html xmlns=”http://www.w3.org/1999/xhtml”>

Chapter 8

Mass Communication and Health

Television and other mass media play an important role in influencing our perceptions of health and our health behaviors in a variety of ways. In addition to entertainment, television, films, newspapers, the Internet, and other media regularly convey information that can influence our health, such as advertisements for fast food, popular film characters engaging in unhealthy behaviors, celebrities who may influence unrealistic body images, and news stories about medical breakthroughs. Americans are avid consumers of the mass media, and our exposure to media content begins when we are young children. Many of our perceptions about health, illness, medicine, and healthcare professionals are shaped by what we see, hear, and read in the mass media. While our family members, peers, and educators also are strong social influences on our health perceptions and behaviors, what we learn from these sources interacts with the mass media to socialize us about health in very complex ways. Increasingly, new media technologies are playing a much larger role in the development and consumption of messages for general target audiences through community-based participation and segmented by social media usage (i.e. Facebook and Twitter) and blogging. Recent events in Egypt, Libya, and Japan have all demonstrated the relevance and power of social media during times of crisis and further propel messages to a larger audience for very little cost (excluding the initial cost for the computer and internet service provider). Thus, media use in the 21st century is evolving and rapidly changing with each new techno toy introduced into the marketplace. As such, it is changing the gatekeepers of how media are able to disseminate health information.

This chapter explores the role of mass media in influencing our perceptions of health and our health behaviors. It primarily focuses on traditional mass media, such as television, film, radio, and print, although we will briefly introduce aspects of new media as well. We begin by discussing two popular theories of media influence and research linking mass media images of health and portrayals of health situations to health behaviors. Next, we explore issues concerning how health-related stories are presented in the news media and the implications of reporting practices on public conceptions of health and health behaviors.

Two Perspectives of Media Influence

Most communication scholars feel that the mass media influence our perceptions and behaviors in a number of ways, including those related to health. However, it is has been difficult for researchers to demonstrate a direct link between specific media content and health behaviors. As you will see in this chapter, the relationship between mass media content and behaviors is complex, and many variables mediate the degree to which the mass media influence our behaviors. This chapter presents two broad perspectives of the relationship between media usage and behaviors. These theoretical frameworks are important to understand before talking about specific health behaviors that appear to be influenced by the mass media, such as eating habits, substance abuse, and violence, which we will explore later in this chapter.

Cultivation Theory

A popular theory that has been used to explain the effects of mass media (particularly television) is cultivation theory (Gerbner, 1998; Gerbner & Gross, 1972; Gerbner, Gross, Morgan, & Signorielli, 1982). Cultivation theorists argue that the reality portrayed in the mass media influences our perceptions of reality in the real world over an extended period of time. In other words, cultivation theory posits that long-term repeated exposure to mass media messages shapes our understanding of the world in ways that are consistent with how reality is portrayed in the media. Cultivation theory holds that television can have a “normalizing” effect in terms of influencing perceptions, and televised behaviors may become perceived as acceptable or desirable over time (Shrum, 1999). Most cultivation theorists have examined the influence of television on behaviors because Americans use television more than any other medium, and because television is relatively inexpensive compared to other media (e.g. the Internet) and does not require consumers to be literate (Gerbner et al., 1978).

Heavy viewers of television often tend to have attitudes and beliefs about the world that are congruent with the reality promoted by television, a concept known as mainstreaming (Gerbner, 1998). Television can also influence perceptions of reality in subtle ways. For example, first-order effects refer to information about a topic that people learn by watching television, and second-order effects are more generalized perceptions about topics and the world that people learn from television (Gerbner, Gross, Morgan, & Signorielli, 1986). For example, a heavy viewer of “Grey’s Anatomy” might learn some basic terminology used in emergency room settings (a first-order effect), but she might also come to believe that biomedical and technological solutions to health problems (used most often in the show) are the most effective ways to deal with them (a second-order effect).

Similar to other perceptions of reality, our perceptions of health are most likely influenced in a variety of ways by our exposure to media content. Given the high prevalence of health-related dramatic entertainment in the mass media and health-related news stories, the mass media present a version of reality surrounding health issues that is often much different than what occurs in the real world (Turow & Coe, 1993). Yet, just because certain images of health are presented in the mass media, critics of cultivation theory argue that this does not necessarily mean that people will pay attention to all of these messages, interpret them, or react to them in the same way. In other words, for some individuals, the effects of encountering media content may be limited due to the reasons they use media. In the next section, we present an alternative framework for examining the influence of the mass media on perceptions and behaviors.

Uses and Gratifications Theory

While early theories about the influence of television and other mass media on individual behavior proposed that the mass media are very powerful in changing behaviors, later theories began to examine the idea of how the effects of the mass media are mediated by audience members as active users of media and choice makers when it comes to interpreting media content. For example, uses and gratifications theory proposes that the effects of media are tempered by the ways in which people use them. Specifically, the theory posits that people actively choose certain types of media and media content to gratify various psychological and social needs or to accomplish certain goals (Katz, Blumler, & Gurevitz, 1974). The reasons why individuals choose one type of media over another or choose specific media content are as diverse as people themselves, but what we choose to view, read, and listen to mediates the influence of the mass media. In the next section, we will explore various needs that the mass media fulfill concerning health.

Needs Fulfilled by the Mass Media Concerning Health

Information Seeking

Media fulfill the need for information about the world or specific interests. Given the rapid changes we have experienced in society in recent years, with the advent of diseases such as HIV and SARS and health threats due to terrorism, most people desire up-to-date news and accurate information about health-related events. The mass media help to fulfill our desire to reduce uncertainty about health issues by gathering information that will help us to make better choices about how we should respond to daily events. Some people may gratify their information-seeking needs about health by paying attention to health stories on CNN or their local television news station. For other individuals, radio, newspapers, and magazines such as Time or Men’s Health or Internet sources such as WebMD may be more important sources of news and information than television. Many consumers are getting the majority of their health information from new media sources such as Twitter and Facebook to augment more traditional media sources. For example, check out the chapmanhcomms Twitter account for weekly updates and feeds germane to health communication issues. Many students just like you are starting their own Twitter feeds and blogs on a variety of topics. It is indeed a new era of health information seeking, consumption, and creation.

Entertainment, Diversion, and Tension Release

Others may learn about health issues by watching shows such as “Grey’s Anatomy” or “House” or even reality shows such as “The Doctors,” “Dr. Phil,” or “Celebrity Rehab,” “In Treatment,” or “The Biggest Loser” for entertainment or as a diversion from the stress of everyday life. While people may initially watch a show to fulfill entertainment needs, they can often learn about a variety of health-related issues that are part of the story of the program episode. For example, “Grey’s Anatomy” deals with many timely health issues (albeit sometimes indirectly) as part of the show’s stories, including medical malpractice litigation, advanced care directives, issues of cultural competence and patient use or denial of treatment, and a variety of up-to-date medical procedures. For many people, television shows like “Grey’s Anatomy” are one of the few places where they acquire information about the world of medicine and current health issues, particularly if they tend to avoid more traditional news stories about health on television or other media.

Individuals may also develop expectations about provider–patient interaction based on this type of entertainment, and characters on television often serve as role models for the ways individuals are expected to behave in health encounters. This may be problematic if people identify with providers who tend to be paternalistic toward patients, and this influences their behaviors when they actually visit their physicians and other providers in real life. However, shows like “Grey’s Anatomy” sometimes show patients behaving in assertive ways, and the stories often give an insight into the stressful lives of healthcare professionals. In these cases, watching such programs can provide people with positive role models or help them see the perspective of providers. These programs also provide a venue for social comparison to others. According to social comparison theory (Festinger, 1954; see also Chapter 4), individuals compare themselves to other individuals in society and make a variety of judgements about their own lives, such as their abilities, opinions, and behaviors. For example, people may perceive themselves to be more or less healthy than the people they see on television. This can sometimes motivate people to engage in diet and exercise programs or be proactive about their health in other ways if they feel that they are relatively unhealthy compared to the people they see on television. However, as we have seen, negative aspects of television and other media, such as advertisements for fast food or role models engaging in unhealthy behaviors, can negatively affect health behaviors.

The media also provide content that can help us divert our attention from the stress of everyday life and fulfill various affective needs, including the need to appreciate aesthetic, emotional, and pleasurable experiences. Watching a situation comedy or emotional drama can help people temporarily forget about their problems and elevate their moods. There is some evidence that humor is linked to positive health outcomes (du Pré, 1998; Lambert & Lambert, 1995; Wanzer, Sparks, & Frymier, 2009). Humor tends to lift a person’s mood and reduce stress levels, both of which are linked to positive psychological and physical health outcomes. However, while experiencing pleasure through using media can have a positive effect on health, diverting attention from problems does not make them go away, and avoidance of problems can sometime create more stress for individuals in the long run. In addition, spending too much time using passive media like television may lead to a sedentary lifestyle in which people limit their physical and mental activity. Sedentary lifestyles have been linked to obesity and other health problems, and there is some evidence that choosing to watch television over more mentally challenging activities (e.g. reading) on a long-term basis may lead to cognitive problems over time (Friedland et al., 2001).

Media Use to Fulfill Social Needs

Television and other mass media provide people with the substance for conversations with members of their social network. Katz, Gurevitch, and Haas (1973) referred to this as the personal integrative function. The personal integrative function of media occurs when the knowledge we gain from the media about the world, current events, or happenings in the lives of media characters helps to enhance our credibility and status in conversations with others. For example, media provide us with content about health issues for conversations with members of our social network, such as sharing information from a news story about a new medical procedure.

Interactive media such as the Internet can fulfill interpersonal needs. In the last few decades, on-line health communities have become important places where people can meet others with similar health concerns and obtain health information from healthcare professionals and other consumers, as well as emotional support and encouragement when coping with health problems (see Chapter 7). Even noninteractive media help to foster a sense of connection with others, particularly when people view the same content on a television program. For example, after the terrorist attacks on 9/11, watching television stories on CNN about how people were coping with the threat of terrorism helped many people feel that they were not alone, and this may have helped them to feel less anxious. Social media communities such as Facebook and Twitter can provide quick and easy access to health information from people’s trusted interpersonal networks as well as health-related organizations and blogs.

Finally, people often choose a certain medium to fulfill their needs because it is convenient to do so. For example, some individuals may find navigating the Internet to be cumbersome, so they prefer to obtain health information from health-related news stories on television, in newspapers, and in magazines. Other people find the Internet to be a cheap and convenient way to discuss health issues with other people, particularly when they are geographically separated from their conversational partner(s). In addition, some people are more active than others when seeking health information, and this may motivate them to use resources like the Internet to find a variety of sources of health information, for example www.cdc.gov, instead of consulting one or two articles in a magazine.

Health information-seeking behavior is almost addictive use of new technologies. Information is “stimuli from a person’s environment that contribute to his or her knowledge or beliefs” (Brashers, Goldsmith, & Hseih, 2002, p. 259) and can be obtained by way of a number of communication channels (Dutta-Bergman, 2004a). Health information can be obtained in a variety of interesting ways via multiple sources. For example, Burkell, Wolfe, Potter, & Jutai (2006) note that health information is typically sought via interpersonal and media sources. Initially, individuals seeking health information are likely to consult personal sources such as family or friends (Buller, Callister, & Reichert, 1995), though media sources such as television, newspapers, and the Internet, are also subsequent, important sources for health information (Brashers, Goldsmith, & Hseih, 2002). The media is certainly an integral health information source, as it defines illness and health, features services and products that that can help consumers manage their health, and provides a representation of others who have specific health conditions to a large number of individuals (Cotten & Gupta, 2004). In fact, Fox (2006) suggests 80 percent of adults surveyed have searched for health information online and 53 percent of them indicated they used the information found in health decisions.

Dutta-Bergman (2004b) examined interpersonal and media health information sources that included TV, radio, newspapers or magazines, hotlines, the Internet, and family or friends. We utilize these information sources here to understand how the public seeks and evaluates information about health care information such as healthcare reform (Bevan et al., 2012). Dutta-Bergman found that individuals who utilized active sources encourage the gathering of information and require participants to communicate with others including family or friends, newspapers and magazines, and the Internet. Further, his research revealed that individuals obtaining that information were more likely to have strong health beliefs and to be health conscious than those employing passive sources such as TV and radio. Pecchioni and Sparks’ (2007) research found that family members of patients reported being significantly more satisfied with the Internet in terms of health information sources, whereas patients themselves reported more satisfaction with doctors and nurses as health information sources. Madden and Fox (2006) found that 58 percent of the caretakers surveyed reported that the Internet was an important tool for making health decisions. Additional research from the NCI 2005 Health Information National Trends Survey revealed that when participants were asked “Where would you go for cancer information” 50 percent stated they would go to their provider followed by Internet (34%), library (5%), family (4%), and print media (4%). Time constraints, competing demands for attention, and a lack of training in effective communication most certainly influences patient health information-seeking behaviors (Sparks & Villagran, 2010), and can greatly impact medical adherence and decision-making for patients (Tinley et al., 2004). Buller, Callister, & Reichert (1995) found that the more individuals sought skin cancer information from print media (i.e. newspapers, magazines, newsletters, or pamphlets), the more they protected their skin. Further, use of healthcare providers and magazines or newspapers as an information source, as opposed to the Internet and toll-free phone numbers, was positively related to requesting a specific prescription medication (Lee, 2009). Lee also found that using the Internet as an information source facilitated consumers to discuss specific prescription medication with their health providers, an effect that grew substantially between 1999 and 2002. As such, using different media and interpersonal sources for obtaining health information has a number of potentially important implications.

Media Usage, Health Portrayals, and Health Behaviors

The mass media play a significant role in their ability to influence health behaviors. Americans are keen consumers of the mass media, and they are exposed to many different messages and images of health through media content. By the time an average American reaches 19 years of age, he or she will have spent more time watching television than most people spend at a full-time job in a year (Dworetzky, 1993). According to Bahk (2001), “because health occupies an essential part of human living, dramatic media presentations frequently depict health-related events for developing their story lines” (p. 188). In addition, the popular media are an important source of health-related information for most Americans (Atkin & Arkin, 1990; Signorielli, 1993), even when health information comes in the form of entertainment. As we have mentioned, information about health issues encountered through entertainment programs such as “Grey’s Anatomy” can potentially raise awareness about health issues and risks, and this information can sometimes motivate positive behavioral changes (Montgomery, 1990; Scharf, Freimuth, Greenspon, & Plotnick, 1996).

However, portrayals of health situations in the mass media are often unrealistic, and they tend to emphasize certain messages about health while excluding others. The following sections explore unrealistic portrayals of health situations and unhealthy role models associated with the entertainment media.

Unrealistic Portrayals of Health Situations

While some television and film dramas have somewhat accurate portrayals of healthcare settings, the mass media can also distort our perceptions of health situations in a variety of ways. Medical procedures and other solutions to health problems are presented as being far more successful in the media than in real life (Diem, Lantos, & Tulsky, 1996; Wallack & Dorfman, 1992). Key healthcare organization members such as administrators, physician assistants, laboratory technicians, and other medical personnel are rarely seen in media portrayals of healthcare situations, while physicians are the healthcare professional that viewers see most frequently. Constraints on providers imposed by managed care and other bureaucratic influences are seen much less than they occur in real healthcare situations. Healthcare teams, telemedicine, and other newer approaches to healthcare are also rarely seen in media portrayals of health situations. Patients on television are more likely to be depicted as having acute medical conditions rather than long-term chronic health conditions (which are more common), and most discussion between providers and patients centers on biomedical rather than psychosocial issues (Turow & Coe, 1993). Individuals with mental illness are often portrayed in stereotypical ways (du Pré, 2005; Sparks & Villagran, 2010), promoting the idea that people with mental illness are dangerous and unstable. Characters with disabilities in the media, when they do appear at all, are rarely depicted as living ordinary lives (Signorielli, 1993). Instead, the media often focus too much attention on a character’s disability or portray people with disabilities in stereotypical ways. Older individuals dealing with health problems are often disproportionately underrepresented in health-related film and television content (Turow & Coe, 1993). When they do appear, health problems are often attributed to age rather than disease, and issues common among older patients, such as polypharmacy or the impact of companions on provider–older patient interaction, do not appear in media portrayals of healthcare situations as often as they occur in real life. Despite these problems, film and television audience members frequently identify with characters who portray physicians and other healthcare professionals. The popularity of television shows like “Grey’s Anatomy,” “House,” “Scrubs,” “Nip/Tuck,” and other health-related programs reflects the enormous interest many Americans have in healthcare situations.

Unhealthy Role Models and the Promotion of Unhealthy Behaviors in Advertising

Most sources of entertainment and advertising in the mass media have been criticized for promoting unhealthy perceptions of health and health behaviors among media consumers (Bahk, 2001; Terre, Drabman, & Speer, 1991; Signorielli, 1993). The media characters that are most attractive to media consumers often serve as role models for a variety of health behaviors, but unfortunately many of the health-related behaviors they engage in are negative (Kline, 2003, 2011). For example, central characters in popular television shows and movies often engage in a variety of unhealthy behaviors, including smoking, drinking alcohol, practicing unsafe sex, and eating unhealthy foods. In many cases it makes little difference whether media role models are real or fictitious in terms of influencing health behaviors (Kline, 2003, 2011). People often look up to television and film actors due to their attractiveness and celebrity status. The media often send competing messages when it comes to health.

For example, while we may often want to look like movie stars, we also associate these actors with behaviors we see them performing in the media. When the characters these actors portray eat unhealthy foods, smoke, drink alcohol, or engage in other unhealthy behaviors, it sends audience members an indirect message that these behaviors are desirable since they are associated with characters to whom we are attracted. To be fair, it should be pointed out that popular films such as “Patch Adams” and television shows like “Grey’s Anatomy” do show positive aspects of healthcare, such as humor and health, alternative medicines, and provider commitment to quality healthcare. Yet, positive portrayals of health situations are often offset by unhealthy role models in health-related entertainment as well as unhealthy lifestyles promoted by advertisements in the media. The following sections explore research on the effects of encountering unhealthy role models on a regular basis in the mass media.

The Influence of Media on Eating Habits

Obesity 

Most Americans love eating cheeseburgers, pizza, french fries, and just about anything fried, or full of carbs, especially if we can wash them down with a high-fructose corn syrup drink like a Coke or Mountain Dew. In addition, people in the US love desserts like cheesecake, cookies, and chocolate in just about any form. Unfortunately, however, obesity has become a major public health concern in the US. According to the Centers for Disease Control and Prevention, in 2006, 67 percent of adults and 17 percent of children were overweight and 34 percent of adults were obese. Obesity is linked to a number of health problems, including diabetes, heart disease, hypertension, and cancer (Allison et al., 1999; Centers for Disease Control and Prevention, 2004; Must et al., 1999). The economic costs of heart disease, diabetes, and cancer treatment alone to the US economy are staggering given their high prevalence and the cost of maintaining these chronic conditions. The risk for obesity often begins at an early age. In the US, nearly 15 percent of children between the ages of 6 and 11 years can be classified as obese, a percentage that has nearly tripled since the 1960s (Ogden, Flegan, Carroll, & Johnson, 2002).

Many aspects of the mass media are related to obesity. The path toward obesity begins at an early age. US children see nearly 5500 messages per year that promote unhealthy food products (Federal Trade Commission, 2007), and health authorities believe that unhealthy food product advertising on television is the leading cause of unhealthy eating habits among children (Brownell & Horgen, 2004). Harrison and Marske (2005) found that during TV programs most frequently watched by children, 83 percent of the advertised foods were fast foods and sweets that far exceeded the daily recommended values of fat, saturated fat, and sodium. Moreover, television personalities often serve as poor role models for healthy eating. According to Byrd-Bredbenner, Finckenor, and Grasso (2003), television actors “constantly talk about, handle, or consume foods and alcoholic beverages, but almost none are overweight or suffer the consequences of overconsumptions” (p. 336). Research suggests that watching TV increases children’s preferences for unhealthy foods (Signorielli & Staples, 1997), and these early patterns of unhealthy food preference tend to become stable and last into adulthood (Harris & Bargh, 2009).

In addition, television advertisements routinely promote unhealthy food products, and the popularity of television and related media in the US has contributed to sedentary lifestyles for many Americans. The food industry spends over $10 billion annually to promote largely unhealthy food products to the American public (Brownell & Horgen, 2004). Both children and adults spend more time watching TV than any other leisure activity (Roberts, Foehr, & Rideout, 2005). For children, there has been a significant shift over the last several decades from physical activities to sedentary behavior that has been linked to media usage, particularly the increased use of computers, DVDs, and electronic games (Hofferth & Sandberg, 2001). Although some video games encourage physical activity, the vast majority of them involve moving little more than one’s fingers. And while there are many other factors related to obesity, including genetics, socioeconomic variables, and a family history of obesity, sedentary activities coupled with an increase in consuming unhealthy fast foods promoted by the mass media appear to be a major contributor to the problem (Greenberg et al., 2009).

Despite this bleak picture, some research has found that parent–child communication interventions may show some promise in terms of helping children understand the potential health risks of frequently consuming the high-fat, high-calorie products that they see advertised on television (Austin & Chen, 2003). When parents engage in mediation, or the critical analysis of media content with their children, this may increase a child’s ability to understand the health dangers of consuming the advertise products, which may help to make them more resistant to food advertisements in the future (Austin, 2001; Boush, 2001). For adults, things can be a bit more difficult, especially when unhealthy eating has become a habit. However, all is not lost when it comes to media exposure as things are slowly changing and some opinion leaders, researchers, and film-makers are paying attention to this evolving problem. Relatively new documentaries such as Morgan Spurlock’s (2004) film “Supersize Me,” Lee Fulkerson and Brian Wendel’s “Forks Over Knives” (2011), or Michael Pollan’s “Food, Inc.” (2008) are raising awareness about what we are putting in our bodies. However, given the negative impact of obesity in the US on morbidity and mortality rates as well as the economic costs associated with obesity-related diseases, health communication researchers should continue to find interventions to educate people about the influence of the mass media on diet and change the eating habits of people from all age groups.

Eating Disorders 

Stay updated, free articles. Join our Telegram channel

Join