Cancer-related stigma in the USA and Israeli mass media: an exploratory study of structural stigma

PURPOSE

Cancer is considered a stigmatized condition in many cultures. One key cultural site that produces illness-related structural stigma is mass media. This study explored the social construction of cancer-related stigma in mass media during the time of COVID-19. Specifically, we compared how cancer-related stigma is constructed in two contexts: American and Israeli mass media.

METHODS

Two samples were drawn: all articles that mentioned cancer and published in a 4-month period in USA Today (N = 117) and Israel Today (N = 108). Inductive Thematic Analysis was used to analyze the articles.

RESULTS

Three similar themes were identified in the samples: "the trivialization of cancer," "cancer as metaphor," and the "the war against cancer." In both samples, people with cancer were depicted as heroic. Despite the similarities in themes, how each theme was constructed reflected sociocultural differences between the two samples.

CONCLUSIONS

There appear to be presented universal mechanisms of cancer-related stigma in the media, alongside cultural differences in how they are employed and constructed.

IMPLICATIONS FOR CANCER SURVIVORS

The results stress the importance of debunking cancer-related stigma in the media and elsewhere. Cancer survivors and their families, reporters, researchers, and other stakeholders in the two studied countries should collaborate to devise culturally informed guidelines for reporting and writing about cancer.

The Impact of High-Profile Sexual Abuse Cases in the Media on a Pediatric Emergency Department

High-profile media cases of sexual abuse may encourage disclosures of abuse from victims of unrelated assaults and also influence parental concerns, leading to increased emergency department visits. In the region of the study authors' institution, there are two recent high-profile sexual abuse cases with media coverage: Earl Bradley, a Delaware pediatrician, and Jerry Sandusky, a Pennsylvania college football coach. This is a retrospective cohort study of children evaluated for sexual abuse at a pediatric emergency department. Patients were classified as either presenting during a media period or non-media period. The media periods were one-month periods immediately following breaking news reports, when the cases were highly publicized in the media. The non-media periods were the 12-month periods directly preceding the first reports. The median number of emergency department visits per month during a non-media period was 9 visits (interquartile range 6-10). There were 11 visits in the month following the Sandusky case and 13 visits following the Bradley case. There was no statistical difference in number of emergency department visits for sexual abuse between the periods (p = .09). These finding have implications regarding use of resources in pediatric EDs after high-profile sexual abuse cases.

The breast cancer fanfare: Sociocultural factors and women's health in Ghana

Traditional notions of the "full" woman and sociocultural beliefs about gender roles contribute to a unique experience of breast cancer in Africa. I used the critical feminist lens to analyze dis-courses about breast cancer in mainstream Ghanaian media. I found that breast cancer awareness is promoted amidst fanfare and that cultural notions of the female breasts, including their sexual appeal, are implied in breast cancer discourse. This obscures a nuanced understanding of the disease and women's health globally, limits the power of women to name their experiences, and contributes to the late presentation of the dis-ease in sub-Saharan Africa. I discuss the implications of the findings for international, interdisciplinary scholarship.

Cancer in the News: Religious Themes in News Stories about People with Cancer

The prevalence of religious themes in 258 news stories of 382 people with cancer is reported in a study of the anglophone press. Such themes are rare, even in news reports from the USA, where other indicators suggest a high level of religiosity in the population. For the 35 people where religious themes are present, religion is portrayed as a marginal set of beliefs. Thus religious belief is associated with membership of a minority ethnic group, outmoded traditional authority, a matter of last resort after medicine has failed, or as childlike. Nevertheless, people with cancer are portrayed as preoccupied with issues of responsibility and moral character that have traditionally been addressed in religious discourse. The view that these preoccupations are addressed by depicting cancer as a psychological journey is considered.

Chemoprevention for Healthy Women: Harbinger of Things to Come?

Chemoprevention is a new form of medicalization in which healthy individuals take medications to reduce their risk of getting a disease. For the first time, a cancer chemotherapy agent has been approved for use in women who may be at high risk of getting breast cancer, but do not have the disease. Rather than promoting this remarkable new use of a drug to physicians alone, the manufacturer is advertising it directly to women in print and broadcast media. The article reports a study of women’s responses to these ads and discusses emerging meanings associated with the new category of being ‘at risk.’

‘The Problem with Men’: Working-class Men Making Sense of Men’s Health on Television

Men have higher rates of premature death than women, and may arguably have higher rates of serious illness. One explanation often suggested to account for this is that men are considered to be stoical about illness and reluctant to seek help for it. This article explores the role of media representations in the construction of men’s views about health. We investigate how a small group of lower socio-economic status men make sense of the reluctance to seek help notion through an analysis of texts from three sources: a television health documentary, individual interviews with the men and a focus group discussion in which the men discuss the documentary. The television documentary frames its presentation to promote early detection and help-seeking. We conclude that televised coverage of men’s health is an important site of social discourse through which men’s health is rendered meaningful. However, it is not accepted passively, but negotiated, resisted and interpreted into men’s lives.

Examining Media Representations: Benefits for Health Psychology

Health psychology has tended to undervalue analyses of media representations of health, disease and illness. In this article I argue that critical approaches to media texts and images are valuable for health psychologists because:

(1) individuals are socially located and gain their beliefs about health and illness from the discourses and constructions that are available to them;

(2) media representations of health, illness and disease produce and reproduce meaning concerning health and illness, for lay people and professionals alike; and

(3) media representations mediate individuals’ lived experiences. These arguments are illustrated throughout with examples from critical and feminist research on representations of women, menopause and midlife. I go on to argue that critical approaches are particularly important in analysing media representations because they explicitly examine the social, cultural and political context of health and illness. Critical approaches increase awareness of control and power issues surrounding dominant representations and also provide possibilities for change and resistance.

"We remain very much the second sex": the constructions of prostate cancer in popular news magazines, 2000-2010

Informed by social constructionism, biomedicalization, and a feminist framework, a discourse analysis was performed on 31 popular news articles published in North America between 2000 and 2010. The magazines construct prostate cancer in a gendered manner. Its construction is rooted in themes that are related to discussions of biology, prostate cancer as a heterosexual problem, the responsibilization of health and masculinity. Through these constructions, the popular news articles reinforce dominant ideals and performances of hegemonic masculinity and male sexuality, traditional femininity, and heteronormativity. While reinforcing such ideals, the prevention, treatment, and knowledge of prostate cancer is constructed as the responsibility of individual men. This study reveals that the articles favor discussions of heteronormativity and hegemonic masculinity over racism, rendering health inequalities silent.

Patterns of self-referral in men with symptoms of prostate disease

OBJECTIVE

Analysis of health statistics reveals that, although men have a shorter life expectancy and a higher mortality rate than women, they have less contact with their GP. This study investigates men's experiences of prostate disease, with a particular focus on how they made the decision to seek medical help.

METHOD

Semi-structured interviews were carried out with 20 men aged 51-75 with prostate disease who had recently contacted their GP. These were audiotaped, transcribed and subjected to interpretative phenomenological analysis.

RESULTS

Analysis revealed that their referral behaviours were profoundly influenced by a need to live up to traditional images of masculinity. Far from being uncaring, men were extremely anxious about their health and fears about the effects of illness and treatment emerged as major influences on their decision to seek help. Their delay in approaching their GP was due to their beliefs about symptoms as markers of serious disease, their ability to hide symptoms from others and their attitude towards male GPs who were often seen as having negative attitudes towards male patients.

CONCLUSIONS

This study identifies some reasons why men with prostate disease may fail to seek medical care and has implications for increasing referral rates for men.

Prostate cancer stories in the Canadian print media: representations of illness, disease and masculinities

Despite the popularity of print media as an information source for men with prostate cancer, the representation of prostate cancer within this medium remains relatively understudied. This article details the findings from an analysis of prostate cancer articles published in two Canadian national newspapers, The Globe and Mail and the National Post, from January 2001 through to December 2006. The 817 prostate cancer articles published during this period were retrieved and reviewed using manifest and latent analyses. Three article categories, illness perspectives, medical perspectives and supplementary were identified in the manifest analysis. The latent analysis was guided by the connections between masculinities and prostate cancer in the newspapers' stories. Findings indicated a low frequency of articles that substantively discussed prostate cancer and that the descriptive content reproduced hegemonic masculine ideals, such as competition and stoicism. The presentation of a truncated illness trajectory and privileging of the curative aspects of biomedicine also depicted medicalised male bodies. Any discussion on the negative effects of treatment or explicit references to marginalized forms of masculinity was conspicuously absent. These findings support how representations of prostate cancer in Canadian newspapers predominately replicate detrimental ideologies and perspectives of men's health.

'Taking charge of your health': discourses of responsibility in English-Canadian women's magazines

This article presents an examination of the ways in which responsibility for health is constructed in popular English-Canadian women's magazines. Women's magazines are a unique media form, acting as guidebooks for women on matters relating to feminine gender roles and are important to examine as part of the corpus of societal discourses which frame our understandings of what it means to be healthy and how good health is achieved. Using discourse analysis several techniques were found which reinforce women's individual responsibility to create and maintain good health for themselves and their families. The magazines instruct women/readers directly about their health-related responsibilities and outline the negative consequences of inaction or incorrect action. The magazines also use the traditional discursive technique of women's personal accounts as both cautionary tales and inspirational stories to encourage readers to actively pursue healthy behaviours. Reflecting and reinforcing the discourse of healthism, women's magazines consistently present health as an important individual responsibility and a moral imperative which creates an entrepreneurial subject position for women. The article concludes by discussing the implications for women's magazine audiences within the ongoing feminist debate about this cultural industry.

A comparison of blogs by depressed men and women

This paper reports on a study comparing Internet blogs written by 45 men and 45 women who self-identified as depressed. Using qualitative and inductive methods, distinct differences among the male and female experiences of depression were documented. Among the most important differences were the distinctions male and female bloggers made in regards to (1) the bio-medicalization of depression; (2) the relative significance of world events as compared to relationships in depression experiences; and (3) violence, including suicide and cutting. Theoretical reasons and explanations for these findings are discussed.

Heart disease and gender in mass print media

Heart disease is a major cause of death, disease and disability in the developed world for both men and women. Nevertheless, the evidence suggests that women are under-diagnosed both because they fail to visit the doctor with relevant symptoms and because doctors tend to dismiss the seriousness of women's symptoms of heart disease. This study examines the way that popular mass print media present the possible links between gender and heart disease. The findings suggest that the 'usual candidates' for heart disease are considered to be high achieving and active men for whom the 'heart attack' is sometimes seen as a 'badge of honour' and a symbol of their success. In contrast, women are less often seen as likely to succumb, but they are portrayed as if they are and ought to be worried about their husbands. Women's own bodies are described as so problematic as to be perhaps useless to diagnose, because they are so difficult to understand and treat.

Mass print media depictions of cancer and heart disease: community versus individualistic perspectives?

This paper is based on a critical discourse content analysis of 40 stories from the 20 highest circulating English-language mass magazines available in Canada and published in Canada or the USA in 2001. It examines the presence or absence of the social determinants perspective in the portrayal of the two most significant causes of morbidity and mortality in these countries: cancer and heart disease. The media analysis documents an absence of reflection of the social determinants viewpoint on these, the most important causes of disease and death. Thus, magazine stories ignore the role of such considerations as income, education level, ethnicity, visible minority or, Aboriginal status, early life experiences, employment and working conditions, food accessibility and quality, housing, social services, social exclusion, or unemployment and employment security in explaining health. Instead, the magazine articles underscore an individualistic approach to disease that assumes that health care is accessible and available to all, and that these diseases are preventable and treatable through individual lifestyle choices in combination with the measures prescribed through conventional medicine. Although cancer and heart disease are framed by a medical discourse, articles tended to emphasise the independence, freedom and power of the individual within the medical care system. The research documents a continuation of the dominance of conventional medicine buttressed by individualism in media stories. Theoretical and methodological issues are discussed. Some of the practical consequences for policy-makers and professionals are noted.

Cancer in the mass print media: Fear, uncertainty and the medical model

Cancer is increasing in incidence and prevalence in North America and around the world. The mass print media play an important role in information provision about prevention, diagnosis and treatment of this disease, as well as informing health policy and personal experience. This paper reports on a content analysis of the portrayal of cancer in the highest circulating magazines available in Canada and published in Canada or the USA in 1991, 1996, 2001. It includes both manifest and latent analysis of the framing and content of cancer stories. Manifest analysis documented the dominance of the medical as compared to the lifestyle and political economy frames and the predominance of articles on breast as compared to other cancers. Latent themes included: an emphasis on fear of cancer in that: (1) cancer and fear are frequently conflated; cancer is said to grow outside of awareness; cancer is portrayed as (almost) inevitable; cancer is associated with normal experiences; early detection is associated with diagnosis; and scary statistics are emphasized; (2) contradictions and confusion exist within and between articles; and (3) metaphors of war and battle are used frequently. The paper concludes with a discussion of the implications of the linking of fear with cancer in the context of medicine as the solution.

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.

The case of the missing person: Alzheimer's disease in mass print magazines 1991-2001

Alzheimer's disease is growing in incidence and prevalence in the developed world. Rates have been increasing as populations have been aging. There are still many unknowns regarding prevention, causes, and treatments. The purpose of this article is to analyze the portrayal of Alzheimer's in the highest-circulation mass print English-language magazines published in the United States and Canada over a period of a decade, specifically those for 1991, 1996, and 2001. This research investigates the portrayal of persons with Alzheimer's, the disease itself, caregivers and experts, and the dominant frames or discourses within which Alzheimer's is described. Twenty-five articles from the highest-circulation mass print magazines available in Canada were studied through qualitative and inductive research of both manifest and latent content. One of the most notable findings is the absence of the person with the disease as a person with a voice, with needs and desires. When the disease itself is described it is characterized as fearsome, relentless, and aggressive. Both the unquestioned duty of the individual caregiver and his or her (usually the caregiver is a woman) suffering are emphasized. The disease, its diagnosis, and potential treatments are framed almost exclusively within a medical rather than a political-economy or lifestyle frame. Minimal attention is paid to prevention, early stages of the disease, social support, options for care, or other alternative understandings of issues related to Alzheimer's. The theoretical and practical significance of these findings is considered.

New directions for critical internet health studies: representing cancer experience on the web

Studies of health representations on the internet have been preoccupied with the assessment of their (medically-defined) accuracy and quality. This contrasts with studies of health representations in 'old' media, where critical sociological analyses are common. Medical sociologists have been concerned to establish the potential of web information in transforming professional-client relations. A case study of breast and prostate cancer web sites provides evidence of the increasing convergence of the 'new' medium of the internet and old media such as newspapers and television. Large institutions are now consolidating their presence on the web so that users experience increasingly similar messages across media platforms. Search engines and links to the web from old media sources direct people to heavily resourced, mainstream health sites where, in the case of cancer, representations of gender are strikingly similar to those found in studies of old media sources. The media convergence thesis contrasts with earlier celebrations of the internet as a new medium that would promote a diversity of perspectives on health. Using existing methods for analysing media texts and developing new methods where appropriate, sociologists and media analysts interested in health need to develop more critical perspectives on this important new medium.

The Information Requirements of People With Cancer

Information is crucial for people with cancer for both successful treatment and rehabilitation and to facilitate user involvement and informed decision making. Research has tended to concentrate on biomedical sources, such as hospital-produced information. There have been few inductive investigations of patients' use of information available outside this environment, despite the media and Internet being identified as pervasive sources of cancer information. This article reports on a study that utilized naturalistic inquiry to explore the extent and manner in which the media and Internet are utilized as information sources by people with cancer. Results confirm that the media was used considerably by the study sample and was an important contributor to knowledge and facilitator for decision making. Participants were not passive receivers of media messages but interpreted it depending on their particular needs or their rating of the media source. Consumption of media-produced information was constrained by certain factors, such as the participants' physical inability to access sources, and needs were not always satisfied because media discourse and "newsworthiness" restricted the reporting of what was sought. The study highlights the importance of the media and Internet as an information source for people with cancer and calls for a greater awareness of this phenomenon.

Masculinity, infertility, stigma and media reports

There is growing concern about the health of men in the developed West. Compared with women they have higher rates of morbidity and mortality and are less likely to seek out and employ medical services. Several authors have drawn on social constructionist models, such as the concept of hegemonic masculinity, to account for these gender differences in risk and behaviour. One might anticipate that certain conditions, such as male infertility, would be perceived as posing a particular threat to conventional views of masculinity. There is some support for this, although there is little research into the social construction of male infertility. In this study Discourse Analysis was employed to analyse newspaper accounts of a reported decline in sperm counts in order to study the way in which infertility and masculinity were represented and constructed in the media. The results indicate a construction of fertility as being in crisis and of male infertility as conflated with impotence. Men were positioned as vulnerable and threatened by forces outside their control. The accounts drew on a range of stereotypically masculine reference points, such as warfare and mechanical analogies. These results are consistent with concepts of hegemonic masculinity and suggest that men are offered a highly restricted set of options in terms of perceiving and representing their bodies and their health.

A comparison of breast, testicular and prostate cancer in mass print media (1996–2001)

This paper compares the portrayal of breast, testicular and prostate cancer in mass print English language magazines in the United States and Canada from 1996 to 2001. It is a follow-up of three papers that examined each of these three diseases separately in high circulating magazines up to 1995. It includes both quantitative and qualitative analyses of magazine stories and notes the continuing dominance of a medical perspective regarding disease as well as the association of each type of cancer examined with stereotypically individualized yet feminine and masculine characteristics and pursuits. It notes the conflation of breast cancer, since the discovery of BRCA1 and BRCA2, with the family. To be a 'feminine' woman is to be vulnerable to breast cancer and to be a 'masculine' man is to be vulnerable to testicular cancer when young and prostate cancer when older. The association of disease not just with personhood but also with the specifics of stereotyped masculinity and femininity may construct a more intimate, more personal link between disease and identity. This close attachment of gender and disease may shore up and exacerbate a fear reaction. It may also serve to diminish the awareness of other, more prevalent, causes of death for men and women. The social control consequences of potentially exacerbated disease-specific fear are discussed.

(Dis)embodying gender and sexuality in testicular cancer

Testicular cancer is the most common cancer in men aged 15-34. Although post-treatment prognosis is generally very good, the impact on sexuality, gender identity and fertility is amplified in this age group. A Canadian study of men with testicular cancer explores how men (re)consider questions of sexuality and gender post diagnosis and treatment. Semi-structured interviews with 40 men were analyzed using thematic decomposition, an analytic technique that combines discursive approaches with thematic analysis. The theoretical framework that guides this work relies on material discursive approaches. From an analytic stance, this perspective is concerned with a focus on the ways in which both subjectivity and the body are experienced and constituted in language. In particular, we are concerned with how these men interpret the (altered) male body as a locus of gender signification and gender disruption. Men in this study construct testicular cancer as alternately inhibiting and enhancing masculinity and sexuality. Disruption interpolates with potentiality. A discourse of precarious masculinity predominates these accounts, wherein the link between anatomy and masculinity is simultaneously asserted and disavowed. Constructions of anatomical essentialism (i.e., testicular integrity is equated with masculinity) are juxtaposed against construals of anatomical superfluousness (i.e., other sites of sexuality and male identity are emphasized as being more central).

Healthy viewing: the reception of medical narratives

This paper draws on two reception studies. One focuses on an American medical drama which respondents perceived as entertainment but also as a reliable source of information from which they collected medical and social data by using emotional and ludic strategies. The second compares parallel illness narratives in a soap opera and a documentary. Soap operas were described by informants as good pedagogic tools because they attracted large audiences and promoted identification and repetition which enhance learning. On the other hand, they criticised the documentary for being incomplete and artificial. The conclusion argues that viewers are media-literate, astute and insightful. They produce sophisticated, subtle interpretations which cannot be predicted by content analyses of programmes alone. More reception research is therefore needed, particularly since television is increasingly omnipresent and provides a considerable portion of the public's medical knowledge.

Cancer coverage in newspapers serving large and small communities in Ontario

Local newspapers are an important source of health news, especially in small communities. We describe the amount and type of cancer information in Ontario daily newspapers dichotomized by circulation size (> 400,000 or < 40,000) and community size (> 250,000 or < 25,000 people) for 1991. All cancer articles (n = 1027) in five newspapers with large circulations, serving large communities, and five newspapers with small circulations, serving small communities, were read and evaluated for focus and newsplay. Although large newspapers had an absolute greater number of cancer articles, there were no significant differences by newspaper size in the number of cancer articles per 1,000 pages. Large newspapers included more cancer articles with a scientific vs. human interest focus than did small newspapers (p < 0.001). Large newspapers tended to use wire services whereas small newspapers tended to use staff reporters. Differences in the type and amount of cancer information varies by newspaper and community size, potentially contributing to differences in community cancer information resources.

Productive readings: the portrayal of health "experts" in women's magazines

This article illustrates how health practitioners are portrayed through advice columns, articles, personal accounts, and advertisements in women's magazines. Magazines provide a valuable source of information about health services and also influence lay knowledge about health and illness. A wide variety of health practitioners provide information and advice in women's magazines, ranging from orthodox medical practitioners to alternative practitioners. However, there is a blurring of boundaries between these, with orthodox practitioners sometimes including alternative therapies in their practice and alternative therapists sometimes encompassing a number of orthodox therapies within their practice. The way health practitioners are represented in the media has implications for how their expertise in health issues is evaluated and used by consumers of health care services.

Patient-blaming and representation of risk factors in breast cancer images

Media coverage of some cancers in the past often equated cancer with a death sentence. Breast cancer coverage in 1990s magazines, however, has become less fatalistic, more frequent, and discusses a broader range of issues than before. This study examined whether the visual images accompanying magazine articles about breast cancer have also evolved. We used Goffman's (1976) rituals of subordination to measure patient-blaming and subordinating, disempowering images. We also analyzed race/ethnicity, body type, and age of females in the images to gauge whether these demographic risk factors were represented in a random sample of images from nine magazines over a 30-year period. Magazines analyzed represented three genres-women's magazines, fashion/beauty, and general news. Findings suggest that patient-blaming images have decreased in some categories and women portrayed are slightly more representative of risk factors of age and race/ethnicity. Magazine images tended to reinforce stereotyped portrayals of femininity to the detriment of cancer patients. Fashion/beauty magazines, aimed at younger women, were most likely to portray breast cancer images in stereotyped, patient-blaming ways, with the least representative images of risk factors. The social construction of feminine beauty seems to overpower accuracy in creating these images.