US Nationwide Multi-City Media Coverage of COVID-19 Responses: Community Structure Theory, Belief System, and a "Violated Way of Life".

Community structure analysis compared city characteristics and newspaper coverage of state/local government responses to COVID-19 in 25 major U.S. cities, sampling all 250+ word articles from 4/4/20 to 7/6/20. The resulting 588 articles were coded for "prominence" and "direction" (favorable/unfavorable/balanced-neutral coverage), then combined into each newspaper's composite "Media Vector" (range=0.3552 to -0.5197, or 0.8749). Twenty-one of 25 newspapers (84%) displayed unfavorable coverage of local COVID-19 responses. Pearson correlations and regression analysis confirmed a muscular "violated way of life" pattern, when a community perceives itself as threatened by a "biological threat or a threat to a cherished way of life." Political and belief system polarization (in particular percent Evangelical and percent voting Republican) were strongly associated with unfavorable coverage of local pandemic responses, compared to more favorable responses linked to percent voting Democratic or percent Catholic. Vulnerability (percent uninsured) was also linked to negative coverage. Conversely, two different measures of access to healthcare (percent municipal spending on health and welfare, and physicians/100,000) were significantly linked to favorable coverage of the same local government efforts. Community structure theory's grass roots "bottom up" expectations linking community demographics to variations in reporting on critical issues were robustly confirmed.

Social capital or vulnerability: Which has the stronger connection with selected U.S. health outcomes?

We tested associations between social capital or vulnerability and health outcome measures of adult obesity, adult diabetes, and life expectancy at the county level in the United States with data from 2015 to 2018. This ecological cross-sectional study utilized secondary data from four open access databases: The Geography of Social Capital (U.S. Congress, 2018), County Health Rankings (2018), CDC's Behavioral Risk Factor Surveillance System (BRFSS, 2018) and the Kaiser Family Foundation (KFF, 2015). Our dependent variables were adult obesity, adult diabetes, and life expectancy. We identified the highest and lowest states' prevalence for each of three health outcomes in each of the four U.S. regions-Northeast, South, Midwest, and West. Each dependent variable was assessed using a sample of 32 counties (N = 32). Data analysis consisted of bivariate and regression analysis. Our results showed that the most consistent measure of "vulnerability" linked significantly to all three health conditions studied was percent births to unmarried women (Obesity p < .001; Diabetes p = .049; Life Expectancy p = .019). The most consistent measure of "social capital" linked to all three health conditions was recreation establishments per 1,000 inhabitants (Obesity p = .006; Diabetes p = .005; Life Expectancy p = .018). We concluded that measures of vulnerability were strongly associated with obesity, diabetes, and life expectancy when compared with social capital indicators. However, measures of social capital consistently accounted for the second-greatest proportion of the variance. Social and community contexts should be constantly addressed by both public health governmental- and scholarly-research agendas in the United States.

How media empower the vulnerable: Using community structure theory to analyze relationships between demographics and health reporting.

Instead of studying the impact of media on society, the traditional "top down" orientation of most communication studies scholars, this keynote presentation adopted the opposite perspective, exploring the "bottom-up" impact of "society" on "media". Unlike conventional "agenda-setting theory", which suggests that nationally prominent news media set issue "agendas" for other news media and public opinion, and also unlike the "guard dog" view that media essentially protect the interests of political and economic elites, the "community structure theory" explores links between different community (typically city or nation-state) demographics and variations in reporting on critical health concerns. Summarizing his scholarship on health communication presented and published over decades, the speaker outlined community structure theory's illumination of two overall patterns in US and cross-national coverage of health communication issues. In US coverage, broad measures of economically "buffered" privilege (educational, income, or occupational advantage) are linked to "favorable" or "government responsibility" coverage of health issues, and specific measures of "health" privilege (physicians, hospitals) are connected to "favorable" or "government responsibility" coverage promoting selected health issues. In cross-national coverage, specific measures of national "health vulnerability" (such as percent without improved water access, infant mortality rate) are linked to "government" responsibility coverage for selected health issues (human trafficking, water handling/contamination). In addition, broad measures of "macro" vulnerability conditions (agricultural dependence, political instability) are associated with "government" responsibility coverage for a wide range of health issues (genetically modified foods, drug trafficking, condom promotion, and food security). Overall, community structure theory's "bottom up" perspective reveals how the vulnerable are empowered by their demographic alignment with variations in health communication.

Framing of AIDS in Africa: press-state relations, HIV/AIDS news, and journalistic advocacy in four sub-Saharan Anglophone newspapers.

This study offers the first systematic analysis of the impact of press-state relations, or media systems, on the HIV/AIDS news agenda in African news coverage. The premise is that media systems play a determining role in the degree to which journalists can independently advocate for social change when covering HIV/AIDS. Drawing on comparative research, four sub-Saharan countries were categorized into two media systems: Contained Democratic (South Africa, Nigeria) and Repressive Autocratic (Zimbabwe, Kenya). A sample of HIV/AIDS stories (n = 393) published from 2002-2007 in each country's leading Anglophone newspaper was content analyzed. Across all coverage, the topic of social costs was framed more for the responsibility borne by nongovernmental agents than governmental agents. In Contained Democratic media systems, however, story emphasis shifted toward government agents taking responsibility for addressing the social costs of HIV/AIDS. Prevention campaigns were framed more as progress than decline across all newspapers; however, campaigns were reported as being more efficacious in Contained Democratic systems than in Repressive Autocratic systems. No impact of media system on framing of medical developments was found. Results show the value of comparative analysis in understanding the agenda-setting process: with greater emphasis on positive efficacy and government initiative, the news agenda in Contained Democratic media systems can facilitate stronger positive societal-level responses than the news agenda in Repressive Autocratic media systems.

Nationwide newspaper coverage of physician-assisted suicide: a community structure approach.

Using a community structure approach linking city characteristics and variations in media coverage, the authors examined newspaper coverage of physician-assisted suicide. A nationwide sample of 15 city newspapers yielded 288 articles in a four year period. Content analysis of article "prominence" (placement, headline size, story length, presence of photos) and overall article direction (favorable, unfavorable, or balanced/neutral) yielded a combined and widely varied single score "Media Vector" or measure of issue "projection" for each newspaper. Correlation and factor analysis yielded two significant city characteristic factors: a "stakeholder" factor, age (percent over 75) associated with unfavorable coverage of physician-assisted suicide (r = -.491; p = 000); and an "access" factor--combining media access (newspaper circulation, cable stations, FM or AM stations) and health care access (health care facilities, physicians)--linked to favorable coverage (r = .472; p = .000), combining to account for 46.3 percent of the variance. Western US newspapers and public opinion are most favorable to physician-assisted suicide.