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TB Notes 2, 2000

Print Media Portrayal of Tuberculosis

Introduction
Awareness of the public's knowledge of TB is important for health educators, providers, and policy makers in TB control. 1 Media exposure can heighten public awareness of health issues and can be a useful tool when used appropriately. The objectives of this assessment are to 1) complete a formative evaluation of TB coverage in the popular press, 2) ascertain the public image of TB, 3) determine the public impact of TB-related information, and 4) recommend interventions for TB control program personnel to deal with the public impact of print media. 2

Methods

A retrospective content analysis was completed of nonscience and nonmedical American periodicals and one locally and one nationally circulated newspaper dated from January 1984–June 1998. Data from 1984 were used for a background rate as the year prior to the resurgence of TB. Data collection began in June 1998.  Two data identification sources, found in public libraries, were used for the article search. These sources, Readers' Guide to Periodical Literature (January 1984–June 1998) and New York Times Current Events Microfiche Indexes (January 1984–June 1998), contain information regarding periodicals available to the general public.3,4 Search keywords used were "tuberculosis" and "TB." Cited articles were collected, read, and examined for accuracy, appropriateness of facts, and context of descriptions and headlines.

Results

Eighty-seven TB-related articles were found. For consistency, the search was confined to feature TB articles only. The following list indicates periodicals with TB articles and the respective number of articles within the search: New York Times (59), Newsweek (4), Time (3), USA Today (3), History Today (2), New York (2), American History Illustrated (1), Black Enterprise (1), Commonweal (1), Education Digest (1), Esquire (1), Forbes (1), Good Housekeeping (1), Jet (1), The New Republic (1), People Weekly (1), Reason (1), Redbook (1), Smithsonian (1) and US News & World Report (1). Frequency of articles was graphically plotted quarterly. In 1984, the year prior to resurgence, one TB article was found. Between 1985 the end of 1993, the years of resurgence, 18 TB articles were found. The balance of 68 articles existed after TB rates began to decline from January 1994 to June 1998. The articles were placed into five topic-related categories: history (6.9%), outbreak or anecdote (10.4%), research or innovation (10.4%), specific TB topic (23.0%), and general information (49.3%). Articles had a variety of TB subject matter including the TB history, DOT, transmission, high-risk groups, outbreaks, and TB control and elimination.

Discussion

The results indicate that the frequency of TB articles increased as TB incidence increased. About 49% of articles were general, as opposed to providing more specific information on TB. This is favorable for a lay public readership of these periodicals who may have little knowledge of TB.

Some of the more specific articles were found in the New York Times which, as a daily paper, regularly reports on scientific topics since it has the space and frequency of circulation to devote to this type of material. The New York Times based its reports on reputable scientific evidence and expertise. The search found other periodical examples that were informative, used facts accurately, contained precise technical explanations, and were suitable to the reading audience. Others acknowledged important scientific work contributing to the success in TB care as well as acknowledging all factors involved in the increase of TB rates. This responsible reporting is important in a time when the public is bombarded with information about incomplete or substandard scientific studies. 5

In contrast, anecdotal material, found scattered throughout the periodicals, gave "color" and sensationalism to TB reporting. This can be easily seen in the headlines that accompanied anecdotal material. Sensational headlines can be of use for dramatic effect, but only if they attract a reader to a well-written factual article. 6  However, an exaggerated introduction or erroneous subliminal message can introduce a bias for the reader, which even a factually accurate article may not counteract. Also, some may only read the sensational headlines without reading the facts that follow in the article.

Many articles, while factually accurate, failed to completely report some explanations for the successful control of TB. In 9.2% of the articles for which DOT was pertinent to the discussion, it was omitted. Successful TB treatment was only attributed to drugs and clinical care in these articles. Poor TB outcomes were blamed on inadequate patient adherence, without citing the need for DOT, case management, education, physician compliance with efficacious treatment regimens, and legal interventions. These omissions can lead to unnecessary speculation about other interventions for TB treatment. One source even suggested the reintroduction of inpatient care for routine cases.

Statements seeking to incriminate certain groups were made as well in 2.3% of articles. Some articles blamed TB on high-risk groups such as HIV infected, foreign-born, and medically underserved individuals. One article about TB in schools offered inappropriate recommendations to conduct mass screening of school children owing to an influx of foreign-born students. This article failed to mention the responsibility of local epidemiologists to develop targeted screening programs. It also failed to mention that many children with TB are rarely infectious. 7

Finally, inaccuracies can lead to the wrong information about the infectiousness of TB. The distinction between latent infection and disease and TB transmission occurring only with close, prolonged exposure, were not clear in nine (10.3%) of the surveyed articles. 8

Conclusion

Popular media will include what is of interest to its readers and is relevant to the current times. 9 The case of TB is no exception. Although this analysis covered a select portion of the print media available on TB, it serves as a valuable needs assessment.  TB is a disease that has been successfully controlled in the general population, but still affects high-risk groups. Therefore, TB does not require a massive media campaign to raise awareness of its existence for the general population. Misrepresentation or sensationalized representation of groups likely to be affected by TB can lead to discrimination against those groups. If transmission and infectiousness of TB are not properly explained, this may result in mass screening policies or low-risk individuals being subjected to unnecessary, routine testing. Incorrect information could be used to influence public policy, moving it in the wrong direction.

TB control programs have a responsibility to inform the public using the avenue of the popular print media. In issuing statements to the press, there is an ethical obligation for brevity, accuracy, and confidentiality.10 Health educators must teach TB program personnel to also report the positive aspects of TB therapy such as the successes of reduced TB rates and the fact that TB is preventable and curable.11

—Submitted by Rajita Bhavaraju, MPH, CHES
National Education and Training Coordinator
New Jersey Medical School National Tuberculosis Center

References

  1. White GL, Henthorne BH, Barnes E, Segarra JT. Tuberculosis: a health education imperative returns. J Community Health. 1995;20:29-57.
  2. Sofalvi AJ, Birch DA. Working with education reporters to advocate for comprehensive school health education. J Sch Health. 1997;67;185-186.
  3. Readers' Guide to Periodical Literature (unabridged). New York: H.W. Wilson Company; 1984-1998.
  4. New York Times Current Events Microfiche Indexes. Ann Arbor, MI: UMI Company; 1984-1998.
  5. Birmingham K. Improving communication between scientists and the press. Nat Med. 1998;4:258.
  6. Ohler L. Organ transplant and the media: the good, the bad, and the ugly. J Transplant Coordination. 1997;7:52-53.
  7. American Academy of Pediatrics, Committee on Infectious Diseases. Tuberculosis. In: Peter G. ed. 1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:541-563.
  8. Etkind SC. Contact tracing in tuberculosis. In: Reichman LB, Hershfield ES, eds.Tuberculosis. New York: Marcel Dekker, Inc; 1993:275-289.
  9. Nandy BR, Nandy S. Health education by virtue of its mission is centered around mass media and communication: implications for professional preparation. J Health Educ. 1997;28:238-244.
  10. Wahl OF. Schizophrenia in the news. Psychiatr Rehabil J. 1996;20:51-54.
  11. Pray R. National TB Partnership Communication Strategy Implementation. TB Notes Newsletter. 1999; 1.

 


Released October 2008
Centers for Disease Control and Prevention
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