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TB Notes 2, 2000
Print Media Portrayal of Tuberculosis
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
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.
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.
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.
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
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
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.
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
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- Sofalvi AJ, Birch DA. Working with education reporters to advocate
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- Readers' Guide to Periodical Literature (unabridged).
New York: H.W. Wilson Company; 1984-1998.
- New York Times Current Events Microfiche Indexes. Ann
Arbor, MI: UMI Company; 1984-1998.
- Birmingham K. Improving communication between scientists and
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- 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.
- Etkind SC. Contact tracing in tuberculosis. In: Reichman LB,
Hershfield ES, eds.Tuberculosis. New York: Marcel Dekker,
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is centered around mass media and communication: implications
for professional preparation. J Health Educ. 1997;28:238-244.
- Wahl OF. Schizophrenia in the news. Psychiatr Rehabil J.
- Pray R. National TB Partnership Communication Strategy Implementation.
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