Health disparities and advertising content of women's magazines: a cross-sectional study

"Our Community Comes First": Investigating Recruitment Ads That Represent and Appeal to Black Women for Online, HIV-Related Research Studies

BACKGROUND

Black women are underrepresented in health-related research. Consulting Black women in the creation of recruitment materials may help increase their representation in research studies, but few of these recruitment materials have been evaluated. This manuscript reports on the impact of two ads (one featuring older women and one featuring younger women) created through multiple focus group sessions with Black women. The purpose of the ads were to recruit Black women to participate in an online research study about HIV prevention and pre-exposure prophylaxis, PrEP.

MATERIALS AND METHODS

Questions about the ads were embedded in the eligibility screener for inclusion in the online parent research study. Respondents were asked which ad they saw, what they liked about it, and what about the ad piqued their interest in the study.

RESULTS

In total, 301 Black women completed the eligibility screener for the online study and answered questions pertaining to the two ads. Most participants reported seeing the ad with younger women (260/301, 86.4%). Representation of Black women (n = 70), ad design (n = 64), relevance to Black women and the Black community (n = 60), and comprehensiveness of ad content (n = 38) were the top 4 ad features respondents liked. Relevance to Black women and the Black community (n = 104) as well as ad content (n = 54) (i.e., study purpose, location, duration, images, incentive) were the top two reasons provided about ads that piqued respondent's interest in the online study.

CONCLUSION

Findings showcase how recruitment ads informed by Black women could help increase their interest and participation in research.

Institutional barriers to clinical trial exploration experienced by the Latinx community

This study evaluated two types of barriers that the authors deemed important to resolve during the early stage of cancer clinical trial exploration by Latinx community members. One was the accessibility of information provided on cancer centers' websites. The other was the telephone responders' clinical trial knowledge and their conveyance of a warm welcome to Latinx callers inquiring about the centers' clinical trials. Simulated clinical trial inquiry calls were made to 17 National Cancer Institute-designated centers in this study. The centers were located in cities where the Latinx community accounted for at least 25% of the population, thereby justifying center-wide efforts to encourage the Latinx community to explore clinical trial participation. A rubric was developed to determine and quantify a Total Score that was partially composed of the accessibility of clinical trial information displayed on each cancer center's website. A research assistant gathered information by posing as a person calling the cancer center to inquire about clinical trials on behalf of a family member with limited English proficiency and evaluated their response using a "mystery shopper" method of data collection. The warmth and sense of welcome conveyed by the telephone responder was also quantified and included in the rubric's Total Score. A perfect Total Score reflected the likely existence of an environment that would encourage Latinx community members to continue exploring clinical trials, i.e., removed or diminished possible barriers. Welcoming characteristics, such as those elements included in the scoring rubric, can be monitored regularly to assure that centers are consistently conveying an optimal sense of welcome to the Latinx community, while also providing accessible clinical trial information. Among the 17 cancer centers, no correlation was found between the size of the Latinx population served and each center's Total Score.

Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study

BACKGROUND

Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of "likes" for each image would not correlate with adherence of the image to these guidelines.

OBJECTIVE

The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines.

METHODS

We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of "likes" for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines.

RESULTS

A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05%) and nonrecommended sleep position (479/1134, 42.24%). The number of "likes" was not correlated with adherence of the image to AAP guidelines.

CONCLUSIONS

Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents.

Maximizing Response Rates to Ads for Free At-Home HIV Testing on a Men-for-Men Geosocial Sexual Networking App: Lessons Learned and Implications for Researchers and Providers

Internet-based recruitment can be effective in reaching large numbers of geographically diverse individuals. Geosocial sexual networking apps on smartphones have emerged as the modal way in which men who have sex with men (MSM) meet sex partners, and as venues for sexual health research. We report on the performance of three types of ads-text-only, text with male figure (no face), and text with male figure (with face)-used on a geosocial sexual networking app to advertise free at-home HIV testing and to enroll in an online study. We ran five 2-week-long ads on a popular MSM geosocial app between fall 2017 and spring 2018 (~2.19 million impressions). Ads were evaluated in terms of the click-through rate (CTR = advertisement clicks/advertisement impressions), conversion rates (CR = number of enrolled participants/ad-generated clicks), cost per enrolled participant, and demographic composition of survey respondents. We enrolled n = 4,023 individuals, n = 2,430 of whom completed HIV testing-$6.21 spent on advertising per participant enrolled and $10.29 spent for everyone who completed HIV testing. Cost per enrolled participant was associated with the content of the ad used-ads featuring male figures (with or without a face shown) were more cost efficient than ads featuring text alone. These ads also outperformed text-only ads across a range of metrics, including responsiveness among younger MSM as well as MSM of color. Advertising materials that combine text with images may have greater appeal among priority populations.

Evaluating the influence of racially targeted food and beverage advertisements on Black and White adolescents' perceptions and preferences

INTRODUCTION

The present study measures how racially-targeted food and beverage ads affect adolescents' attitudes toward ads and brands, purchase intentions for advertised products, and willingness to engage with brands on social media.

METHODS

Black and White adolescents were recruited through Survey Sampling International in 2016. Participants completed an online survey in which they were randomized to view either four food and beverage ads (e.g., soda, candy commercials) featuring Black actors or four food and beverage ads featuring White actors.

RESULTS

For the two components of the attitudinal outcome, Black participants were more likely to report a positive affective response toward racially-similar ads compared to Whites. However, White participants were more likely to like ads that were racially-dissimilar compared to Black participants. Data were analyzed in 2016-2017, and we used an alpha level of 0.05 to denote statistical significance.

CONCLUSIONS

Both Black and White adolescents reported more positive affective responses to ads that featured Blacks compared to ads that featured Whites. Because there were no differences on two outcomes, future research should examine the influence of racially-targeted marketing in real-world contexts (e.g., social media) and longitudinal exposure to targeted advertising on dietary behavior.

Stock Photographs Do Not Comply With Infant Safe Sleep Guidelines

We evaluated images in popular stock photography websites for adherence with American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices. Three top stock photo websites were used to collect photographs generated from key phrases. All images depicting an infant sleep environment were analyzed for consistency with AAP guidelines. Descriptive statistics, chi-square and z test of proportions, were conducted. A total of 1233 of 1947 stock photographs showed sleeping infants on a flat surface. In all, 627 (50.8%) photographs showed the infant in the supine position and 79 (5%) of all infant sleep environments were adherent with AAP recommendations. Bedding inconsistent with safe sleep recommendations was identified in 1133 images (71.3%), with blankets noted in 49.5%. Images depicting sleeping infants on stock photography sites do not routinely adhere to AAP recommendations. Media messages inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.

Ethnicity, education attainment, media exposure, and prenatal care in Vietnam

OBJECTIVE

Prenatal care coverage in Vietnam has been improving, but ethnic minority women still lag behind in receiving adequate level and type of care. This paper examines ethnic disparities in prenatal care utilization by comparing two groups of ethnic minority and majority women.

DESIGN

We examine the roots of ethnic disparity in prenatal care utilization, focusing on how education and media exposure change health behaviours and lessen disparities. We rely on the 2002 Vietnam Demographic and Health Survey to draw our sample, predictors and the three dimensions of prenatal care, including timing of onset, frequency of visits, and type of provider.

RESULTS

Results from multinomial-, and binary-logistic regression provide evidence that ethnic minority women are less likely to obtain frequent prenatal care and seek care from professional providers than their majority counterparts. However, we find that ethnic minority women are more likely to obtain early care compared to ethnic majority women. Results for predicted probabilities suggest that education and media exposure positively influenced prenatal care behaviours with higher level of education and media exposure associating with accelerated probability of meeting prenatal care requirements.

CONCLUSION

Our results imply the needs for expansion of media access and schools as well as positive health messages being broadcasted in culturally competent ways.

Characteristics of medication advertisements found in US women's fashion magazines

Background: Although prescriptions are dispensed at discretion of medical professionals, many pharmaceutical companies use direct-to-consumer (DTC) advertising to increase sales. Over-the-counter (OTC) medications are similarly marketed.

Methods: We examined the content of advertisements in 38 issues of 9 popular US women’s fashion magazines. We evaluated target audience, health condition, product availability, message appeal, target to females, and mention of potential side effects and benefits.

Results: Sixty total medication advertisements were identified, 58.3% (95% CI: 45.8, 70.8) for prescription products. In magazines targeted to non-Hispanic Whites, >65% of advertisements were for OTC medications whereas 80% (95% CI: 66.7, 94.5) of advertisements found in Black/Latina magazines were for prescription medications. The rational appeal was used most commonly in non-Hispanic White magazines (75.9%; 95% CI: 60.3, 91.5). Emotional appeal was featured more often in prescription advertisements magazines (60.0; 95% CI:43.8, 76.2) compared to OTC (8.0; 95% CI: -2.6, 18.6).

Conclusion: Although emotional appeal may be effective for selling medication to women, it often does not completely inform consumers of potential risks.

Applying Common Latino Magazine Cover Line Themes to Health Communications

This study aimed to describe strategies used in magazine cover lines to capture the attention of Latino consumers. A content analysis of cover lines ( n = 581) from six top-selling Latino women’s and parenting magazines ( n = 217 issues) sold in the United States identified 12 common themes: great/inspiring, beauty/health, bad/negative, love/passion, family/protective, strength/power, daring, informative/how-to, newness/uniqueness, improve/organize, happiness/fun, and easy/simple, with the first seven being unique to Latino-targeted magazines. Theses unique themes may be related to certain Latino cultural constructs, such as familismo, machismo, and respeto. Cover lines for nutrition education information mini-magazines were written using the strategies identified in the content analysis, then cognitive tested with 112 Spanish-speaking Latino parents. Parents felt the cover lines matched the guide content, were attention grabbing and catchy, and would motivate parents to read the mini-magazine. Findings can assist health communicators in creating brief Latino-targeted messages that are culturally responsive and capture reader interest.

Food and Beverage Marketing to Latinos

Obesity rates among U.S. adults and children have increased over the past two decades and, although signs of stabilization and decline among certain age groups and geographies are being reported, the prevalence of obesity among Latino adults and children remain high. The Latino population is growing in parallel to these obesity rates and marketers realize they cannot ignore this growing, high-spending, media-consuming segment. Studies examining food and beverage marketing strategies tend to discuss minority groups in general but do not account for racial and ethnic differences, reducing our ability to explain existing inequities. This article aimed to identify the food and beverage marketing strategies used to influence food environments for Latinos versus non-Latinos. A systematic literature review and analysis, guided by an established marketing conceptual framework, determined that the food and beverage marketing environment for Latinos is less likely to promote healthy eating and more likely to encourage consumption of low-nutrient, calorie-dense foods and beverages. This analysis also determined that Latinos’ food environment and the placement of food retail stores appears to influence their body mass index; however, placement of these stores cannot be generalized, as geographical differences exist. While food and beverage marketing is only one of many sources of influence on food and beverage consumption, these findings reinforce the notion that Latinos are at a disadvantage when it comes to exposure of healthy lifestyle messaging and health-promoting food environments.

A Study of the Frequency and Social Determinants of Exposure to Cancer-Related Direct-to-Consumer Advertising Among Breast, Prostate, and Colorectal Cancer Patients

Cancer-related direct-to-consumer advertising (DTCA) is controversial because cancer treatment is complex and entails more risks and costs than typical treatments that are advertised for other conditions. Drawing from the Structural Influence Model of Communication, this study explores communication inequalities in DTCA exposure across social determinants among a population-based sample of 2013 patients diagnosed with breast, prostate, or colorectal cancers. Three survey items assessed patients' frequency of encountering ads concerning treatment alternatives for cancer, dealing with side effects of treatment, and doctors or hospitals offering services for cancer following their diagnosis. The analysis showed that overall exposure to DTCA in this study population was modest (median was once per week). Breast cancer patients reported significantly higher exposure to all three ad categories and overall DTCA exposure than prostate and colorectal cancer patients. Older patients consistently reported lower overall exposure to DTCA across the three cancer types. Other significant correlates included ethnicity (higher exposures among African American prostate cancer patients vs. White; lower exposures in Hispanic colorectal cancer patients vs. White) and cancer stage (higher exposures in Stage IV prostate cancer patients vs. Stages 0-II). Education level did not predict patients' DTCA exposure. The implications of these observed inequalities in DTCA exposure on cancer outcomes are discussed.

Temporality in British young women's magazines: food, cooking and weight loss

OBJECTIVE

The present study examines seasonal and temporal patterns in food-related content of two UK magazines for young women focusing on food types, cooking and weight loss.

DESIGN

Content analysis of magazines from three time blocks between 1999 and 2011.

SETTING

Desk-based study.

SUBJECTS

Ninety-seven magazines yielding 590 advertisements and 148 articles.

RESULTS

Cluster analysis of type of food advertising produced three clusters of magazines, which reflected recognised food behaviours of young women: vegetarianism, convenience eating and weight control. The first cluster of magazines was associated with Christmas and Millennium time periods, with advertising of alcohol, coffee, cheese, vegetarian meat substitutes and weight-loss pills. Recipes were prominent in article content and tended to be for cakes/desserts, luxury meals and party food. The second cluster was associated with summer months and 2010 issues. There was little advertising for conventional foods in cluster 2, but strong representation of diet plans and foods for weight loss. Weight-loss messages in articles focused on short-term aesthetic goals, emphasising speedy weight loss without giving up nice foods or exercising. Cluster 3 magazines were associated with post-New Year and 2005 periods. Food advertising was for everyday foods and convenience products, with fewer weight-loss products than other clusters; conversely, article content had a greater prevalence of weight-loss messages.

CONCLUSIONS

The cyclical nature of magazine content - indulgence and excess encouraged at Christmas, restraint recommended post-New Year and severe dieting advocated in the summer months - endorses yo-yo dieting behaviour and may not be conducive to public health.

Skin cancer prevention coverage in popular US women's health and fitness magazines: an analysis of advertisements and articles

The desire to be tan is a phenomenon that public health researchers have investigated, as exposure to UV radiation increases the chances of developing skin cancer. Media messages in women’s magazines have been shown to contribute to this problem. Much less is known about the prevalence of skin cancer prevention messages in these magazines. This study’s aim was to identify the number and type of articles and advertised products devoted to skin health (sun protection and skin cancer prevention in particular) within five popular U.S. greater than women’s health and fitness magazines. We analyzed articles and advertisements over seven months of issues of the following popular women’s health and fitness magazines: Fitness, Health, Self, Shape, and Women’s Health, March 2013 through September 2013. Overall, 31 issues of the five magazines with a total of 780 articles and 1,986 advertisements were analyzed. Of the 780 articles, a mere 2.9% (n=23) were devoted to skin. Of the 258 skin product advertisements, less than 20% of the products contained sun protection factor (SPF). These findings suggest that women’s health and fitness magazines can improve their efforts in informing women of skin cancer risks and preventive measures to minimize these risks. The role of these magazines in building health literacy among their readers is also discussed.

Food, nutrition and slimming messages in British women's magazines, 1950-1998

BACKGROUND

The present study examined temporality in the representation of food in two popular British women's magazines between 1950 and 1998.

METHODS

A quantitative content analysis of (i) prevalence of cooking, slimming, nutrition advice in articles; (ii) prevalence of food advertising by food type; and (iii) likelihood of various nutrition and consumer messages in advertising was performed on a sample comprising 200 magazines, with 3045 advertisements and 88 articles.

RESULTS

The prevalence of food advertisements decreased (P < 0.001), whereas food articles increased, across decades (P < 0.001). Cooking tips dominated 1950s food writing (100%), contrasting with miniscule coverage in the 1990s (5%). Slimming advice was not represented in 1950s articles and was most common in 1970s articles (55% of articles). Food advertising for all food types decreased in the 1990s decade. There were greater bread and cereals (P < 0.001), protein foods (P = 0.001) and dairy (P < 0.001) advertising in later decades; advertising for sugar- and fat-rich foods (P < 0.001), condiments and baking ingredients (P < 0.001) and beverages (P < 0.001) was greater in earlier decades. Odds of advertising claims for energy, easy digestion, nourishment, general health, economy, good for family (all P < 0.01), pleased others (P = 0.017) and convenience (P = 0.031) were greater in the 1950s and decreased thereafter. Claims around taste and quality were highest in the 1960s (all P < 0.01). Mineral, additive-free, and protein claims were most likely to be invoked in 1970s advertising (all P < 0.01). Low-fat, low-calorie and fibre claims peaked in the 1980s (all P < 0.01), whereas the odds of specific fat claims was greatest in the 1990s (P = 0.015).

CONCLUSIONS

Representation of food resonated with prevailing food culture but was not always congruent with nutrition policy.

Representation of ideal figure size in Ebony magazine: a content analysis

Studies examining trends over time in mainstream magazines observe decreases in women's figure size, and increases in figure exposure and amount of diet/exercise content. Little is known, however, regarding the content of African American magazines. Utilizing methods from classic studies, this investigation examined content in Ebony, a magazine with wide African American readership, from 1969 to 2008. We included the full content of N=462 issues, with a total of N=539 cover images of women, of which N=208 were full-body shots. Analyses indicated a curvilinear relationship between time and figure exposure, with a recent trend toward more full-body shots, similar to mainstream magazines. Contrary to previous studies, however, the majority of figures across time were average size, and a curvilinear relationship between time and diet/exercise content showed peak content in the early 1990s. Results are considered in context of research indicating African American women show less body dissatisfaction than other racial/ethnic groups.

Sociodemographic and substance use correlates of tobacco use in a large, multi-ethnic sample of emergency department patients

Strong evidence suggests marked disparities among ethnic minorities in relation to tobacco use. To date, a majority of the data available discusses tobacco use in the general population. Using a sample of Latino, non-Latino Black (NLB), and non-Latino White (NLW) patients presenting to the emergency departments, the present study examined sociodemographic and substance use correlates of past 3-month tobacco use. Over 48,000 patients were interviewed as part of a screening and brief intervention program in southern California. Overall, although NLB adults reported the greatest prevalence of tobacco use compared to NLWs and Latinos (43% vs. 34% and 22% respectively), associations between tobacco use, demographics and substance use were similar across groups. Males, younger individuals, those with lower income, and being at higher risk for alcohol and drug use were more likely to report recent tobacco use. Future tobacco interventions in emergency settings should highlight these specific risk factors for Latinos, NLBs, and NLWs.

Educational content and health literacy issues in direct-to-consumer advertising of pharmaceuticals

Direct-to-consumer (DTC) pharmaceutical advertisements have been analyzed in many ways, but richer conceptualizations of health literacy have been largely absent from this research. With approximately half of U.S. adults struggling to understand health information, it is important to consider consumers' health literacy when analyzing DTC advertisements. This project, framed by the health belief model, analyzed 82 advertisements. Advertisements provided some kinds of educational content (e.g., drugs' medical benefits) but typically failed to offer other useful information (e.g., other strategies for dealing with conditions). Issues likely to be barriers to low health literate consumers, such as nonstandard text formatting, are common.

An ethic of resistance: choosing life in health messages for African American women

Media messages directed to African American women are more likely to have health content that emphasizes negative outcomes or sexual stereotypes. This paper critiques the use of health messages that focus on high mortality and morbidity rates, yet have not reduced health disparities, but have instead reduced Black women's bodies to carriers of disease. I introduce an ethic of resistance that privileges the authority and wholeness of Black women rather than disease and fragmentation. An ethic of resistance helps Black women connect to their spiritual health, move from passive receiver to active resister of negative messages, and break the generational silence to demystify sexuality and integrate it into a lifestyle of wholeness. My hope is to improve the health outcomes of African American women by improving the message.

Race, ethnicity, language, social class, and health communication inequalities: a nationally-representative cross-sectional study

Background

While mass media communications can be an important source of health information, there are substantial social disparities in health knowledge that may be related to media use. The purpose of this study is to investigate how the use of cancer-related health communications is patterned by race, ethnicity, language, and social class.

Methodology/Principal Findings

In a nationally-representative cross-sectional telephone survey, 5,187 U.S. adults provided information about demographic characteristics, cancer information seeking, and attention to and trust in health information from television, radio, newspaper, magazines, and the Internet. Cancer information seeking was lowest among Spanish-speaking Hispanics (odds ratio: 0.42; 95% confidence interval: 0.28–0.63) compared to non-Hispanic whites. Spanish-speaking Hispanics were more likely than non-Hispanic whites to pay attention to (odds ratio: 3.10; 95% confidence interval: 2.07–4.66) and trust (odds ratio: 2.61; 95% confidence interval: 1.53–4.47) health messages from the radio. Non-Hispanic blacks were more likely than non-Hispanic whites to pay attention to (odds ratio: 2.39; 95% confidence interval: 1.88–3.04) and trust (odds ratio: 2.16; 95% confidence interval: 1.61–2.90) health messages on television. Those who were college graduates tended to pay more attention to health information from newspapers (odds ratio: 1.98; 95% confidence interval: 1.42–2.75), magazines (odds ratio: 1.86; 95% confidence interval: 1.32–2.60), and the Internet (odds ratio: 4.74; 95% confidence interval: 2.70–8.31) and had less trust in cancer-related health information from television (odds ratio: 0.44; 95% confidence interval: 0.32–0.62) and radio (odds ratio: 0.54; 95% confidence interval: 0.34–0.86) compared to those who were not high school graduates.

Conclusions/Significance

Health media use is patterned by race, ethnicity, language and social class. Providing greater access to and enhancing the quality of health media by taking into account factors associated with social determinants may contribute to addressing social disparities in health.

Racial and ethnic disparities in response to direct-to-consumer advertising

PURPOSE

Racial and ethnic disparities in response to direct-to-consumer advertising (DTCA) of pharmaceuticals were studied.

METHODS

Using national survey data of 2814 Americans, Hispanics and African Americans were compared to whites with respect to their exposure and response to DTCA. A 20-minute telephone survey collected basic demographic information from each respondent. Exposure to DTCA was measured by asking if individuals had seen or heard an advertisement for a prescription within the past 12 months. Those who had were asked about their responses to DTCA. Participants' perceptions of the role of DTCA were also examined. Six different variables were used to measure perceived health benefits of DTCA exposure. Exploratory analyses were performed to detect differences, and multivariate logistic regression was conducted to test whether race or ethnicity remained significant in explaining differences while controlling for other personal factors.

RESULTS

Hispanics and African Americans were less likely than whites to be exposed to DTCA, more likely to be influenced by DTCA, and more positive about the health benefits of DTCA exposure. African Americans were also more likely to ask their physicians for a drug advertised via DTCA and have their request refused, which raises an issue about the impact of DTCA on provider-patient relationships.

CONCLUSION

Hispanics and African Americans were less likely than whites to be exposed to DTCA, were more likely to be influenced by DTCA, and were more positive about the health benefits of DTCA exposure. African Americans were more likely to ask their physicians for an advertised drug and be refused.

Health journalism internships: a social marketing strategy to address health disparities

The USA seeks to eliminate health disparities by stimulating the rapid uptake of health-promoting behaviors within disadvantaged communities. A health journalism internship incorporates social marketing strategies to increase communities' access to cancer information, while helping the interns who are recruited from underrepresented communities gain admission to top graduate schools. Interns are taught basic health journalism skills that enable them to create immediate streams of cancer-related press releases for submission to community newspapers. Interns are charged with the social responsibility of continuing this dissemination process throughout their careers. Intermediate outcomes are measured as mediators of distal behavioral change goals.

Analysis of participatory photojournalism in a widely disseminated skin cancer prevention program

This article describes the content of pictures submitted to a photo contest as part of a nationally disseminated skin cancer prevention program called Pool Cool. The aims of this analysis are to describe sun-safety behaviors and environmental supports depicted in the photos and to gain insight into pool staff perceptions of the program. A directed approach was used to assess the content of 1,886 photos submitted in 2005 and 2006. Staying in the shade and applying sunscreen were the most common sun-safety behaviors shown among children. Among adults and lifeguards, wearing sunglasses and a shirt with sleeves were most common. Most photos contained at least one sun-safety support, and half showed use of Pool Cool program materials. Most photos promoted the use of Pool Cool materials, sun-safety behaviors, or sun-safe pool environments. Participatory photojournalism is a low-cost and effective way to generate widespread interest and support for community health promotion programs.

Direct-to-consumer advertising in black and white: racial differences in placement patterns of print advertisements for health products and messages

If direct-to-consumer advertising (DTCA) increases consumer participation in healthcare, then it may provide a useful strategy for addressing health disparities, in part, where patient-level barriers have contributed to such disparities. However, this presumes equitable access to DTCA. Using mixed methods, we explored advertisement patterns in matched African American and general audience magazines across a range of genres and ad types. Results suggest no significant differences in ad frequencies by race. However other meaningful categorical and qualitative differences were found, suggesting that advertisers may fall short in maximizing DTCA as an adjunctive strategy for empowering populations at risk for health disparities.

Representation of African Americans in direct-to-consumer pharmaceutical commercials: a content analysis with implications for health disparities

While direct-to-consumer (DTC) pharmaceutical drug advertising has been the center of controversy, proponents argue these ads provide educational and social benefits. This study explores the potential of these ads to address one of the proposed social benefits of reducing racial health disparities, particularly for African Americans. To examine this issue, a content analysis was conducted on DTC pharmaceutical television commercials assessing the presence and role portrayal of Black models in the ads. Findings revealed that Blacks were well represented overall but appeared to serve a token role and were underrepresented in ads for some of the most serious health conditions.

Infant sleep environments depicted in magazines targeted to women of childbearing age

OBJECTIVE

The goal was to evaluate pictures in magazines widely read by women of childbearing age, for adherence to American Academy of Pediatrics (AAP) guidelines for safe infant sleep practices.

METHODS

Magazines were included in this study if they had an average female readership of >5 million, circulation of >900000, and median age of female readers of 20 to 40 years. Twenty magazines met these criteria. An additional 8 magazines targeted toward expectant parents and parents of young children were included, for a total of 28 magazines. Pictures of infant sleep environments and sleeping infants in articles and advertisements in issues of these 28 magazines were analyzed for adherence to AAP guidelines for decreasing the risk of sudden infant death syndrome.

RESULTS

A total of 391 unique pictures from 34 magazine issues were included in the analysis. Only 57 pictures (64%) portraying sleeping infants not being held by an adult portrayed the infants in the supine position, and 14.8% of sleeping infants were portrayed as sleeping with another person. Only 36 pictures (36.4%) of infant sleep environments portrayed a safe sleep environment, as recommended by the AAP.

CONCLUSIONS

More than one third of pictures of sleeping infants in magazines geared toward childbearing women demonstrated infants in an inappropriate sleep position, and two thirds of pictures of infant sleep environments were not consistent with AAP recommendations. Messages in the media that are inconsistent with health care messages create confusion and misinformation about infant sleep safety and may lead inadvertently to unsafe practices.

Preferences among immigrant Hispanic women for written educational materials regarding upper respiratory infections

The need for culturally appropriate health education materials for Hispanic populations has been widely recognized, and Spanish-language materials are available through a number of private and governmental organizations. We convened two focus groups to elucidate preferences regarding how health-related messages are obtained and to identify which educational materials available in Spanish were preferred by 26 recently immigrated Hispanic homemakers who had received 15 different bimonthly written documents as part of a community-based clinical trial to prevent household transmission of colds and influenza. Participants gave three primary reasons for volunteering to participate in the study: to provide better care for their children (96.2%, 25/26), to get information (96.2%, 25/26), and to get free products (47.1%, 8/17). Their primary sources of health-related information were relatives and friends (42.9%, 6/14), clinicians (35.7%, 5/14), mass media (14.3%, 2/14) or the emergency room (7.1%, 1/14); none mentioned the internet. Materials using either a question and answer or true/false format were clearly preferred, even when other options were more colorful or had lower reading levels. Printed educational materials may be ineffective unless they include a more systematic assessment of the user's perceived needs for the information as well as consideration of format. In this population, a question and answer or true/false format and materials that could be shared with their children were greatly preferred.

A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising

CONTEXT

Commercial marketing is a critical but understudied element of the sociocultural environment influencing Americans' food and beverage preferences and purchases. This marketing also likely influences the utilization of goods and services related to physical activity and sedentary behavior. A growing literature documents the targeting of racial/ethnic and income groups in commercial advertisements in magazines, on billboards, and on television that may contribute to sociodemographic disparities in obesity and chronic disease risk and protective behaviors. This article examines whether African Americans, Latinos, and people living in low-income neighborhoods are disproportionately exposed to advertisements for high-calorie, low nutrient-dense foods and beverages and for sedentary entertainment and transportation and are relatively underexposed to advertising for nutritious foods and beverages and goods and services promoting physical activities.

METHODS

Outdoor advertising density and content were compared in zip code areas selected to offer contrasts by area income and ethnicity in four cities: Los Angeles, Austin, New York City, and Philadelphia.

FINDINGS

Large variations were observed in the amount, type, and value of advertising in the selected zip code areas. Living in an upper-income neighborhood, regardless of its residents' predominant ethnicity, is generally protective against exposure to most types of obesity-promoting outdoor advertising (food, fast food, sugary beverages, sedentary entertainment, and transportation). The density of advertising varied by zip code area race/ethnicity, with African American zip code areas having the highest advertising densities, Latino zip code areas having slightly lower densities, and white zip code areas having the lowest densities.

CONCLUSIONS

The potential health and economic implications of differential exposure to obesity-related advertising are substantial. Although substantive legal questions remain about the government's ability to regulate advertising, the success of limiting tobacco advertising offers lessons for reducing the marketing contribution to the obesigenicity of urban environments.

The context for choice: health implications of targeted food and beverage marketing to African Americans

Targeted marketing of high-calorie foods and beverages to ethnic minority populations, relative to more healthful foods, may contribute to ethnic disparities in obesity and other diet-related chronic conditions. We conducted a systematic review of studies published in June 1992 through 2006 (n = 20) that permitted comparison of food and beverage marketing to African Americans versus Whites and others. Eight studies reported on product promotions, 11 on retail food outlet locations, and 3 on food prices. Although the evidence base has limitations, studies indicated that African Americans are consistently exposed to food promotion and distribution patterns with relatively greater potential adverse health effects than are Whites. The limited evidence on price disparities was inconclusive.

Comida en venta: after-school advertising on Spanish-language television in the United States

OBJECTIVE

To analyze the content of food and drink commercials aired during after-school hours on Spanish-language television.

STUDY DESIGN

We performed a content analysis of food and drink advertisements, evaluating product type, food category, and message content. All advertisements aired during after-school hours (3 to 9 p.m.) on 2 U.S. Spanish-language television stations were sampled over a 1-week period in the spring of 2006.

RESULTS

We reviewed 60 hours of programming. Of the non-program content, 47% was for product advertisements, 15% (n = 153) of which was for food/drink. A mean of 2.5 food/drink commercials aired per hour (range 0-8), and the median duration was 30 seconds; 31% of food/drink commercials advertised fast food, and 27% advertised drinks, most (54%) of which were sugared. About one third (31%) of the food/drink commercials targeted children, 12% featured Latino celebrities, and 19% made reference to Latino culture. Only 16% of the food/drink commercials had health-related content.

CONCLUSIONS

Children viewing Spanish-language television in the United States after school are exposed to food and drink commercials, most of which advertise unhealthy foods, including fast food and sugared drinks. Food and beverage advertising on Spanish-language television may play an important role in the high risk of overweight among Latino children.

Health disparities and direct-to-consumer prescription drug advertising: a content analysis of targeted magazine genres, 1992-2002

Health disparities exist in the United States based on race, gender, and socioeconomic status. One way to alleviate some of the disparities regarding certain diseases or conditions is to increase awareness among populations most affected. Physicians have suggested that direct-to-consumer advertising (DTCA) of prescription drugs could play a role in awareness. Social identity theory suggests that individuals are likely to attend messages if they can identify, often based on race or gender, with people portrayed in the messages. This study analyzed DTCA in 11 years of Black, women's, news, and entertainment magazines to determine whether models in the ads targeted specific populations. Black magazines were more likely to contain ads featuring Black models only than were other genres, which had more DTCA picturing White models only. Health conditions the drugs were intended for varied by genre and over time, with STD drugs appearing primarily in Black magazines, and DTCA for heart disease not published in Black magazines, despite cardiovascular diseases being the No. 1 cause of death for Blacks (and Whites). Women's magazines featured DTCA for a wide variety of drugs, reinforcing their roles as caretakers, with proportionally few ads for women's health. Implications for targeted use of magazine genres as a means of providing health information to specific populations are discussed.

Beauty Or Health? A Personal View

This paper deals with the question of beauty and health in women. It discusses changing definitions of beauty as a result of influences from the entertainment, beauty and health product industries. Advertisements are seen to be major players in defining beauty through promotion of cosmetic, skin, hair and slimming products. Concerns relating to beauty become inculcated in girls through the process of socialisation as they mature into womanhood. The media plays a significant role in portraying the meaning of beauty through its representation of women. These influences largely influence and alter women's perceptions of their body image and in trying to meet the goals of beauty as represented by the media. This may result in dissatisfaction with their body image. Advertisements can encourage women to indulge in smoking as a fashionable trend or opt for plastic surgery in attempts to acquire beauty. This paper concludes with implications of the issues relating to changing perceptions of beauty and suggests recommendations.