

Exposure to secondhand smoke causes lung cancer; however, there are little data in the open literature on the in vivo toxicology of fresh sidestream cigarette smoke to guide the debate about smoke-free workplaces and public places.

OBJECTIVE

To investigate the unpublished in vivo research on sidestream cigarette smoke done by Philip Morris Tobacco Company during the 1980s at its Institut für Biologische Forschung (INBIFO).

METHODS

Analysis of internal tobacco industry documents now available at the University of California San Francisco Legacy Tobacco Documents Library and other websites.

RESULTS

Inhaled fresh sidestream cigarette smoke is approximately four times more toxic per gram total particulate matter (TPM) than mainstream cigarette smoke. Sidestream condensate is approximately three times more toxic per gram and two to six times more tumourigenic per gram than mainstream condensate by dermal application. The gas/vapour phase of sidestream smoke is responsible for most of the sensory irritation and respiratory tract epithelium damage. Fresh sidestream smoke inhibits normal weight gain in developing animals. In a 21 day exposure, fresh sidestream smoke can cause damage to the respiratory epithelium at concentrations of 2 microg/l TPM. Damage to the respiratory epithelium increases with longer exposures. The toxicity of whole sidestream smoke is higher than the sum of the toxicities of its major constituents.

CONCLUSION

Fresh sidestream smoke at concentrations commonly encountered indoors is well above a 2 microg/m3 reference concentration (the level at which acute effects are unlikely to occur), calculated from the results of the INBIFO studies, that defines acute toxicity to humans. Smoke-free public places and workplaces are the only practical way to protect the public health from the toxins in sidestream smoke.

A decade of research on health content in the media: the focus on health challenges and sociocultural context and attendant informational and ideological problems

There is a burgeoning interest in the health and illness content of popular media in the domains of advertising, journalism, and entertainment. This article reviews the past 10 years of this research, describing the relationship between the health topics addressed in the research, the shifting focus of concerns about the media, and, ultimately, the variation in problems for health promotion. I suggest that research attending to topics related to bodily health challenges focused on whether popular media accurately or appropriately represented health challenges. The implication was that there is some consensus about more right or wrong, complete or incomplete ways of representing an issue; the problem was that the media are generally wrong. Alternatively, research addressing topics related to sociocultural context issues focused on how certain interests are privileged in the media. The implication was that competing groups are making claims on the system, but the problem was that popular media marginalizes certain interests. In short, popular media is not likely to facilitate understandings helpful to individuals coping with health challenges and is likely to perpetuate social and political power differentials with regard to health-related issues. I conclude by offering some possibilities for future health media content research.

Framing pub smoking bans: an analysis of Australian print news media coverage, March 1996-March 2003

OBJECTIVE

To investigate framing strategies used by the Australian Hotels Association (AHA) and tobacco control groups to (respectively) resist or advocate laws providing smoke free bars.

METHODS

Online archives of Australian print media were searched 1996 to 2003. A thematic analysis of all statements made by AHA spokespeople and tobacco control advocates was conducted. Direct quotes or journalistic summaries of statements attributed to named people were coded into four broad themes and the slant of articles coded.

RESULTS

More than three times as many articles reported issues that were positive (n = 171) than negative (n = 48) for tobacco control objectives. The AHA emphasised negative economic issues and cultural/ideological frames about cultural identity, while tobacco control interests emphasised health concerns as well as cultural/ideological frames about threats to inequitable workplace policies.

CONCLUSIONS

Smoke free bars have now been secured, suggesting that health advocates' position prevailed. The inability of the AHA to avoid the core health arguments, its wildly exaggerated economic predictions, and its frequent recourse to claiming smoke bans threatened nostalgic but outmoded vistas of Australian day to day life were decidedly backward looking and comparatively easily dismissed as being out of touch with views held by many in contemporary Australia. Health groups' emphasis on the unfairness in denying the most occupationally exposed group the same protection that all other workers enjoyed under law was powerfully and consistently argued. Australia's recent success in securing dates for the implementation of smoke free pubs is likely to have owed much to the enduring media advocacy by health groups.

News media tracking of tobacco control: a review of sampling methodologies

News media tracking can be used to understand the content of news coverage and quantify its influence on public opinion and the social environment. We hypothesize that a parsimonious sampling of public health news coverage can gather statistically equivalent information to capture a census of coverage. We tested two general approaches to sampling. First, we randomly selected articles within a timeframe. Second, we randomly selected dates during 2000. None of these strategies showed a substantial deviation from the 2000 census of articles. We conclude that sampling coverage can produce estimates statistically equivalent to a census. Researchers should utilize coverage sampling.

Media advocacy and newspaper coverage of tobacco issues: A comparative analysis of 1 year's print news in the United States and Australia

Tobacco control advocates now recognize the value of influencing news coverage of tobacco; news coverage influences attitudes and behavior as well as policy progression. It is, however, difficult to assess the progress of such efforts within a single national and temporal context. Our data represent the first systematic international comparison of press coverage of tobacco issues. Tobacco articles from major daily newspapers in Australia (12 newspapers; 1,188 articles) and the United States (30 newspapers; 1,317 articles) were collected over 1 year (2001). The analysis shows that coverage in the two countries was similarly apportioned between hard news (>70%) and opinion pieces. Similarly, stories in both countries were most likely to recount positive events. The substantive focus of coverage, however, differed, as did the expression of hostile opinion toward tobacco control efforts (United States, 4%; Australia, 7.1%). Although secondhand smoke and education, cessation, and prevention efforts were covered widely in both settings, these topics dominated coverage in Australia (29.2%) more than in the United States (17.6%), where a more diffuse set of tobacco topics gained relative prominence. The difference in policy conditions seems to offer contrasting opportunities for advocates in the two countries to use newspapers to promote helpful tobacco control messages for both behavior and policy change.

Turning free speech into corporate speech: Philip Morris' efforts to influence U.S. and European journalists regarding the U.S. EPA report on secondhand smoke

BACKGROUND

Previously secret internal tobacco company documents show that the tobacco industry launched an extensive multifaceted effort to influence the scientific debate about the harmful effects of secondhand smoke. Integral to the industry's campaign was an effort to derail the Environmental Protection Agency's (EPA) risk assessment on environmental tobacco smoke (ETS) by recruiting a network of journalists to generate news articles supporting the industry's position and pushing its public relations messages regarding the ETS issue.

METHODS

Searches of previously secret internal tobacco industry records were conducted online and at the Minnesota Tobacco Document Depository. In addition, searches on the World Wide Web were conducted for each National Journalism Center alumnus. Lexis-Nexis was used to locate news stories written by the journalists cited in this paper.

RESULTS

Philip Morris turned to its public relations firm Burson Marsteller to "build considerable reasonable doubt em leader particularly among consumers" about the "scientific weaknesses" of the EPA report. A Washington, DC, media and political consultant Richard Hines was a key player in carrying out Burson Marsteller's media recommendations of "EPA bashing" for Philip Morris. In March 1993, Philip Morris' vice president of corporate affairs policy and administration reported to Steve Parrish, vice president and general counsel of Philip Morris, that their consultant was "responsible for a number of articles that have appeared in em leader major news publications regarding EPA and ETS." In addition to placing favorable stories in the press through its consultant, Philip Morris sought to expand its journalist network by financially supporting a U.S. school of journalism; the National Journalism Center (NJC). Philip Morris gleaned "about 15 years worth of journalists at print and visual media throughout the country em leader to get across [its] side of the story" resulting in "numerous pieces consistent with our point of view." The company planned to "design innovative strategies to communicate [its] position on ETS through education programs targeting policy makers and the media" via the NJC. Finally, journalists associated with think tanks that were financially supported by Philip Morris wrote numerous articles critical of the EPA.

CONCLUSIONS

This is the first report, from the tobacco industry's own documents, to show the extent to which the tobacco industry has gone to influence the print media on the issue of the health effects of secondhand smoke. Unfortunately, what we report here is that even journalists can fall victim to well-orchestrated and presented public relations efforts regardless of their scientific validity. It is not clear how various professional media organizations oversee the ethical conduct of their members. Certainly, on the topic of the health effects of secondhand smoke, more scrutiny is warranted from these organizations for articles written by their members lest the public be misinformed and thus ill served.

Role of the media in influencing trajectories of youth smoking

This paper summarizes results of empirical studies on cigarette advertising and promotions, antismoking advertising, product placement in movies, on television and in music media and news coverage about smoking. In addition, we provide an overview of some of the theoretical literature relevant to the study of media uses and effects. Finally, we discuss empirical findings in the context of these theories to draw some conclusions about media influences on smoking and identify issues for further research. We conclude that (a) the media both shape and reflect social values about smoking; (b) the media provide new information about smoking directly to audiences; (c) the media act as a source of observational learning by providing models which teenagers may seek to emulate; (d) exposure to media messages about smoking also provides direct reinforcement for smoking or not smoking; (e) the media promote interpersonal discussion about smoking; (f) the media can influence "intervening" behaviors that may make teenage smoking less likely; and (g) antismoking media messages can also set the agenda for other change at the community, state or national level. We outline priorities for further research which emphasize the need for longitudinal studies, multi-level studies, an awareness of the probably dynamic relationship between tobacco advertising and antismoking advertising, the importance of determining appraisal of tobacco industry youth smoking prevention efforts and the dearth of research on news coverage about smoking.

Tobacco industry efforts to defeat the occupational safety and health administration indoor air quality rule

OBJECTIVES

We describe tobacco industry strategies to defeat the Occupational Safety and Health Administration (OSHA) Indoor Air Quality rule and the implementation of those strategies.

METHODS

We analyzed tobacco industry documents, public commentary on, and media coverage of the OSHA rule.

RESULTS

The tobacco industry had 5 strategies: (1) maintain scientific debate about the basis of the rule, (2) delay deliberation on the rule, (3) redefine the scope of the rule, (4) recruit and assist labor and business organizations in opposing the rule, and (5) increase media coverage of the tobacco industry position. The tobacco industry successfully implemented all 5 strategies.

CONCLUSIONS

Our findings suggest that regulatory authorities must take into account the source, motivation, and validity of arguments used in the regulatory process in order to make accurately informed decisions.

Helping journalists get it right: a physicians's guide to improving health care reporting

News reports are the way that most people, including many physicians and scientists, first learn about new developments in medicine. Because these reports can raise awareness, influence behavior, and confer credibility, physicians should share responsibility with the media for accurate reporting. Physicians can work with reporters to avoid sensationalizing tentative findings, overstating benefits, and making inappropriate generalizations. This article includes pragmatic suggestions for crafting effective news releases and explaining numerical data. It details "rules of the road" for interviews. Working collaboratively with news reporters to improve the quality of medical stories in the lay press benefits patients and physicians alike.

Tobacco industry success in preventing regulation of secondhand smoke in Latin America: the "Latin Project"

OBJECTIVE

To examine the tobacco industry's strategy to avoid regulations on secondhand smoke exposure in Latin America.

METHODS

Systematic search of tobacco industry documents available through the internet. All available materials, including confidential reports regarding research, lobbying, and internal memoranda exchanged between the tobacco industry representatives, tobacco industry lawyers, and key players in Latin America.

RESULTS

In Latin America, Philip Morris International and British American Tobacco, working through the law firm Covington & Burling, developed a network of well placed physicians and scientists through their "Latin Project" to generate scientific arguments minimising secondhand smoke as a health hazard, produce low estimates of exposure, and to lobby against smoke-free workplaces and public places. The tobacco industry's role was not disclosed.

CONCLUSIONS

The strategies used by the industry have been successful in hindering development of public health programmes on secondhand smoke. Latin American health professionals need to be aware of this industry involvement and must take steps to counter it to halt the tobacco epidemic in Latin America.

Programs and policies to discourage the use of tobacco products

The past 50 years has witnessed a dramatic change in attitudes toward and use of tobacco by Americans that has resulted in recent declines in the incidence of lung cancer. Most public health scholars believe that this change has been accelerated by public policy interventions to reduce tobacco use. The research literature suggests that the most potent demand reducing influences on tobacco use have been efforts to increase the financial cost of using tobacco products primarily through taxation, smoke-free policies, comprehensive advertising bans, and paid counter-advertising campaigns. New therapies for treating nicotine dependence and measures to liberalize access to medicinal forms of nicotine have the potential to revolutionize the way societies address the problem of tobacco use in the future. Unfortunately, the economic reality of the tobacco business has hindered public health efforts to curb the use of tobacco products. While government regulation of tobacco products is a worthy goal, capitalism, and not government regulation, most likely holds the greatest potential to rapidly alter the worldwide epidemic of tobacco caused disease. It is up to the public health community to harness the powers of capitalism to speed the development of less dangerous alternatives to the conventional cigarette.

The cigar revival and the popular press: a content analysis, 1987-1997

OBJECTIVES

The purpose of this study was to examine print media coverage of cigars during the period 1987 to 1997.

METHODS

A content analysis of 790 cigar-focused newspaper and magazine articles was conducted.

RESULTS

Cigar-focused articles increased substantially over the study period, paralleling increased cigar consumption. Articles focused on cigar business (39%) and events (19%). Only 4% of articles focused on health effects. Sixty-two percent portrayed cigars favorably. The tobacco industry was mentioned in 54% of articles and portrayed positively in 78%. Forty-two percent of the individuals quoted or described in articles were affiliated with the tobacco industry; only 5% were government/public health figures.

CONCLUSIONS

Print coverage of cigars failed to communicate health risk messages and contributed to positive images of cigars.

Coverage by the news media of the benefits and risks of medications

BACKGROUND

The news media are an important source of information about new medical treatments, but there is concern that some coverage may be inaccurate and overly enthusiastic.

METHODS

We studied coverage by U.S. news media of the benefits and risks of three medications that are used to prevent major diseases. The medications were pravastatin, a cholesterol-lowering drug for the prevention of cardiovascular disease; alendronate, a bisphosphonate for the treatment and prevention of osteoporosis; and aspirin, which is used for the prevention of cardiovascular disease. We analyzed a systematic probability sample of 180 newspaper articles (60 for each drug) and 27 television reports that appeared between 1994 and 1998.

RESULTS

Of the 207 stories, 83 (40 percent) did not report benefits quantitatively. Of the 124 that did, 103 (83 percent) reported relative benefits only, 3 (2 percent) absolute benefits only, and 18 (15 percent) both absolute and relative benefits. Of the 207 stories, 98 (47 percent) mentioned potential harm to patients, and only 63 (30 percent) mentioned costs. Of the 170 stories citing an expert or a scientific study, 85 (50 percent) cited at least one expert or study with a financial tie to a manufacturer of the drug that had been disclosed in the scientific literature. These ties were disclosed in only 33 (39 percent) of the 85 stories.

CONCLUSIONS

News-media stories about medications may include inadequate or incomplete information about the benefits, risks, and costs of the drugs as well as the financial ties between study groups or experts and pharmaceutical manufacturers.