Communicating uncertainty--how Australian television reported H1N1 risk in 2009: a content analysis.

BACKGROUND: Health officials face particular challenges in communicating with the public about emerging infectious diseases of unknown severity such as the 2009 H1N1(swine 'flu) pandemic (pH1N1). Statements intended to create awareness and convey the seriousness of infectious disease threats can draw accusations of scare-mongering, while officials can be accused of complacency if such statements are not made. In these communication contexts, news journalists, often reliant on official sources to understand issues are pivotal in selecting and emphasising aspects of official discourse deemed sufficiently newsworthy to present to the public. This paper presents a case-study of news communication regarding the emergence of pH1N1. METHODS: We conducted a content analysis of all television news items about pH1N1. We examined news and current affairs items broadcast on 5 free-to-air Sydney television channels between April 25 2009 (the first report) and October 9 (prior to the vaccine release) for statements about [1] the seriousness of the disease [2] how the public could minimise contagion [3] government responses to emerging information. RESULTS: pH1N1 was the leading health story for eight of 24 weeks and was in the top 5 for 20 weeks. 353 news items were identified, yielding 3086 statements for analysis, with 63.4% related to the seriousness of the situation, 12.9% providing advice for viewers and 23.6% involving assurances from government. Coverage focused on infection/mortality rates, the spread of the virus, the need for public calm, the vulnerability of particular groups, direct and indirect advice for viewers, and government reassurances about effective management. CONCLUSIONS: Overall, the reporting of 2009 pH1N1 in Sydney, Australia was generally non-alarmist, while conveying that pH1N1 was potentially serious. Daily infection rate tallies and commentary on changes in the pandemic alert level were seldom contextualised to assist viewers in understanding personal relevance. Suggestions are made about how future reporting of emerging infectious diseases could be enhanced.

Framing responsibility: coverage of lung cancer among smokers and non-smokers in Australian television news.

OBJECTIVE: To analyse news portrayals of lung cancer and associated inferences about responsibility in Australian television news. METHODS: Analysis of television news reports, broadcast on Sydney's five free-to-air television channels between 2 May 2005 and 31 August 2009, for all statements pertaining to lung cancer. RESULTS: Of 2,042 reports mentioning any cancer, 45 made reference to lung cancer, and 28 (62%) referred to diagnoses of lung cancer in non-smokers. Of 157 statements in these reports, 107 (68%) noted that the person featured was a non-smoker. Non-smokers were portrayed sympathetically and as tragic victims, implying they were not responsible for their condition, the sub-text being that smokers are responsible for theirs. CONCLUSIONS: Television news portrays non-smokers with lung cancer with considerable sympathy. Conversely, smokers are implicitly and occasionally explicitly depicted as responsible for their disease. IMPLICATIONS: The marginalisation of tobacco caused lung cancer in news, together with sympathetic reporting of lung cancer in non-smokers may contribute to stigma surrounding smoking caused disease that may promote delay in seeking treatment, and de-emphasise the role of the tobacco industry's decades-long smoker reassurance program in promoting smoking.

"No respecter of youth": over-representation of young women in Australian television coverage of breast cancer.

Ninety four percent of new breast cancer cases in Australian women occur in those aged over 40. Mammographic breast screening programs target women over 40, especially those aged 50-69, but participation rates in this age group have recently declined. To test the hypothesis that young women, at low risk for breast cancer, are overrepresented in television news, we analyzed all televised news reports on age and breast cancer shown on five free-to-air Sydney television stations, from 3 May 2005 to 28 February 2007, to determine the age of women shown with, or at risk for, the disease. Over half (55%) of statements about age and breast cancer referred to young women stated or known to be aged under 40. Sixty seven percent of images of women in breast cancer reports were known or judged to be women aged under 40. Three cases in young celebrity women accounted for 53% of all statements and 24% of all images about young women and breast cancer. Overrepresentation of young women with breast cancer in television news coverage does not reflect the epidemiology of the disease. This imbalance may contribute to public uncertainty regarding screening policy.

'A disease many people still feel uncomfortable talking about': Australian television coverage of colorectal cancer.

OBJECTIVE: To examine the coverage of colorectal cancer on Australian television news over a 3 year period commencing May 2005, and compare it with that given to other cancers. METHODS: News reports on colorectal cancer broadcast on Sydney's five free-to-air television channels between 3 May 2005 and 30 May 2008 were reviewed for statements by news actors. The frequency of coverage was compared with that for other cancers. RESULTS: Colorectal cancer news reports accounted for 4.1% (95% CI 2.9-5.1%) of all cancer news reports while the cancer represents 13.5% of cancer incidence and 11.5% of cancer deaths. Compared to cancers receiving greater television news coverage, there was a near total absence of reports of celebrity diagnoses, and of representations by colorectal advocacy groups. A national colorectal screening programme received limited coverage. CONCLUSIONS: Media neglect of colorectal cancer may be an important factor in explaining low participation in the Australian colorectal screening programme. Those advocating for colorectal cancer screening face ingrained cultural challenges in gaining broad media coverage, but investment in efforts to generate news and commentary would appear to be overdue.

The content and structure of Australian television reportage on health and medicine, 2005-2009: parameters to guide health workers.

OBJECTIVE: To describe the content and structure of health and medical news and current affairs reportage on free-to-air television in Sydney, New South Wales. DESIGN AND SETTING: Review of content of all health-related evening news and current affairs items recorded over 47 months (May 2005-March 2009). MAIN OUTCOME MEASURES: Number and length of health-related items on news and current affairs programs, and topics covered in these (21 broad content areas and the leading 50/237 specific content areas); use of news actors, soundbite duration and apparent news triggers. RESULTS: 11,393 news items and 2309 current affairs items were analysed. Health news items lasted a median of 97 seconds. In a randomly selected sample of 251 items, items featured a mean of 2.2 news actors (3.9 in longer current affairs items). Median soundbite duration was 7.2 seconds for news items and 8.9 seconds for current affairs items. People affected by disease or injury were the most commonly featured news actors (84% of items), followed by experts and health professionals (56%). Many items (42%) appeared to be triggered by incidents, but a further 42% could have been triggered by press releases and other forms of publicity. CONCLUSIONS: Health workers wishing to participate in news coverage should be aware that complex issues are reduced to fit the time constraints and presentational formulae of the news media. Advocates should plan their communication strategies to accommodate these constraints.

Smoking-related disease on Australian television news: inaccurate portrayals may contribute to public misconceptions.

OBJECTIVES: To describe the range and frequency of reportage of tobacco-related disease on Australian television news. METHODS: Content analysis of all news items mentioning smoking-related disease broadcast on five free-to-air Sydney television channels 2 May 2005 to 31 December 2007. RESULTS: Three in four tobacco-related disease news reports focus on lung cancer. Other cancers and smoking attributable diseases attract modest coverage. CONCLUSION: Television news coverage may contribute to public misconceptions regarding the associated health risks of smoking, limiting understanding about the many risks involved. Tobacco control advocates should seek to increase the newsworthiness of diseases in addition to lung cancer. IMPLICATIONS: While the Australian public is generally aware of the connection between lung cancer and tobacco, considerable misconception exists as to the broad range of tobacco-related mortality and disease. Given television's role as a key source of public information on health issues in Australia, such coverage can limit understanding about the many attributable risks involved. Tobacco control advocates need to find ways to improve the newsworthiness of tobacco related illness.

Mixed messages and a missed opportunity: Australian news media coverage of Clare Oliver's campaign against solaria.

OBJECTIVE: To review television and print media coverage of the campaign to regulate solaria that was initiated by Clare Oliver before her death from melanoma in late 2007, and to investigate how the media constructed the aetiology of her disease. DESIGN AND SETTING: Frame analysis of all direct and attributed statements about the causes of, and responsibility for, Oliver's melanoma, and about the legacy of her campaign, in report on five free-to-air Sydney television stations and in Australian capital city newspapers, 21 August 2007 to 20 February 2008. RESULTS: 26 television and 83 print media reports were identified, containing 279 statements on Oliver: 146 (52%) dealt with the responsibility of solaria or their need for regulation, 23 (8%) were on issues of self-responsibility, and 110 (40%) were on her legacy. Oliver stated she had visited solaria 10 times, but had spent years acquiring a tan outdoors. However, less than one in 10 statements about the aetiology of her melanoma referred to her outdoor tanning history, with most explaining the cause as solarium ultraviolet radiation. Oliver's campaign was credited with precipitating rapid regulation of solaria in Australia. However, the new regulations will not prevent a person of her age or skin type visiting solaria and fall well short of the ban she hoped for. CONCLUSION: Unlike sun exposure, solaria are an entirely tractable factor contributing to melanoma. Failure to ban solaria has been a disappointment in a high-profile window of opportunity to change public health law.

The newsworthiness of cancer in Australian television news.

OBJECTIVES: To test the hypothesis that television news coverage of different cancers reflects their incidence and burden, and to examine the journalistic approaches used in reporting cancer. DESIGN AND SETTING: Content analysis of all news, current affairs and infotainment reports on cancer broadcast on five free-to-air television channels in Sydney, New South Wales, 2 May 2005 - 6 January 2008. MAIN OUTCOME MEASURES: Number of items on specific cancers, relationship with burden of that cancer (disability-adjusted life-years [DALYs]), and category of "story lead" used for the item. RESULTS: Cancer was the fifth most reported health issue, with 1319 items; 25 different cancers received news coverage. The most reported cancers were breast cancer (42.5% of all items on specific cancers), melanoma (11.9%) and cervical cancer (11.6%). Some cancers were significantly over-reported in relation to their DALYs (eg, cervical cancer was over-reported by a factor of 10.2 compared with the number of reports predicted on the basis of DALYs) while others were under-reported, including colorectal, lung and pancreatic cancers. The most common story leads used in cancer reports were treatment (32% of items) and celebrities with cancer (21%), particularly breast cancer. CONCLUSIONS: The current predominance of reports on breast and cervical cancer and on young women with cancer may be distorting public and political perceptions of the burden of cancer. The success of advocates in raising the news profile of breast cancer may hold lessons for agencies wishing to improve the newsworthiness of other cancers.

Media influence on Herceptin subsidization in Australia: application of the rule of rescue?

BACKGROUND: In August 2006, the Australian government announced that Herceptin (Trastuzumab) would be added to the national Pharmaceutical Benefits Scheme (PBS) of government-subsidized drugs, for treatment with adjuvant chemotherapy of HER2 breast cancer. Following initial reticence, the health minister responded to a campaign by patients and patient advocacy groups by announcing PBS subsidization which lowered the cost of a weekly dose from A$1000 to A$30. The cost to the government would be A$470 million over three years for treatment of an estimated 2100 women annually. DESIGN: We analysed the news frames used in all direct and attributed statements (n=239) in television news coverage of the discourse preceding the Herceptin decision by the Australian government. SETTING: Five Sydney free-to-air channels between October 2005 and August 2006. MAIN OUTCOME MEASURES: News frames or themes. RESULTS: Of five news frames identified, one ('desperate, sick women in double jeopardy because of callous government/incompetent bureaucracy') accounted for 54% of all reported statements. Government financial parsimony was framed as responsible for the women's plight, with drug industry pricing never mentioned. Claimed benefits of Herceptin often conflated cancer non-recurrence and survival and favoured quantification rhetoric which emphasized percentage increases in improvement rather than the more modest increases in absolute survival. CONCLUSIONS: News frames invoking key tenets of the 'rule of rescue' dominated television discourse on Herceptin. Clinicians, patients, their families and patient advocacy groups invoking the rule of rescue can increase the likelihood of achieving their objective of gaining access to expensive healthcare such as pharmaceuticals. Rational, criteria-based public health policy will find it hard to resist the rule of rescue imperative.

'A matter of faith, not science': analysis of media coverage of prostate cancer screening in Australian news media 2003-2006.

OBJECTIVE: Despite a near universal absence of evidence-based policies supporting population screening for prostate cancer, the prostate-specific antigen (PSA) test is aggressively promoted in the media as a life-saving form of screening. The objective of this study was to examine media coverage of prostate-cancer screening in Australia. DESIGN: Frame analysis of all direct or attributed quotes about prostate cancer. SETTING: Australian capital city newspapers (February 2003-December 2006) and Sydney television news (January 2003-December 2006). MAIN OUTCOME MEASURES: Quotes regarding prostate cancer screening: n=436 in newspapers and television news. RESULTS: Seven rhetorical frames were identified. 86% of all quotes framed prostate screening and its outcomes as desirable, associating PSA testing as being consonant with other early-detection cancer-control messages. Adverse surgical sequelae to screening were often minimized, scientific progress highlighted and gender equity appeals appropriated. Those questioning screening were vilified, with epidemiology being framed as an inferior form of knowledge than clinical experience. CONCLUSIONS: Australian men are exposed to unbalanced and often non-evidence-based appeals to seek PSA testing. There is a disturbing lack of effort to redress this imbalance.

"The news is [not] all good": misrepresentations and inaccuracies in Australian news media reports on prostate cancer screening.

OBJECTIVE: To list and critically review recent inaccurate statements made by advocates of prostate cancer screening in Australian news media. DESIGN: Accuracy audit of all news on prostate cancer broadcast on Sydney footprint free-to-air television stations between 2 May 2005 and 18 December 2006 (42 items), and published in print media from 6 February 2003 to 31 December 2006 in Australian capital cities (388 items). These contained 436 direct or attributed statements. RESULTS: Of the 436 statements analysed, 44 (10%) were factually inaccurate or made claims not supported by the scientific literature or most cancer control agencies. Misleading statements about prostate screening and its sequelae were found in five categories: mortality from prostate cancer; expert agency support for screening; the efficacy of screening in preventing death from prostate cancer and the importance of early detection; the accuracy of the prostate-specific antigen test; and prevalence and severity of adverse effects from treatment. CONCLUSIONS: Despite near universal lack of support for prostate cancer screening of asymptomatic men by leading international and Australian cancer control agencies, Australians are exposed to an unbalanced stream of encouragement to seek testing. This coverage includes inaccurate information which ignores scientific evidence and the general lack of expert agency support.

Choice and voice: obesity debates in television news.

OBJECTIVE: To examine whether television news and current affairs coverage of overweight and obesity frames obesity in ways that support or oppose efforts to combat obesity. DESIGN AND SETTING: A content and framing analysis of a structured sample of 50 television news and current affairs items about overweight and obesity broadcast by five free-to-air television channels in New South Wales between 2 May and 31 October 2005. MAIN OUTCOME MEASURES: Dominant discourses about causes of overweight and obesity; proposed solutions and location of responsibility for the problem; the age-group focus of television items; the relative prominence of stakeholders; and the aspects of obesity which attract news attention. RESULTS: Most television items (72%) framed obesity as a problem of poor nutrition. Obesity was largely seen as the responsibility of individuals (66% of items). Just over half of news items (52%) focused only on adults while 26% focused only on children. Obesity was framed largely as a problem to be solved by individual nutritional changes, exercise and surgical and medical interventions. CONCLUSIONS: While individual lifestyle is crucial to controlling weight, the research community now recognises the importance of sociocultural and environmental factors as drivers of the obesity epidemic. However, television news portrays obesity largely as an individual problem with individual solutions centred mostly on nutrition. Media emphasis on personal responsibility and diet may detract attention from the sociopolitical and structural changes needed to tackle overweight and obesity at a population level.

Impact of news of celebrity illness on breast cancer screening: Kylie Minogue's breast cancer diagnosis.

OBJECTIVES: To describe the main media narratives in the reportage of singer Kylie Minogue's illness with breast cancer; and to assess the impact of this coverage on bookings for screening for breast cancer by mammography in four Australian states. SETTING: Government sponsored BreastScreen programs in Queensland, Victoria, Tasmania and Western Australia. MAIN OUTCOME MEASURES: Narratives on breast cancer in television news programs 17-27 May 2005; initial and re-screening bookings for mammograms. PARTICIPANTS: Women aged > or = 40 years who booked for mammograms in BreastScreen programs in the 19 weeks before, the 2 weeks during, and the 6 weeks after the publicity. RESULTS: There was a 20-fold increase in news coverage of breast cancer, which emphasised that young women do get breast cancer and that early detection was critical. Overall screening bookings rose 40% in the 2 weeks of the publicity, with a 101% increase in non-screened women in the eligible age-group 40-69 years. Six weeks after the publicity, bookings remained more than a third higher in non-screened women. CONCLUSIONS: News coverage of Kylie Minogue's breast cancer diagnosis caused an unprecedented increase in bookings for mammography. Health advocates should develop anticipatory strategies for responding to news coverage of celebrity illness.