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A Decade of Research on Health Content in the
Media: The Focus on Health Challenges and
Sociocultural Context and Attendant Informational
and Ideological Problems
KIMBERLY N. KLINE
Department of Speech Communication, Southern Illinois University,
Carbondale, Illinois, USA
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, ulti-
mately, 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 early 1980 s heralded a burgeoning interest in the health and illness content of
popular media or mass media not ‘‘identifiably or strategically designed for a
definable health campaign goal’’ such as that in the domains of advertising, journal-
ism, and entertainment (Kline, 2003, p. 557; cf., Basil et al., 1991; Gerbner et al.,
1981; Larson, 1991; Payne et al., 1989; Turow & Coe, 1985). By 1990, one edited
volume in health communication included a chapter on health images in the mass
media (Ray & Donhew, 1990) and another dealt specifically with news, advertising,
and entertainment media (Atkin & Wallack, 1990). In the past decade, health com-
munication survey textbooks and edited volumes increasingly used popular media
examples throughout their texts and also included more focused discussions of
research in at least one chapter (Beck et al., 2004; duPre, 2000; Geist-Martin et al.,
2003; Jackson & Duffy, 1998; Kar & Alcalay, 2001; Thompson et al., 2003). Othe r
books provided analyses of health-related representations in different genres and
topics (Gwyn, 2002; Marchessault & Sawcchuk, 2000; Parrott & Condit, 1996;
Address correspondence to Kimberly N. Kline, Department of Speech Communication,
Southern Illinois University, Mailcode 6605, Carbondale, IL 62901, USA. E-mail: kkline@
siu.edu
Journal of Health Communication, 11:43–59, 2006
Copyright # Taylor & Francis Group, LLC
ISSN: 1081-0730 print/1087-0415 online
DOI: 10.1080/10810730500461067
43
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Seale, 2004a, 2004b; Tulloch & Lupton, 1997). These texts evidence the widespread
attention to health content in popular media in a range of interdisciplinary journals.
What are the lessons learned from research on mass media content for health
communication? Briefly, research consistently has concluded that health-related con-
tent in popular media is problematic from a health promotion standpoint. As I will
demonstrate in this review, research indicates that popular media is not likely to
facilitate understand ings helpful to individuals coping with health challenges; at
the same time, popular media is likely to perpetuate social and political power differ-
entials with regard to health-related issues.
The purpose of this review is to examine the relationship between the health
topics addressed in the research, the shifting focus of concerns about the media,
and, ultimat ely, the variation in problems for health promotion.
1
First, I suggest
that, broadly speaking, there are two categories of health topics that have garnered
attention from media content scholars: bodily health challenges and political =
sociocultural context issues.
2
More to the point, with shifts in research topic , there
are concomitant shifts in the focus of the concerns about media content that give dif-
ferent impressions about how the media (can) represent health concerns and, thus,
suggest different types of problems with the media. Conversely, attention to the
topics and foci of media content research brings into sharp relief a dditional possibi-
lities for interrogating health media. Thus, I conclude with suggestions for future
research.
Search
Because mass media research in health co mmunication is so diverse, it is important
to explain my search criteria. I searche d regional, national, and international com-
munication journals, examining titles, abstracts, and article text (i.e., not keywords
in indexes, which often missed relevant studies) for indicators that the study
addressed the domains of journalism, entertainment, and advertising media.
3
I merged this list with a bibliography of interdisciplinary an d international journal
articles, book chapters, and books I have been developing during about 10 years
of research on media content including those from a 2003 review of health in the
media (Kline, 2003). Then, I excluded research related to the Internet and health
promotion campaigns (the purview of other reviews in this issue) and mass media
reception or audience response research since these studies do not focus on the
content of media representation s. One dilemma was whether or how to talk about
entertainment education (Singhal & Rogers, 1999) literature, which generally con-
siders popular media as a channel for health intervention messages and is therefore
more consistent with health campaigns research. I briefly refer to this research
when discussing the scope of popular media studies, but do not include it in the
review.
1
Kline’s (2003) review revealed that the problems identified by content-analytic research
vary given guiding theoretical assumptions and related methodologies; notably, the research I
review here employed comparable theory and methods and drew similar conclusions.
2
Surprisingly, only one study addressed representations of health care relationships (Simi,
1997).
3
I could not bring myself to categorize pornography as entertainment, though it is likely
this is the most relevant domain; I categorized it as ‘‘other’’ (likewise with popular books on
self-help).
44 K. N. Kline
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Scope of Popular Media Considered
The majority of content-analytic research attends to journalism, especially maga-
zines and newspapers, a sharp contrast to Neuendorf’s (1990) observation in her
1990 review that ‘‘entertainment television has received the lion’s share of social
scientific study’’ (p. 115). Certainly, there is substantial research related to entertain-
ment media: many studies are concerned with the cognitive and behavioral effects
(both pos itive and negative) of media representations, others with entertainment-
education activities that discuss the potential of interventions that strategically
integrate health-promoting messages in mainstream and targeted entertainment
media, and still others that combine the two and address the cognitive and beha-
vioral efficacy of entertainment-education interventions. As already noted, this
research is beyond the purview of this review.
A new addition to media research is the content analysis of advertising for over-
the-counter (OTC) and prescription drugs (Brow nfield et al., 2004; Cline & Young,
2004; Kaphingst et al., 2004; Kirksey et al., 2004; Pinto, 2000; Tsao, 1997; also Miles,
1998, on commodified natural medicines). Given space limitations, I note only that
concerns about these advertisements have not dissipated (Novelli, 1990) and refer-
ence other relevant advertising research throughout this review.
Notably, when research attended to a particular sociocultural group, studies
often limited analyses to media with a principle readership of that group:
4
research
about racial=ethnic groups looked at African American media (Hoffman-Goetz,
1999; Hoffman-Goetz et al., 1997; Johnson et al., 1999; Krishnan et al., 1997; Pickle
et al., 2002; Stoddard et al., 1998; exceptions include Pratt & Pratt, 1996; Pratt et al.,
1996), Hispanic=Latino media (Subervi-Ve
´
lez, 1999; Vargas & dePyssler, 1999;
exceptions include Vargas, 2000), and Canadian Aboriginal media (Hoffman-Goetz
et al., 2005; Hoffman-Goetz et al., 2003). Likewise, research focused on age-related
issues and analyzed media targeted to specific age groups including prime-time
television for children aged 2–11 (Byrd-Bredbenner et al., 2003), teen media (DuRant
et al., 1997; Malone et al., 2002; Smith, 2005; Stern, 2005), and, aside from
depictions of menopause, magazines popular among older readers (Kava, et al.,
2002).
4
Sociocultural groups also were acknowledged by addressing health concerns biophysi-
cally associated with one group. Homosexuality was referenced in the context of talking about
the ‘‘gay gene’’ (Conrad & Markens, 2001), the ‘‘reparative therapy’’ controversy (Stewart,
2005), or HIV=AIDS (Lupton, 1999; see also Gwyn, 1999). Exceptionally, Yadlon’s (1997)
analysis of breast cancer representations included an insightful discussion of how mainstream
media represents a heteronormative discourse (e.g., lesbianism replaces parity as a risk factor),
but this is not apparent from the title or abstract of the article. Except for studies about the
way that HIV=AIDS depictions ‘‘produce and reiterate notions of normative and deviant
sexuality’’ for women (Sacks, 1996; see also Mensah, 2000), gender, in particular, was invoked
by talking about health concerns like breast cancer for women and prostate or testicular can-
cer for men. Additionally, gender studies were concerned with women’s health issues such as
sexual and reproductive health in general (e.g., Johnson et al., 1999) as well as menstruation,
pregnancy and childbirth, and menopause specifically (e.g., Carlson et al., 1997; Gannon &
Stevens, 1998). Considering each of these health concerns in terms of the broader categories
of sexual and reproductive health related to puberty, fertility, and physiological changes
related to aging it becomes apparent that there is a subtle gendering of these as health issues
since there is a dearth of research on representations of analogous states in men. In fact, there
were few studies concerned with men’s health, especially when compared with the proliferate
scholarship on women’s health.
Health Media Content Research 45
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In the next section, I differentiate between research focused on challenges to bodily
health and that focused on sociocultural context issues, emphasizing the concomitant
shifts in the ways popular media are problematized for health communication.
Topics
Challenges to Bodily Health (i.e., Health States)
Most media content research addressed specific challenges to physical and mental
health with the goal of assessing the potential of representations for helping people
understand or cope with such challenges to themselves or others. Essentially, these
studies questioned whether popular media accurately or appropriately represented
health challenges, giving the impression that there are more right or wrong, complete
or incomplete ways of representing an issue and alluding to the possibility of con-
sensus about basic understandings of a health issue. Consistent with past research,
this research suggests that media representations are still suspect—fraught with
inaccuracies, misleading and problematic themes, and images that stereotype and
stigmatize.
Even as we try to distinguish between ill and well states of the body, the bound-
aries are blurred (Geist-Martin et al., 2003). Illness generally is thought to be an
impaired state of ‘‘normal’’ physical= mental functioning. Yet, bodily states have
been steadily medicalized so that natural processes are reduced to states of illness
(i.e., pregnancy or menopause); conversely, social understandings of what constitutes
normality have expanded to accommodate the lived experiences of individuals who
might in the past have been considered ill (i.e., physically impaired individuals or
homosexuals). Notwithstanding this caveat, it is useful to differentiate between
illnesses generally traceable to a widely accepted physiological threat (e.g., cancer
by cell mutation, diabetes by above-normal blood glucose levels, etc.), chronic con-
ditions that impinge on an individual’s state of health that may or may not be con-
sidered health ‘‘threats’’ per se (e.g., physical and mental disabilities),
5
lifestyle
behaviors that place individuals at risk for health threats, and behaviors that pre-
sumably offer opportunities to foster wellness. Like the broader topic areas and as
I demonstrate in the following section, the shifting focus in research on illnesses,
chronic conditions, lifestyles, and wellness led to different conclusions about pro-
blems with media representations.
Illness. Research focused on illnesses typically found informational value to be
wanting regardless of whether the evaluation was based on the scope of coverage,
information provided, or the framing of the topic. First, surveys of journalistic
media suggested that the scope of illnesses attended to in the media do not reflect
prevalent health threats (e.g., Finnegan et al., 1999; Frost et al., 1997; Subervi-Ve
´
lez,
1999; Vargas, 2000; Vargas & dePyssler, 1999). For instance, in various magazine
and news media, diabetes and HIV=AIDS received more coverage than cancer
and cardiovascula r disease (Hoffman-Goetz et al., 2003), reporting on various can-
cers does not reflect actual mortality rates (Hoffman-Goetz & MacDonald, 1999;
5
Changes and processes related to reproductive health could have been included here, but
it appears that their gendered nature trumps their status as chronic conditions; thus, they are
discussed in the section on health politics.
46 K. N. Kline
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Hoffman-Goetz et al., 1997), and there was insufficient coverage of colon cancer
(Gerlach, et al., 1997) and of non-HIV STDs (Davidson & Wallack, 2004).
Second, research questioned the efficacy of the information provided about ill-
nesses. So, while journalistic treatments of osteoporosis provided a fairly compre-
hensive and accurate list of risk factors and prevention measures, the information
often was ambiguous or incomplete (Wallace & Ballard, 2003). Likewise,
HIV=AIDS reporting in African American magazines not only included little new
information, but symptoms and transmission methods, treatment modalities, policy,
and economics were poorly covered (Krishnan et al., 1997; see also Hoffman-Goetz
et al., 2005). Breast cancer reporting was equally inadequate (e.g., Jones, 2004;
Marino & Gerlach, 1999); specifically noted was the lack of coverage of scientific
research indicating oral contraceptives neither increase breast cancer risk nor protect
against ovarian and end ometrial cancer (Lebow, 1999), imbalanced reporting of
scientific research on hor mone replacement therapy (Whiteman et al., 2001), mini-
mal coverage of environmental carcinogens (Brown et al., 2001), and the misleading
information in a popular breast cancer diet book (Morgan et al., 1999).
Third, research discussed thematic variations in representations of illnesses, invit-
ing consideration of, if not accuracy per se, at least the appropriateness of framing
for helping or hindering individual negotiation of health challenges. In particular,
research on cancer representations demonstrated the divers e ideological inflections
that can coincide with the different audiences addressed or types of cancer discussed,
each with more or less potential to resonate for individuals experiencing the problem.
For instance, breast cancer in women’s magazines generally used a ‘‘woman-
centered’’ sense-making approach by framing coverage in terms of coping with its
effects, personal experiences, and risk facto rs (although the same could not be said
of silicone breast implant coverage; Andsager & Powers, 2001; see also Andsager &
Powers, 1999; McKay & Bonner, 1999). Alternatively, representations of prostate
cancer in the NYPD Blue prime-time series emphasized that prostate cancer is a
‘‘couples’ disease’’ and more pointedly though often simplistically addressed marital
and sexual relationships (Arrington & Goodier, 2004).
Identification of similar framing strategies often evoked conflicting evaluations.
Indeed, the ‘‘struggle’’ metaphor s associated with cancer elicited several assessments.
Seale (2001b) challenged Sontag’s (1990) original premise that cancer is (problemati-
cally) framed using a military metaphor, arguing that the sporting metaphor is more
explanatory and has more positive connotations. Images of childhood cancer depict-
ing children as brave and stoic and parents as unremitting guardians of their chil-
dren’s identity however, may create ‘‘public expectations and stereotypes that are
difficult for parents and children to fulfill’’ (Dixon-Woods et al., 2003, p. 162). Simi-
lar discord was true in studies of the presence or absence of religious discourse in
cancer discourse. In mainstream media, the marginalization of religious discourse
may be problematic in as much as medical and scientific ideas are unable to ‘‘address
existential questions of ultimate meaning or justice that often trouble people when
they face a life-threatening illness’’ (Seal e, 2001a, p. 437). Alternatively, religiosity
and associated cancer fatalism was a central theme in magazines popular with
African American women, though the saliency of these messages for the audience
still needs to be determined (Hoffman-Goetz, 1999).
Perhaps reflecting a shift in the way that HIV=AIDS and the herpes sexually
transmitted disease (STD) are perceived in our society, the discussion of these issues
were more in line with the research focused on chronic conditions (dis cussed below);
Health Media Content Research 47
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thus, studies described the proliferat ion of stereotyping and stigmatization in herpes
discourse (Roberts, 1997) and in HIV =AIDS discourse (Gwyn, 1999; Lupton, 1998,
1999; Sacks, 1996; see also Tul loch & Lupton, 1997, for a singularly comprehensive
study of HIV=AIDS and television).
Conditions. Whereas research on illnesses tended to focus on informational
value, studies concerned with chronic conditions attended to the ways repres enta-
tions stereotype and stigmatize individuals with these conditions. For instance,
studies of disability representations noted the use of ‘‘disabling’’ terminology in
Canadian and Israeli newspapers (Auslander & Gold, 1999a; 1999b) and the prom-
ulgation of pornographic images that sexualize and ridicule women with disabilities
(Elman, 1997); another (Kerson et al., 2000) discussed the filmic portrayal of char-
acters with epilepsy, concluding, ‘‘Whether people with epilepsy are depicted as
freaks or treasures, prodigious or aberrant, if they are demeaned or valued, they
are always viewed as diff erent’’ (p. 107). Even as media coverage of the Paralympic
Games included messages about athletes with disabilities that were less stereotypical
and potentially more empowering, other messages reinforced damaging stereotypes
and belittled the competition and athletes (Schell, 1999). Likewise, studies focused on
mental health (cf., Brickman, 2004; Coyle & Morgan-Sykes, 1998, for gendered
aspects) consistently reported negative portrayals (Hannigan, 1999) whereby people
with mental illness were shown to be unpredictable and dangerous (Allen & Nairn,
1997), violent (Diefenbach, 1997), and (among other findings) bizarre and curious
(Hazelton, 1997).
Lifestyle=At Risk. In our prevention-oriented society, any number of lifestyle
choices are generally accepted to overtly pose a threat to the body—tobacco use
and alcohol abuse, illicit and legal drug use, unsafe sexual practices, and refusal
to wear a motorcycle helmet or automobile seatbelt (cf., Jacobsen et al., 2001;
Pelletier et al., 2000). In these studies, the primary concern was with injurious role
modeling. Except for a study about the lack of print media coverage of passive
smoking research (Kennedy & Bero, 1999; Sepe & Glantz, 2002), most focused
on prosmoking content (cf., Mekemson et al., 2004), including: the prevalence of
brand and nonbrand prosmoking messages that appeal to teenagers in a range of
media (Lee et al., 2004); prevalence of tobacco, alcohol, and drug use in teen
movies (Stern, 2005), tobacco and alcohol in music v ideos (DuRant et al., 1997);
violence, sex, and substance use in music videos (Smith, 2005); and appealing
characteristics of smokers in movies (Escamilla et al., 2000; McIntosh et al.,
1998). A number focused on marketing efforts such as special placements in movies
(Basil, 1997), advertising meant to counter New Year’s resolutions to quit smoking
(Basil et al., 2000), and bill board ads for alcohol and tobacco (Schooler et al., 1996;
Stoddard et al., 1998).
Wellness. In contrast to the idea that some behaviors pose a threat to health,
the idea of wellness speaks to opportunities for impr oving health such as eating
nutritious foods and exercising to bolster physical health in general and to avoid
weight-related health threats. Yet it appears that media messages do more to
undermine wellness than to foster it. Media messages perpetuate the social ideal
of slimness that contributes to body dissatisfaction and, thus, eating disorders
(Wilson & Blackhurst, 1999): television shows over-represent thin women and
deprecate heavier women (Fouts & Furggraf, 2000) and men (Fouts & Vaughan,
48 K. N. Kline
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2000) and underweight Playboy centerfolds highlight social pressure to be thin
(Katzmarzk & Davies, 2001). At the same time, media messages about diet and
nutrition emphasize personal management of weight or the ‘‘watch what you
eat’’ mentality (cf., Lawre nce, 2004; Rothblum, 1999) but give little advice on
how to do this in healthful ways: food advertisements do not conform to dietary
recommendations (Byrd-Bredbenner & Grasso, 1999), dietary supplement adver-
tisements do not attend to safety issues (Kava et al., 2002), and alcohol advertise-
ments outweigh healthful food product advertisements in African American
women’s magazines (Pratt & Pratt, 1996). While Pratt and colleagues (1996)
reported a decrease in diet pill advertising and increases in advertisements related
to more healthful methods of weight management, in this study the determination
of ‘‘healthful’’ was based on advertising claims (e.g., low calorie, light, low salt,
etc.) that may lack credibility (Novelli, 1990).
Politics and Sociocultural Context: Public Policy, Controversies, Health Scares,
and Ideologies
While research on health challenges tacitly assumed that some form of consensus
could be reached about the ‘‘right’’ way to represent health issues, research related
to sociocultural context issues suggested that the basic unde rstandings of the issues
discussed are contested and that competing groups are making claims on the system.
In these cases, the question was whose voice is privileged, why, and to what effect,
including the media’s own interests and how they affect coverage. Some of this
research suggested that there is more multivocality in pol itical discourse than gener-
ally presumed in critical studies (Gabe & Bury, 1996; Pollock & Yulis, 2004; Turow
& Gans, 2002). The prepo nderance, however, indicated that the problem with the
media is that it marginalizes certain interests while other interests are privileged.
In the discussion that follows, I describe the research concerned with the privileging
of certain interests in the media, noting some studies that either did not compare the
representation of competing interests or posit the perpetuation of so cial power
differentials, detailing those that were concerned about hegemonic influences,
emphasizing the implications of politicizing challenges to bodily health, and sum-
marizing conclusions abou t the role of the media in privileging interests.
Privileged Interests. On occasion, studies described the rhetorical strategies used
to gain acceptance of a particular narrative or perspective without overtly comparing
competing voices. One study analyzed the book The Hot Zone, a nonfiction account
of (overhyped) real-life events as an exemplar of the rhetorical strategies invoked to
perpetuate the ‘‘urban legend’’ of the Ebola virus scare (for similar discussions of
journalistic media, see Gwyn, 1999, 2002); another considered the popular film Erin
Brockovich to discuss the ‘‘visual imagery from which the theme of risk-related ‘cover
up’ is culturally constructed’’ (Ferreira, 2004, abstract). Other studies suggested that
privileging may be more a matter of effective framing than an implicit power differ-
ential, as when one political candidate gets more coverage because his campaign
platform makes for better news than the other (Mebane, 2003) or when competing
interests are covered as frequently but one side (e.g., the tobacco industry) appears
to present qualitatively more consistent and persuasive framing than the other (e.g.,
health control advocates; Menashe, 1998; see also Malone et al., 2002).
Health Media Content Research 49
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More frequently, however, the issue was whether hegemonic forces contributed
to the entitlement of certain interests and, thus, constituted social power differen-
tials. Studies in this vein were consistent with dominant ideology critiques that affirm
binary or oppositional discourses that privilege powerful groups and marginalize
subordinated groups (Condit, 1994; cf., Logan, Park, & Shin 2004). For instance,
research regarding silicone breast implants generally found influential policy actors’
perspectives prevailed over those of marginalized activists (Andsager & Smiley, 1998;
Powers, 1999; Powers & Andsager, 1999; Vanderford & Smith, 1996). In particular,
when broadly construed institutional discourses such as those of science, medicine,
and patriarchy were examined, findings decisively concluded that representations
constituted hegemonic discourses. Thus, with regard to scientific and medical
hegemony, prime-time medical dramas privileged the technological imperative asso-
ciated with medical hegemony (and medicalization) and marginalized nontechnolo-
gical or alternative forms of health care (Harter & Japp, 2001) and television health
documentaries fostered medicalization by using depictions of lay people to ‘‘perso-
nalize and normal ize medical care and to legitimize medical surveillance and inter-
vention’’ (Hodgetts & Chamberlain, 1999).
Overwhelmingly these studies recount the uneq ual gender relations represented
by health discourses and, importantly, demonstrate the effect for research of
politicizing challenges to bodily health. Studies identified a variety of oppressive
discourses including the medicalized representations of menopause (Kaufert & Lock,
1997) and menstruation (Cheek, 1997; Markens, 1996), paternalistic racism in news
accounts of ‘‘crack mothers’’ (Meyers, 2004), and victim-blaming representations of
breast cancer (Clarke, 1999a; Kline, 1999). Research also suggested that women who
do not enact traditional codes of femininity are depicted as posing a threat to both
women and men. A comparison of news portrayals of breast, testicular, and prostate
cancers revealed that ‘‘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’’ (Clarke, 2004, p. 550; see also Clarke, 1999a, 1999b;
Clarke & Robinson, 1999), thus ‘‘the threat of the disease seems to be less a threat
to life itself than a threat to the proper, i.e., gendered enactment of life’’ (p. 549).
Moreover, breast cancer discourse perpetuated the notion that the disease is caused
by individual risk factors resulting from nontraditional behaviors including repro-
ductive choices, diet, and use of tobacco and alcohol (Lantz & Booth, 1998; Yadlon,
1997). Conversely, men were depicted as suffering a mental health ‘‘crisis’’ resulting
from ‘‘the enactment of a traditional, hegemonic masculinity’’ (Coyle & Morgan-
Sykes, 1998, p. 279). Yet hegemonic masculinity was not the problem; rather, the
threat was a function of discord between traditional male and contemporary fema le
roles that makes men ‘‘the new victims of advancing, ambitious, driven, sexually
demanding woman who are unattuned and inattentive to men’s needs and who
are succeeding often at men’s expense’’ (p. 279; see also Lyons & Willott, 1999).
In other words, the most remar kable aspect of studies on men’s health media was
the implication that representations undermined women or petitioned them to main-
tain and perpetuate male privilege and power (Bloom, 1997; Lyons & Willott, 1999).
The Media’s Role. That news values can conflict with science, medicine, and
public health agendas is not new to health commun ication scholars (Atkin &
Wallack, 1990); yet, in considering the ways that media can privilege certain inter-
ests, many of these studies try to refine our understanding of those competing
50 K. N. Kline
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priorities.
6
Most generally, representations of issues vary from one source to the
next. In part, this was a function of the media genre (Andsager & Powers, 1999;
Henderson & Kitzinger, 1999). In representations of managed care, general news-
papers had more neutral stories, busines s press attended to economic news and poli-
tical debate with less dramatic elements, and broadcast stories and special series were
more negative and incorporated more graphic personal stories (Brodie, et al., 1998;
see also Burgoyne, 1997). Other variations derive from the political biases of differ-
ent news sou rces (Stewar t, 2005 ). Unders tanding this aspect of news media is parti-
cularly salient for health media advocacy groups and health campaign specialists
intent on employing the news media to the greatest possible advantage; in short,
information (especially press releases) must be tailored for different media outlets.
It is also difficult to synchronize information provided by scientific outlets with
that reported in the news. Wh ile there may be correlations between media coverage
and medical activities associated with a health threat (Corbett & Mori, 1999), it is
difficult to convey complicated and contingent information to journalists who need
to be direct and succinct—and also dramatic. For instance, the Centers for Disease
Control and Prevention (CDC) issued extensive highly detailed information about
Anthrax during that scare, but there were still numerous incongruities between the
information provided and news reports (Mebane, Temin, & Pravanta, 2003). Jour-
nalists generally were responsive to CDC requests however, to add specific infor-
mation or revise statements when pointedly asked to do so. Thus, ‘‘health officials
should request that reporters disseminate specific pieces of information’’ (Mebane,
Temin, & Prevanta, 2003, p. 79). Still, health promoters sh ould carefully attend to
how information is disseminated to the press; as one study revealed, press confer-
ences may only contribute to the sensationalizing of health threats (Lofstedt,
2003). Moreover, health promoters may want to keep in mind that the scientific
paradigm associated with epidemiological research attends to the scientific ‘‘facts,’’
whereas news reporting is concerned with ‘‘storied’’ accounts of health threats.
One study suggested that the ‘‘news media’s framing of risk has more to do with
its reproduction of moral out rage components than with ‘scientific’ notions of calcu-
lable risk’’ (Brown, Chapman, & Lupton 1996, abstract; also Bird, 1996).
Conclusion and Suggestions for Future Research
In sum, this research recognizes that we cannot take for granted that popular media
representations will or can reflect health issues in ways that are health promoting,
but also that we cannot ignore the influence of these often-unintended messages
on health and illness knowledges and ideologies. By reflecting on the ways that
the topics considered engender different foci and, thus, point to particular problems
with media content, we not only gain a more sophisticated understanding of the rel-
evance of popular media for the discipline of health commun ication, it also directs
attention to the opportunities for health promoters to integrate in their projects
6
The entertainment media research I include here referred to media that was commen-
surate with or was treated like traditional news, invoking, if not journalistic standards, an
alignment with the critiques of news media. For example, West’s (2005) study of the intense
public debate about the movie John Q. analyzed news media and discussed the controversy
over whether the movie met the standards of good journalism and good political debate.
The ‘‘fair and balanced’’ criteria also was used in Turow and Gan’s (2002) analysis of the
health policy issues depicted in prime-time medical dramas.
Health Media Content Research 51
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strategies for responding to these concerns. In short, it is not just the informational
value of popular media, but also the ideological commitments reflected, maintained,
and perpetuated in popular media that should be taken into account in health edu-
cation and promotion campaigns, media advocacy, and entertainment-education
efforts and even interpersonal, group, and organizational training activities.
At the outset of this review, I suggested that the topics and foci of previous
research not only give certain impressions about how the media can represent health
concerns, but also bring into sharp relief opportunities for redirection in the
research. Thus, here I summarize some possibilities for future health media content
research.
. We could expand our repertoire of media domains content analyzed, especially
entertainment media that can impinge on the health understandings of the average
person who may or may not read newspapers or magazines but who, in all likeli-
hood, watches television and rents videos. This could include but should not be
limited to entertainment-education research.
. We could atten d to a wider range of sociocultural groups and the ways in whi ch
their concerns are invoked and unde rmined in both targeted and mainstream
media. Not only are specific sociocultural group s influenced by undifferentiated
messages about health and illness, privileged sociocultural groups also gain an
understanding of marginalized groups from mainstream mass media; limiting
racial=ethnic studies to ethnic media misses an important element of social under-
standings of health issues that affect these different groups.
. We could diversify the health challenges that gain our attention. One need only
take a look at the list on the National Institutes of Health (NIH) website to get
a sense of the array of health concerns faced by individuals in our society. For
instance, notably absent from this literature was consideration of ‘‘invisible’’
chronic illnesses including chronic fatigue syndrome, irritable bowel syndrome,
and fibromyalgia; ethnic=racial illnesses such as Tay Sachs or sickle cell anemia;
or even mundane health concerns (like the childhood fevers that frighten and frus-
trate many parents of young children).
. We could identify ways popular media represents a plurality of voices (Condit,
1994) in order to understand and then grapple with competing interests. There
is some suggestion that medical establishment hegemony is being challenged
(our own research is evidence of that) and that alternative approaches to health
understandings and care are on the rise (i.e., holistic and homeopathic medicine,
self-help, and natural remedies, and nonmedicalized strategies for dealing with
health concerns such as midwife attended maternal care and home births).
Assuming that popular media has articulated and contrib uted to this movement,
we could explore how these competing interest s are represented in the mass
media. In other words, we should not presume that popular media inevitably
undermines social, political, and individual health.
If we acknowledge that popular media is an important force in our society—that
individuals dealing with a health situation bring ‘‘into that interaction all of the
personal knowledge and experiences that define them, including exposure to any
number of news, entertainment, and commercial messages coming from sources that
vary from televisio n to print to Internet bulletins’’ (Parrott, 1996, p. 275)— then we
must continue to find ways to tease out the nuanced meanings and implications of
those representations.
52 K. N. Kline
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